individual
and family
health
insurance
plans
CALL TODAY: (800) 895-2421
MercyCare has a plan for you.
MercyCare’s individual health plans are backed by a company that’s been helping people like you stay healthy for over 20 years. MercyCare provides quality, affordable health insurance for health care services close to home.
We are proud to say that MercyCare, as part of Mercy Health System, received the Malcolm Baldrige National Quality Award, the nation’s highest presidential honor for quality and organizational performance excellence.
Did you know that MercyCare:
• Has an open access network, meaning no referrals are needed for in-plan services?
• Provides you access to more than 400 medical professionals?
• Has local customer service to assist you?
• Manages over 40,000 members?
• Is one of the largest HMO plan providers in the area?
About us
To see more of what MercyCare Health Plans has to offer, visit MercyCareHealthPlans.com.
Green
Rock
Walworth
Jefferson
Watertown Lake Mills Johnson Creek Jefferson Fort Atkinson Cambridge Whitewater Delavan Lake Geneva Beloit Janesville Brodhead Evansville Milton Edgerton Crystal Lake McHenry BarringtonMcHenry
Harvard Woodstock * Sharon Walworth H H H H HIllinois
If you are looking for a provider, MercyCare Health Plans offers
a complete, up-to-date listing of our physicians, clinics and pharmacies at MercyCareHealthPlans.com.
To locate a participating provider, follow these simple steps: 1. Visit MercyCareHealthPlans.com
2. Click on the “Find a Doctor” box on the home page 3. Select your plan or enter your group number 4. Search by location, specialty or name
A printed copy of our provider directory is also available upon request. Please call MCHP at (800) 895-2421 to have a copy sent to you.
*Where applicable. Not all providers are available on all plans. See your provider directory for plan providers.
24-hour emergency care
Mercy Hospital andTrauma Center 1000 Mineral Point Ave. Janesville, WI 53548
(608) 756-6000 (800) 756-4147 Mercy Walworth Hospital and Medical Center N2950 State Rd. 67 Lake Geneva, WI 53147 (262) 245-2230
Mercy Harvard Hospital 901 Grant St.
Harvard, IL 60033 (815) 943-5431
Fort HealthCare, Inc. Fort Memorial Hospital 611 Sherman Ave. East Fort Atkinson, WI 53538 (920) 568-5000
Watertown Memorial Hospital 125 Hospital Dr.
Watertown, WI 53098 (920) 262-4210
Mercy East Urgent Care 3524 E. Milwaukee St. Janesville, WI 53546 (608) 756-8484 Monday-Friday, 8 am-8 pm Saturday-Sunday, 9 am-5 pm InQuicker
Mercy South Urgent Care 849 Kellogg Ave.
Janesville, WI 53546 (608) 755-7960
Monday, Wednesday, 8 am-7 pm Tuesday, Thursday, Friday, 8 am-5 pm Saturday, 8 am-noon
Mercy North Urgent Care 3400 Deerfield Dr.
Janesville, WI 53546 (608) 314-3605
Monday-Friday, 7 am-9 pm
Saturday, Sunday, holidays, 9 am-9 pm
InQuicker
Mercy Mall Urgent Care 1010 N. Washington St. Janesville, WI 53548 (608) 741-3800
Daily, 7 am-7 pm, Closed holidays
InQuicker
Mercy Beloit Urgent Care 2825 Prairie Ave.
Beloit, WI 53511 (608) 363-5500 Monday-Friday, 5-8 pm Saturday, 8 am-1 pm
Mercy Walworth Urgent Care N2950 State Rd. 67
Lake Geneva, WI 53147 (262) 245-2230
Monday-Friday, 8 am-8 pm Saturday-Sunday, 9 am-1 pm
Mercy Whitewater Urgent Care 507 W. Main St.
Whitewater, WI 53190 (262) 473-0401 Monday-Friday, 5-9 pm Saturday, 9 am-2 pm Fort HealthCare Lake Mills Urgent Care 200 E. Tyranena Park Rd. Lake Mills, WI 53551 (920) 648-3113 Monday-Friday, 5-8 pm Saturday, 8 am- 8 pm Sunday, 10 am-8 pm Fort HealthCare, Inc.
