Silver
- Silver Option A Limited Cost Share 58326WI0090002-03
- Silver Standard Limited Cost Share 58326WI0090022-03
- Silver HDHP Limited Cost Share 58326WI0090016-03
Must reside in Rock or Walworth Counties to be eligible.
2023 plan information
Individual/family plan summaries of benefits and coverage: Wisconsin
Gold
- 2023 Application
- 2023 Individual/family booklet
- 2023 Formulary
- 2023 Certificate of Coverage
- 2023 Claims payment policies and other information
2022 plan information
Individual/family plan summaries of benefits and coverage: Wisconsin
Gold
- Gold Option A 58326WI0090001-00 & 58326WI0090001-01
- Gold Option B 58326WI0090012-00 & 58326WI0090012-01
- Gold Option C 58326WI0090013-00 & 58326WI0090013-01
Silver
- Silver Option A 58326WI0090002-00& 58326WI0090002-01
- Silver Option B 58326WI0090015-00 & 58326WI0090015-01
- Silver Option C 58326WI0090016-00 & 58326WI0090016-01
Bronze
Summaries of benefits and coverage: Only available on Exchange
Gold
- Gold Option A Limited Cost Share Plan 58326WI0090001-03
- Gold Option B Limited Cost Share Plan 58326WI0090012-03
- Gold Option C Limited Cost Share Plan 58326WI0090013-03
Silver
- Silver Option A Limited Cost Share Plan 58326WI0090002-03
- Silver Option B Limited Cost Share Plan 58326WI0090015-03
- Silver Option C Limited Cost Share Plan 58326WI0090016-03
Bronze
Summaries of benefits and coverage: Only available on Exchange
Gold
- Gold Option A Zero Cost Share Plan 58326WI0090001-02
- Gold Option B Zero Cost Share Plan 58326WI0090012-02
- Gold Option C Zero Cost Share Plan 58326WI0090013-02
Silver
- Silver Option A Zero Cost Share Plan 58326WI0090002-02
- Silver Option B Zero Cost Share Plan 58326WI0090015-02
- Silver Option C Zero Cost Share Plan 58326WI0090016-02
Bronze
2021 plan information
Individual/family plan summaries of benefits and coverage: Wisconsin
Gold
- Gold Option A 58326WI0090001-00 & 58326WI0090001-01
- Gold Option B 58326WI0090012-00 & 58326WI0090012-01
- Gold Option C 58326WI0090013-00 & 58326WI0090013-01
Silver
- Silver Option A 58326WI0090002-00& 58326WI0090002-01
- Silver Option A CSR 94% 58326WI0090002-06– Only on Marketplace
- Silver Option A CSR 87% 58326WI0090002-05– Only on Marketplace
- Silver Option A CSR 73% 58326WI0090002-04– Only on Marketplace
- Silver Option B 58326WI0090015-00 & 58326WI0090015-01
- Silver Option B CSR 94% 58326WI0090015-06– Only on Marketplace
- Silver Option B CSR 87% 58326WI0090015-05– Only on Marketplace
- Silver Option B CSR 73% 58326WI0090015-04– Only on Marketplace
- Silver Option C 58326WI0090016-00 & 58326WI0090016-01
- Silver Option C CSR 94% 58326WI0090016-06– Only on Marketplace
- Silver Option C CSR 87% 58326WI0090016-05– Only on Marketplace
- Silver Option C CSR 73% 58326WI0090016-04– Only on Marketplace
Bronze
Summaries of benefits and coverage: Only available on Exchange
Gold
- 2021 Gold Option A Limited Cost Share Plan 58326WI0090001-03
- 2021 Gold Option B Limited Cost Share Plan 58326WI0090012-03
- 2021 Gold Option C Limited Cost Share Plan 58326WI0090013-03
Silver
- 2021 Silver Option A Limited Cost Share Plan 58326WI0090002-03
- 2021 Silver Option B Limited Cost Share Plan 58326WI0090015-03
- 2021 Silver Option C Limited Cost Share Plan 58326WI0090016-03
Bronze
Summaries of benefits and coverage: Only available on Exchange
Gold
- 2021 Gold Option A Zero Cost Share Plan 58326WI0090001-02
- 2021 Gold Option B Zero Cost Share Plan 58326WI0090012-02
- 2021 Gold Option C Zero Cost Share Plan 58326WI0090013-02
Silver
- 2021 Silver Option A Zero Cost Share Plan 58326WI0090002-02
- 2021 Silver Option B Zero Cost Share Plan 58326WI0090015-02
- 2021 Silver Option C Zero Cost Share Plan 58326WI0090016-02
Bronze
Additional documents
- 2021 Wisconsin individual/family enrollment application
- Covered preventive services
- Voluntary discontinuation of coverage (fillable)
MercyCare HMO Network
Our HMO network includes Mercyhealth providers and contracted providers. Please see map for details.
- Contracted providers: MercyCare contracts with Fort Healthcare, Watertown Regional Medical Center and others to provide healthcare to our members.