Patient Rights and Responsibilities

As a participant in this health insurance program, you have certain rights and responsibilities. By becoming familiar with them, you will be able to make the most of your health care.

Program Option
  • Local Deductible Health Plan (PO14) & Supplemental Benefits
  • Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits
  • Local Health Plan (PO16) & Supplemental Benefits
  • Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
  • Local High Deductible Health Plan (PO17) & Supplemental Benefits
  • Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
  • Local Traditional Health Plan (PO12) & Supplemental Benefits
  • Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
  • State Employee and Retiree Health Plan & Supplemental Benefits

Form 1095: Proof of Health Insurance

The 1095 form provides documentation of your individual health insurance information. This statement is sent to you annually by your insurance provider.

Some Out-Of-State Coverage

Medical Associates Health Plan

Major Health Systems
  • Medical Associates Clinic
  • Mercy Medical Center - Dubuque
  • Crossing Rivers Health
  • Grant Regional Health Center
  • Southwest Health Center
Full Service Areas
  • Crawford County
  • Grant County
  • Iowa County
  • Lafayette County
Limited Service Areas
  • Iowa
  • Illinois
Some Out-Of-State Coverage

MercyCare Health Plan

Major Health Systems
  • Mercyhealth Hospital and Trauma Center–Janesville, WI
  • Mercyhealth Hospital and Medical Center–Walworth, WI
  • Mercyhealth Hospital and Medical Center–Harvard, IL
  • Javon Bea Hospital’s–Riverside & Rockton, IL
  • Fort HealthCare, WI
  • Watertown HealthCare, WI
Full Service Areas
  • Green County
  • Jefferson County
  • Rock County
  • Walworth County
Limited Service Areas
  • Illinois