Fort Memorial Hospital-Urgent Care 611 Sherman Ave. East
Fort Atkinson, WI 53538 (920) 568-5330 Monday-Friday, 5-11 pm
Saturday, Sunday, holidays, noon-11 pm Watertown Memorial Hospital Urgent Care
(located outside emergency department) 806 Schuman Dr.
Watertown, WI 53098 (920) 262-4222 Daily, 10 am-8 pm
Mercy McHenry Immediate Care 3922 Mercy Dr.
McHenry, IL 60050 (815) 578-2020
Monday-Friday, 8 am-8 pm
Saturday, 8 am-6 pm, Sunday, 8 am-4 pm Mercy Woodstock Immediate Care 2000 Lake Ave. Woodstock, IL 60098 (815) 337-1544 Daily, 8 am-6 pm
Hospitals
Immediate care
Urgent care
When it comes to safeguarding your health, MercyCare Health Plans gives you access to a network of top Mercy Health System specialists right here at home, so it’s easy to get the care you need, when you need it.
Mercy offers over 150 specialty services that range from the most basic to the highly complex. Right here at home, our patients receive the highest standard of care, including:
Quality, affordable health care … close to home
VerifiedLevel II emergency trauma
Certifiedprimary stroke care
Cardiac catheterization labs 24/7
Certifiedheart failure care
Certifiedchest pain care
Accreditedcancer care (radiation and chemotherapy)
Accreditedjoint replacement care
Radiology department staffed 24/7
MD-1 emergency response vehicle
ICU critical care physician coverage 24/7
Neurosurgery physician coverage 24/7
Orthopaedic physician coverage 24/7
Plastic surgery physician coverage 24/7
InQuicker for emergency and urgent care And so much more
MercyCare My Plan
– Manage your health insurance online
With MercyCare My Plan, you can view your benefits, claims and eligibility, request additional ID cards, change your primary care provider, ask questions and so much more. Visit MercyCareMyPlan.com to log it.
Mercy MyChart
– Your health record. At your convenience.
As a MercyCare member, you have access to Mercy MyChart, your online medical record. • Review your medical history
• Schedule appointments
• Send messages to your provider • View test results
• Request prescription refills
• Print your child’s immunization records • And more
frequently asked questions
Why should I have health insurance?
• No one plans to get sick or hurt, but mostpeople need medical care at some point. MercyCare Health Plans’ individual plans cover many of your expected and unexpected health care costs, and protect you from very high expenses.
• Health insurance is a contract between you and MercyCare Health Plans. You buy a plan that best meets your needs, and MercyCare Health Plans pays part of your medical costs when you get sick or hurt.
• There are other important benefits of health insurance. MercyCare’s individual plans provide free preventive care, vaccinations, screenings and check-ups. We also provide prescription drug coverage.
Do I have to have health insurance?
If you don’t have coverage in 2015, you’ll pay the higher of these two amounts:
• 2% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.
• $325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.
You’ll pay the fee on the federal income tax return you file for the year you don’t have coverage.
Can I keep my doctor?
If you currently see a Mercy doctor, you can continue to see him/her by choosing a MercyCare plan. Please note that different plans have different networks and providers. Networks include health care providers that a plan contracts with to take care of the plan’s members. Depending on the type of policy you buy, care may be covered only when you get it from a network provider. When comparing MercyCare plans in the Marketplace, you will see a link to the list of providers in each plan’s network.
What if I have a pre-existing
condition?
Whether you need health coverage or have it already, the health care law offers new rights and protections that make coverage fairer and easier to understand. Essential health benefits for pre-existing medical conditions are covered under all Marketplace plans. No insurer can reject you, charge you more, or refuse to pay for essential health benefits for any medical condition you had before your coverage started. MercyCare plans do not contain exclusions for any pre-existing conditions.
What do essential health benefits
include?
• Ambulatory patient services (outpatient care you get without being admitted to a hospital)
• Emergency services
• Hospitalization
• Maternity and newborn care (care before and after your baby is born)
• Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services
Essential health benefits are minimum requirements for all MercyCare plans.
What is the health insurance
marketplace?
• Also sometimes called the Exchange, the Marketplace is a new way to find health coverage that fits your budget and meets your needs. With one application, you can see all your MercyCare options and enroll.
