Mercy Health Plans/Premier - Southwest Illinois

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General Information

Plan Name:	Mercy Health Plans/Premier
Service Area:	Southwest Illinois
Brochure:	PDF Version
Brochure:	Text Version
NCQA Accreditation:	No
JCAHO Accreditation:	No
URAC Accreditation:	No
Plan Type:	POS
Enrollment Code-Self:	7M1
Enrollment Code-Self & Family:	7M2
Link to Plan Home Page:	http://www.mercyhealthplans.com
Telephone:	800/327-0763
Summary results of the 2001 consumers assessment of health plans survey

Benefits

In Network - Doctor Care/ Primary Office Visits:	$10
In Network - Hospital Inpatient Room and Board Charges:	Nothing
In Network - RX/ Generic/ Retail:	$7
In Network - RX/ Brand/ Retail:	$12
In Network - RX/ Brand/ NonFormulary:	$25
Out of Network - Doctor Care/ Primary Office Visits:	30%
Out of Network - Hospital Inpatient Room and Board Charges:	30%
Out of Network - RX/ Generic/ Retail:	N/A
Out of Network - RX/ Brand/ Retail:	N/A
Out of Network - RX/ Brand/ NonFormulary:	N/A

Rates

Non-Postal
___Monthly	Self: $78.48	Self: & Family: $191.62
___Twice Biweekly	Self: $72.44	Self: & Family: $176.88
___Biweekly	Self: $36.22	Self: & Family: $88.44
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Annuitants
___Monthly	Self: $78.48	Self: & Family: $191.62
_
U.S. Postal Service Employees (Type A)
___Monthly	Self: $40.22	Self: & Family: $104.22
___Biweekly	Self: $18.56	Self: & Family: $48.10
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U.S. Postal Service Employees (Type B)
___Biweekly	Self: $24.85	Self: & Family: $76.71
___Monthly	Self: $53.84	Self: & Family: $166.21
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Worker's Compensation Recipients
___Twice Biweekly	Self: $72.44	Self: & Family: $176.88
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Certain Temporary Employees
___Biweekly	Self: $134.08	Self: & Family: $311.85
___Monthly	Self: $290.51	Self: & Family: $675.68
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Former Spouse Enrollees
___Monthly	Self: $290.51	Self: & Family: $675.68
___Biweekly	Self: $134.08	Self: & Family: $311.85
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Temporary Continuation of Coverage
___Biweekly	Self: $136.76	Self: & Family: $318.09
___Monthly	Self: $296.32	Self: & Family: $689.19
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FDIC
___Biweekly	Self: $18.56	Self: & Family: $48.10
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