Plan Documents


Select the name of the plan you are enrolled in to view your plan-specific documents — Summary of Benefits, Evidence of Coverage, and Annual Notice of Changes. You can find your plan name on your member ID card. 

2025 Plan Name Changes

Several of our plans will have a new name beginning Jan. 1, 2025:

  • MercyOne Health Plan Cash Back (HMO) will change to MercyOne Health Plan Glory No RX (HMO)
  • MercyOne Health Plan Cash Back MAPD (HMO) will change to MercyOne Health Plan Cash Back (HMO)
  • MercyOne Health Plan No Premium Choice (PPO) will change to MercyOne Health Plan Choice (PPO)

The menu below has been updated to reflect the 2025 plan names.

Other Coverage Information

Formulary (Drug List)

Preferred Diabetic Testing Supplies

Over-the-Counter (OTC) Catalog

Provider Directory

MercyOne Health Plan offers a large network of high-quality providers. You can use the Provider/Pharmacy Directory below to find network providers and pharmacies in your area. You can also search the directory on the Find a Provider page of our website.

2024-2025 Provider/Pharmacy Directory (last updated 11/01/24)

At any time, you can request a printed copy of the Provider/Pharmacy Directory by calling Member Services. You can also call Member Services for more information about our network providers, including their qualifications and any changes in the pharmacy network. 

This page was last updated 11/01/2024