• When you use the Marketplace, you’ll fill out an application and find out if you can get lower costs on your monthly premiums for private MercyCare insurance plans. You’ll find out if you qualify for lower out-of-pocket costs through Medicaid or the Children’s Health Insurance Program (CHIP).
How do I find out if I qualify
for assistance?
When you buy health insurance coverage in the Marketplace, you may be able to get a premium tax credit that lowers what you pay in monthly premiums. This will depend on your 2015 household size and income.
You can apply part or all of this tax credit each month to your premium payments. The Marketplace will send your tax credit directly to your insurance company, so you pay less for your premiums each month.
The Federal Poverty Level (FPL) is the measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits. If your 2015 income falls within the following ranges you’ll generally qualify for a premium tax credit. The lower your income is within these ranges, the bigger your credit. To see the ranges turn to page 10. Call a MercyCare sales representative at (800) 895-2421 to see if you qualify for additional premium assistance.
What is Cost Sharing Reduction (CSR)?
A discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments. You can get this reduction if you get health insurance through the Marketplace, your income is below a certain level, and you choose a health plan from the Silver plan category If your income is at least 100 percent and not more than 250 percent of the Federal Poverty Level, you are eligible for special plans with Cost Sharing Reductions to lower your out-of-pocket costs, in addition to the Advanced Premium Tax Credits. Only the Marketplace can determine if you are eligible for, and how much you can receive in, Cost Sharing Reductions.
Find out more and apply at
MercyCareHealthPlans.com.
Here are some definitions to help you understand insurance coverage:
• Premium: Premium is a fixed amount you pay to MercyCare Health Plans, usually every month. You pay this even if you don’t use medical care that month.
• Deductible:If you need medical care, a deductible is the amount you pay for care before MercyCare starts to pay its share. Once you meet your deductible, MercyCare begins to cover some costs of your care. Many plans provide preventive services, and sometimes other care, before you’ve met your deductible.
• Copayment:Copayment is a fixed amount you’ll pay for a medical service. For example, if your visit to the doctor’s office is $150 and your copay is $25, you pay $25 and
MercyCare pays the remaining $125.
• Coinsurance:Coinsurance is similar to copayment, except it’s a percentage of costs you pay. For instance, you may pay 20% of the cost of a $100 medical bill. So you would pay $20 and MercyCare would pay the rest.
• Individuals with a household income under 400% will receive a tax credit (subsidy) to help pay monthly premiums.
• Individuals with a household income under 250% will receive a cost share reduction which will reduce your deductible and maximum out-of-pocket.
• If you want to receive tax credit or cost share reduction, you need to purchase your individual MercyCare plan at healthcare.gov. (Please follow the steps on page 12.)
• If you don’t qualify or don’t want to receive a tax credit, you can purchase directly from MercyCare by calling (800) 895-2421.
Household
size
Percent of federal poverty line (FPL)
100% 150% 200% 250% 300% 400% one $11,670 $17,505 $23,340 $29,175 $35,010 46,680 two 15,730 23,595 31,460 39,325 47,190 62,920 three 19,790 29,685 39,580 49,475 59,370 79,160 four 23,850 35,775 47,700 59,625 71,550 95,400 five 27,910 41,865 55,820 69,775 83,730 111,640 six 31,970 47,955 63,940 79,925 95,910 127,880
How do I apply for
Marketplace coverage?
• You can apply for health coverage, compare all your options and enroll in a plan in one streamlined application through the Marketplace. • You can go to the
Marketplace by visiting MercyCareHealthPlans.com and see the health coverage options available to you. Then you can compare plans side-by-side and choose a plan that meets your needs and fits your budget.
Set up an account.
You’ll provide some basic information to get started, like your name, address and email address.
Fill out the online application.
You’ll provide information about you and your family, like income, household size, current health coverage information and more. This will help the Marketplace find options that meet your needs.
Compare your options.
You’ll be able to see all the options you qualify for, including private insurance plans and free and low-cost coverage through Medicaid and the Children’s Health Insurance Program (CHIP). The Marketplace will tell you if you qualify for lower costs on your monthly premiums and out-of-pocket costs on deductibles, copayments and coinsurance. You’ll see details on costs and benefits before you choose a plan.
