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 2021 Member Materials menu below to view the materials for the 2021 plan year.
- Click on the 2022 Member Materials menu below to view the materials for the 2022 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/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.
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2021 Member Materials
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2021 Member Materials
H5580_21_003_M
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.
H5580_21_003_M
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.
H5580_21_009_C
Medicare deductible and coinsurance amounts. Montos deducibles y coseguros de Medicare.
H5580_21_007_C
This booklet explains the details about health care coverage and prescription drug coverage with Mercy Care Advantage.
H5580_21_046_C
Este folleto explica los detalles sobre la cobertura de atención médica y la cobertura de medicamentos recetados con Mercy Care Advantage.
H5580_21_004_M
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.
H5580_21_004_M
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 10/2021
H5580_21_006_C
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 10/2021
H5580_21_035_C
This is a list of prescription drugs that require prior authorization with Mercy Care Advantage.
Step Therapy Criteria No changes made since 10/2020
H5580_21_036_C
This is a list of prescription drugs that require step therapy with Mercy Care Advantage.
H5580_21_008_C
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.
H5580_21_053_M
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.
H5580_21_053_M
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.
H5580_21_001_C
This is the Evidence of Coverage Rider for people who get extra help paying for prescription drugs – benefit increased.
H5580_21_001_C
Esta es la Evidencia de Cobertura Rider para las personas que reciben ayuda adicional para pagar los medicamentos recetados - beneficio aumentado.
H5580_21_002_C
This is the Evidence of Coverage Rider for people who get extra help paying for prescription drugs – benefit decreased.
H5580_21_002_C
Esta es la Evidencia de Cobertura Rider para las personas que reciben ayuda adicional para pagar los medicamentos con receta - disminución del beneficio.
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2022 Member Materials
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2022 Member Materials
H5580_22_003_M
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.
H5580_22_003_M
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.
2022 Medicare Part A and B Deductible and Coinsurance Amounts English|Español
-Coming Soon-
Medicare deductible and coinsurance amounts. Montos deducibles y coseguros de Medicare.
H5580_22_007_C
This booklet explains the details about health care coverage and prescription drug coverage with Mercy Care Advantage.
Evidencia de Cobertura
-Coming Soon-
Este folleto explica los detalles sobre la cobertura de atención médica y la cobertura de medicamentos recetados con Mercy Care Advantage.
H5580_22_004_M
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.
H5580_22_004_M
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 10/2021
H5580_22_006_C
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.
H5580_22_056_C
This is a list of prescription drugs that require prior authorization with Mercy Care Advantage.
H5580_22_057_C
This is a list of prescription drugs that require step therapy with Mercy Care Advantage.
H5580_22_008_C
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.
H5580_22_061_M
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.
H5580_22_061_M
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.
H5580_22_001_C
This is the Evidence of Coverage Rider for people who get extra help paying for prescription drugs – benefit increased.
H5580_22_001_C
Esta es la Evidencia de Cobertura Rider para las personas que reciben ayuda adicional para pagar los medicamentos recetados - beneficio aumentado.
H5580_22_002_C
This is the Evidence of Coverage Rider for people who get extra help paying for prescription drugs – benefit decreased.
H5580_22_002_C
Esta es la Evidencia de Cobertura Rider para las personas que reciben ayuda adicional para pagar los medicamentos con receta - disminución del beneficio.
H5580_20_010
Last Updated: 10/18/2021