Member Materials

Health care can be complex, and at times difficult to understand. We want you to have access to all the important documents you need to help you manage your health care. This Member Materials page has the documents you need to understand the benefits and services covered by Mercy Care Advantage.

If you have questions, Mercy Care Advantage Member Services representatives are available to help you 8:00 a.m. - 8:00 p.m., 7 days a week. Please call 602-586-1730 or 1-877-436-5288 (TTY 711).

  • Click on the 2019 Member Materials menu below to view the materials for the 2019 plan year.
  • To learn more about plan benefits and cost sharing information, select the Summary of Benefits or the Evidence of Coverage.
  • To find out more about providers or pharmacies, click on the “Find a Provider” link or “Find a Pharmacy” link at the top of this page.
  • For information about prescription drug coverage select the Formulary. You can find out more about the Formulary on the Part D: Prescription Drug Benefits page.
  • We can communicate with you in other languages. To learn more, view the Mercy Care Advantage Nondiscrimination Notice and Multi-language Interpreter Services documents English | Español.

Benefits and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary.  

2019 Member Materials

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This booklet is mailed to current Mercy Care Advantage members every year in September. It explains changes to the plan benefits for the upcoming year.

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Este folleto se envía por correo a los miembros actuales de Mercy Care Advantage cada año en septiembre. Explica los cambios en los beneficios del plan para el próximo año.

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Medicare deductible and coinsurance amounts. Montos deducibles y coseguros de Medicare.

Evidence of Coverage  Updated 6/26/2019

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This booklet explains the details about health care coverage and prescription drug coverage with Mercy Care Advantage.

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Este folleto explica los detalles sobre la cobertura de atención médica y la cobertura de medicamentos recetados con Mercy Care Advantage.

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This booklet lists certain features of the Mercy Care Advantage plan. It does not list every service we cover or list every limitation or exclusion. For complete details about our plan, please see the Evidence of Coverage.

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Este folleto enumera ciertas características del plan Mercy Care Advantage. No incluye todos los servicios que cubrimos o enumeramos todas las limitaciones o exclusiones. Para obtener detalles completos sobre nuestro plan, consulte la Evidencia de cobertura.

Comprehensive Formulary | Formulario              Updated 07/2019

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This booklet lists the prescription drugs covered by Mercy Care Advantage plan.  Este folleto enumera los medicamentos recetados cubiertos por el plan Mercy Care Advantage.

 

Prior Authorization Criteria  Updated 07/2019

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This is a list of prescription drugs that require prior authorization with Mercy Care Advantage.

Step Therapy Criteria       No changes made since 10/2018

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This is a list of prescription drugs that require step therapy with Mercy Care Advantage.

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This notice describes how members can access certain Mercy Care Advantage materials online, or how to request a copy by mail. Este aviso describe cómo los miembros pueden acceder a ciertos materiales de Mercy Care Advantage en línea o cómo solicitar una copia por correo

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The Centers for Medicare and Medicaid Services (CMS) rates all health and prescription drugs plans each year. The ratings are based on a plan’s quality and performance. This document shows the plan ratings for Mercy Care Advantage.

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Los Centros de Servicios de Medicare y Medicaid (CMS) tasan todos los planes de salud y medicamentos recetados cada año. Las calificaciones se basan en la calidad y el desempeño de un plan. Este documento muestra las calificaciones de los planes de Mercy Care Advantage.

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This is the Evidence of Coverage Rider for people who get extra help paying for prescription drugs – benefit increased.

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Esta es la Evidencia de Cobertura Rider para las personas que reciben ayuda adicional para pagar los medicamentos recetados - beneficio aumentado.

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This is the Evidence of Coverage Rider for people who get extra help paying for prescription drugs – benefit decreased.

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Esta es la Evidencia de Cobertura Rider para las personas que reciben ayuda adicional para pagar los medicamentos con receta - disminución del beneficio.