Enroll.
After you choose a plan, you can enroll online and decide how you pay your premiums to your insurance company. If you or a member of your family qualify for Medicaid or CHIP, a representative will contact you to enroll. If you have any questions, there’s plenty of live and online help along the way.
Ready to enroll? Call (800) 895-2421 or apply
1
2
3
4
Key dates you’ll want to mark on your calendar:
Marketplace open enrollment has started
• You can compare and select from the different insurance plans that MercyCare offers.
• After reviewing your options, you can enroll in a plan that fits your needs and budget.
• You’ll also learn if you can get lower costs on your health insurance before you enroll in a plan through Medicaid or the Children’s Health Insurance Program (CHIP).
January 1, 2015: Health coverage can start
• If you enroll in a MercyCare plan before December 15, 2014, and make your first premium payment, your new health insurance starts January 1, 2015.
• During the rest of open enrollment, if you enroll between the 1st and 15th day of the month and pay your premium, your coverage begins the first day of the next month. So, if you enroll on January 10, 2015, your coverage begins February 1, 2015.
• If you enroll between the 16th and the last day of the month and pay your premium, your effective date of coverage will be the first day of the second following month. So, if you enroll on January 16, 2015, your coverage starts on March 1, 2015.
February 15, 2015: Open enrollment for 2015 health insurance ends
• Be sure to visit MercyCareHealthPlans.com or the Marketplace and enroll in a plan before this date.
When does this new health care
insurance program take place?
We now have nine individual plans tailored to suit your needs and those
of your family. The plans are laid out in metal tiers and detailed on
pages 17-20.
Individual health plans offered through the Marketplace are grouped into
four metal levels (bronze, silver, gold and platinum) to help you compare
plans. All health plans in the Marketplace get a metal designation based
on the level of cost-sharing. Cost-sharing refers to the costs that
members share when they get medical care, such as a deductible
and co-insurance.
*On average, the plan will pay this percentage of the total cost of the policy’s benefits. **If your income level is between 100% to 250% FPL, you might qualify for
Cost-sharing subsidies to reduce out-of-pocket costs. Must enroll in Silver plan for cost-sharing subsidies shown on pages 19-20.
MercyCare has a plan for you!
OUT-OF-POCKET COSTS Lower Moderate Higher PLAN PAYS* 80% 70% 60% METAL LEVEL GOLD SILVER BRONZE PREMIUMS Higher Moderate Lower
Gold MercyCare HMO Gold Option A
Deductible $2,000 single/$4,000 family
Maximum out of Pocket $3,500 single/$7,000 family
Coinsurance 20% after deductible
Primary Care Visit $25
Specialist Visit $25
Preventive Services Covered at 100%
ER Visit $100
Urgent Care $35 In-network
Prescription Drug $20/$40/$60/25%
Silver MercyCare HMO Silver Option A
Deductible $5,000 single/$10,000 family
Maximum out of Pocket $6,350 single/$12,700 family
Coinsurance 30% after deductible
Primary Care Visit $30
Specialist Visit $30
Preventive Services Covered at 100%
ER Visit $100
Urgent Care $35 in-network
Prescription Drug $20/$40/$60/25%
Bronze MercyCare HMO Bronze Option A
Deductible $5,000 single/$10,000 family
Maximum out of Pocket $6,350 single/$12,700 family
Coinsurance 30%
Primary Care Visit 30% coinsurance after deductible
Specialist Visit 30% coinsurance after deductible
Preventive Services Covered at 100%
ER Visit 30% coinsurance after deductible
Urgent Care 30% coinsurance after deductible
Prescription Drug $20/$40/$60/25% after deductible
M
e
rc
y
C
a
re
p
la
n
d
e
ta
il
s
MercyCare HMO Gold Option B MercyCare HMO Gold Option C
