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 2018 Member Materials menu below to view the materials for the 2018 plan year.
  • 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 Opens In New Window.
  • 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.  

2018 Member Materials

Annual Notice of Changes

H5580_18_005 CMS Accepted

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.


Notificación anual de cambios

H5580_18_028 CMS Aceptado

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.


Evidence of Coverage

H5580_18_009 CMS Accepted

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


Evidencia de Cobertura

H5580_18_030 CMS Aceptado

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


Summary of Benefits

H5580_18_006 CMS Accepted

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.


Resumen de beneficios

H5580_18_029 CMS Aceptado

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

H5580_18_008 CMS Accepted | H5580_18_027 CMS Aceptado

This booklet lists the prescription drugs covered by Mercy Care Advantage plan (English/Espanol combined).

 


Prior Authorization Criteria

 H5580_18_035_NM

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


Step Therapy Criteria

H5580_18_036_NM

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


Provider/Pharmacy Directory Notice|Aviso de Directorio de Proveedores/Farmacias

H5580_18_010_NM

This notice describes the Provider/Pharmacy Directory and explains how members can access our online directory or request a copy by mail. (English/Espanol combined).


Mercy Care Advantage Plan Ratings

H5580_18_040 CMS Accepted

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.


Mercy Care Advantage Plan Calificaciones

H5580_18_041 Aceptado por CMS

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.


Low Income Subsidy (LIS) Rider – Benefit Increased

H5580_18_001 CMS Accepted

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


Subsidio de bajos ingresos (LIS) rider-Benefit Aumentado

H5580_18_002 CMS Aceptado

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


Low Income Subsidy (LIS) Rider – Benefit Decreased

H5580_18_003 CMS Accepted

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


Subsidio de bajos ingresos (LIS) rider-Benefit Disminuido

H5580_18_004 CMS Aceptado

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


Transition of Coverage Letter

H5580_17_024_NM

This is an example of a letter you may get during the Transition of Coverage process for prescription drugs.


Carta de Transición de Cobertura

H5580_17_025_NM

Este es un ejemplo de una carta que puede recibir durante el proceso de Transición de Cobertura para medicamentos recetados.

2019 Member Materials

Annual Notice of Changes

H5580_19_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.


Notificación anual de cambios

H5580_19_037_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.


Evidence of Coverage - coming soon

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


Evidencia de Cobertura - Próximamente

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


Summary of Benefits

H5580_19_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.


Resumen de beneficios

H5580_19_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  -Coming Soon

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 - Coming Soon

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


Step Therapy Criteria - Coming Soon

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


Notice - How to access Mercy Care Advantage materials | Aviso: cómo acceder a los materiales de Mercy Care Advantage

H5580_19_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


Mercy Care Advantage Plan Ratings - Coming Soon

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.


Mercy Care Advantage Plan Calificaciones - Próximamente

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.


Low Income Subsidy (LIS) Rider – Benefit Increased

H5580_19_001_C

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


Subsidio de bajos ingresos (LIS) rider-Benefit Aumentado

H5580_19_001_C

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


Low Income Subsidy (LIS) Rider – Benefit Decreased

H5580_19_002_C

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


Subsidio de bajos ingresos (LIS) rider-Benefit Disminuido

H5580_19_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_18_048
Approved: 1/30/2018
Last Updated: 10/2/2018

Mercy Care Advantage is an HMO SNP with a Medicare contract and a contract with the Arizona Medicaid Program. Enrollment in Mercy Care Advantage depends on contract renewal.