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 Change. You can find your plan name on your Member ID Card.
2026
2027
- Annual Notice of Change
- Evidence of Coverage (last updated 10/19/2026)
- Summary of Benefits
2026
2027
- Annual Notice of Change
- Evidence of Coverage (last updated 10/19/2026)
- Summary of Benefits
2026
2027
- Annual Notice of Change
- Evidence of Coverage (last updated 10/19/2026)
- Summary of Benefits
2026
2027
- Annual Notice of Change
- Evidence of Coverage (last updated 10/19/2026)
- Summary of Benefits
Other Coverage Information
Medicare Part D Drugs Prior Authorization Criteria and Step Therapy
Medicare Part B Drugs Prior Authorization Criteria and Step Therapy
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.
Provider and Pharmacy Directory (last updated 10/01/2026)
Dental and Vision Directory (last updated 10/09/2026)
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.