$1,000 single/$2,000 family $1,000 single/$2,000 family $3,500 single/$7,000 family $3,000 single/$6,000 family 20% after deductible 20% after deductible
$30 $30 $60 $60 Covered at 100% Covered at 100% $500 $250 $35 In-network $35 In-network $20/$40/$60/25% $10/$25/$50/25%
MercyCare HMO Silver Option B MercyCare HMO Silver Option C
$2,000 single/$4,000 family $3,000 single/$6,000 family $6,600 single/$13,200 family $6,350 single/$12,700 family 30% after deductible 30% after deductible
$30 30% coinsurance after deductible
$60 30% coinsurance after deductible
Covered at 100% Covered at 100%
$250 $500
$35 In-network 30% coinsurance after deductible $20/$40/$60/25% $10/$25/$50/25%
MercyCare HMO Bronze Option B MercyCare HMO Bronze Option C
$4,000 single/$8,000 family $6,250 single/$12,500 family $6,600 single/$13,200 family $6,250 single/$12,500 family
20% 0%
20% coinsurance after deductible No charge after deductible 20% coinsurance after deductible No charge after deductible Covered at 100% Covered at 100%
20% coinsurance after deductible No charge after deductible 20% coinsurance after deductible No charge after deductible 20% coinsurance after deductible No charge after deductible
M
e
rc
y
C
a
re
p
la
n
d
e
ta
il
s
Silver - Cost Share Reduction MercyCare HMO Silver Option A (100-150% FPL)
Deductible $0 single/$0 family Maximum out of Pocket $500 single/$1,000 family
Coinsurance 0%
Primary Care Visit $15 Specialist Visit $15
Preventive Services Covered at 100%
ER Visit $100
Urgent Care $35 in-network Prescription Drug $20/$40/$60/25%
Silver - Cost Share Reduction MercyCare HMO Silver Option A (151-200% FPL)
Deductible $750 single/$1,500 family Maximum out of Pocket $1,500 single/$3,000 family Coinsurance 20% after deductible Primary Care Visit $25
Specialist Visit $25
Preventive Services Covered at 100%
ER Visit $100
Urgent Care $35 in-network Prescription Drug $20/$40/$60/25%
Silver - Cost Share Reduction MercyCare HMO Silver Option A (201-250% FPL)
Deductible $2,500 single/$5,000 family Maximum out of Pocket $5,200 single/$10,400 family Coinsurance 30% after deductible Primary Care Visit $30
Specialist Visit $30
Preventive Services Covered at 100%
ER Visit $100
Urgent Care $35 in-network Prescription Drug $20/$40/$60/25%
MercyCare HMO Silver Option B (100-150% FPL)
MercyCare HMO Silver Option C (100-150% FPL)
$50 single/$100 family $0 single/$0 family
$750 single/$1,500 family $1,000 single/$2,000 family
0% 10%
$15 10% coinsurance after deductible $15 10% coinsurance after deductible Covered at 100% Covered at 100%
$100 $100
$35 In-network 10% coinsurance after deductible $10/$25/$50/25% $10/$25/$50/25%
MercyCare HMO Silver Option B (151-200% FPL)
MercyCare HMO Silver Option C (151-200% FPL)
$250 single/$500 family $500 single/$1,000 family $1,500 single/$3,000 family $1,500 single/$3,000 family 10% after deductible 20% after deductible
$30 20% coinsurance after deductible $60 20% coinsurance after deductible Covered at 100% Covered at 100%
$250 $250
$35 in-network 20% coinsurance after deductible $20/$40/$60/25% $10/$25/$50/25%
MercyCare HMO Silver Option B (201-250% FPL)
MercyCare HMO Silver Option C (201-250% FPL)
$2,000 single/$4,000 family $2,000 single/$4,000 family $5,200 single/$10,400 family $5,000 single/$10,000 family 20% after deductible 20% after deductible
$30 20% coinsurance after deductible $60 20% coinsurance after deductible Covered at 100% Covered at 100%
$250 $500
$35 in-network 20% coinsurance after deductible $20/$40/$60/25% $10/$25/$50/25%
Call our office toll-free (800) 895-2421, or TTY for the hearing impaired (800) 947-3529, Monday-Friday, 8 am-4:30 pm, Central time. Our sales representatives can answer your questions and make an appointment to discuss your individual needs.
Email us at [email protected].
Interested in attending a brief seminar? Visit MercyCareHealthPlans.com or call us at (800) 895-2421 to find out future dates.
