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2018 Medica Insure

Medica Insure

Plan Highlights

Medica Insure plans include:

  • Access to a large tiered network of doctors, clinics and hospitals
  • Nationwide coverage when you travel
  • Access to Mayo Clinic through the Centers of Excellence program
  • 100% coverage of routine preventive exams
  • Gold, silver and bronze metal level plan options
  • Copay, copay plus, health savings account compatible or catastrophic plan options

2018 Plan Options at a Glance


Plans that are right for you

Copay Plus and Copay - For individual and families

With a copay plus or copay plan, your benefits will vary depending on the provider you visit. You're free to see any provider, but you receive your highest level of benefits and typically the lowest out-of-pocket costs when you see Tier 1 – Preferred providers.

Network Benefits Gold Copay Plus 
Deductible Tier 1
Individual: $1,000
Family: $3,000 shared family
Tier 2
Individual: $1,500
Family: $4,500 shared family
Out-of-pocket maximum Tier 1
Individual: $5,000
Family: $5,000 per family member or $10,000 for the entire family**
Tier 2
Individual: $7,000
Family: $7,000 per family member or $14,000 for the entire family**
Office visits Tier 1
Primary care: $30  copay
Urgent care: $30  copay
Specialty: $30 copay
Tier 2
Primary care: $60 copay
Urgent care: $60  copay
Specialty care: $120 copay
Prescription drugs (Medica Drug List) Tier 1 and Tier 2
Preferred generic: $5 copay
Generic: $5 copay
Preferred brand: $35 copay
Non-preferred brand:$150 copay
Other eligible health care services Tier 1 and Tier 2
30% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Iowa SBC (PDF)
View Nebraska SBC (PDF)

**Cost Sharing Details:
Family plans have an embedded individual out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tipsheet

Network Benefits Silver Copay
Deductible Tier 1
Individual: $3,500
Family: $10,500 shared family
Tier 2
Individual: $4,500
Family: $13,500 shared family
Out-of-pocket maximum

Tier 1
Individual: $7,000
Family: $7,000 per family member or $14,000 for the entire family**
Tier 2
Individual: $7,350
Family: $7,350 per family member or $14,700 for the entire family**

Office visits Tier 1
Primary care: $30 copay
Urgent care: $30  copay
Specialty: $60 copay
Tier 2
Primary care: $60 copay
Urgent care: $60 copay
Specialty: $120 copay
Prescription drugs (Medica Drug List) Tier 1 and Tier 2
Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 40% coinsurance after deductible
Non-preferred brand: 60% coinsurance after deductible
Other eligible health care services Tier 1 and Tier 2
40% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Iowa SBC (PDF)
View Nebraska SBC (PDF)

**Cost Sharing Details:
Family plans have an embedded individual out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tipsheet

Network Benefits Bronze Copay
Deductible Tier 1 and Tier 2
Individual: $6,850
Family: $13,700 shared family 
Out-of-pocket maximum Tier 1 and Tier 2
Individual: $7,350
Family: $7,350 per family member or $14,700 for the entire family**
Office visits Tier 1
Primary care: $80  copay
Urgent care: $80  copay
Specialty: $150 copay
Tier 2
Primary care: $120 copay
Urgent care: $120  copay
Specialty: $225 copay
Prescription drugs (Medica Drug List) Tier 1 and Tier 2
Preferred generic: $10 copay
Generic: $20 copay
Preferred brand: 50% coinsurance after deductible
Non-preferred brand: 70% coinsurance after deductible
Other eligible health care services Tier 1 and Tier 2
50% coinsurance after deductible
Summary of Benefits and Coverage (SBC)

View Iowa SBC (PDF)
View Nebraska SBC (PDF)

**Cost Sharing Details:
Family plans have an embedded individual out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tipsheet

Health Savings Account (HSA) Compatible - For individuals and families

With an HSA-compatible plan, your benefits are the same for network (tier 1 and 2) providers.

Network Benefits Bronze HSA Plus   Bronze HSA
Deductible Individual: $2,600
Family: $5,200 shared family
Individual: $6,000
Family: $12,000 shared family
Out-of-pocket maximum Individual: $6,650
Family: $6,650 per family member or $13,300 for the entire family**
Individual: $6,650
Family: $6,650 per family member or $13,300 for the entire family**
Office visits Primary, urgent, and specialty care: 40% coinsurance after deductible Primary, urgent, and specialty care: 20% coinsurance after deductible
Prescription drugs (Medica Drug List) Preferred generic, generic, preferred brand, non-preferred brand : 40% coinsurance after deductible Preferred generic, generic, preferred brand, non-preferred brand : 20% coinsurance after deductible
Other eligible health care services 40% coinsurance after deductible 20% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Iowa SBC (PDF)
View Nebraska SBC (PDF)
View Iowa SBC (PDF)
View Nebraska SBC (PDF)

**Cost Sharing Details:
Family plans have an embedded individual out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tipsheet

Cost Sharing Reduction (CSR) - For individuals and families who meet certain income requirements

With a CSR plan, your benefits are the same for network (tier 1 and 2) providers.

Network Benefits Silver Copay 94% Silver Copay 87% Silver Copay 73%
Deductible Individual: $100
Family: $300 shared family
Individual: $500
Family: $1,500 shared family
Individual: $2,500
Family: $7,500 shared family
Out-of-pocket maximum Individual: $1,000
Family: $1,000 per family member or $2,000 for the entire family**
Individual: $2,000
Family: $2,000 per family member or $4,000 for the entire family**
Individual: $5,850
Family: $5,850 per family member or $11,700 for the entire family**
Office visits Primary care: $30 copay 
Urgent care: $30 copay
Specialty care: $60 copay
Primary care: $30 copay 
Urgent care: $30 copay
Specialty care: $60 copay
Primary care: $30 copay
Urgent care: $30 copay
Specialty care: $60 copay
Prescription drugs (Medica Drug List) Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 5% coinsurance after deductible
Non-preferred brand: 25% coinsurance after deductible
Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 20% coinsurance after deductible
Non-preferred brand: 40% coinsurance after deductible
Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 30% coinsurance after deductible
Non-preferred brand: 50% coinsurance after deductible
Other eligible health care services 5% coinsurance after deductible 20% coinsurance after deductible 30% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Iowa SBC (PDF)
View Nebraska SBC (PDF)
View Iowa SBC (PDF)
View Nebraska SBC (PDF)

View Iowa SBC (PDF)
View Nebraska SBC (PDF)

**Cost Sharing Details:
Family plans have an embedded individual out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tipsheet

Catastrophic - For individuals and families under age 30 or those with an eligible exemption

With a catastrophic plan, your benefits are the same for network (tier 1 and 2 providers).

Network Benefits Catastrophic
Deductible Individual: $7,350
Family: $7,350 per family member or $14,700 for the entire family**
Out-of-pocket maximum Individual: $7,350
Family: $7,350 per family member or $14,700 for the entire family**
Office visits Primary care: $30 copay for the first 3 visits per person per calendar year. After 3rd, 0% coinsurance after deductible
Urgent care: 0% coinsurance after deductible
Specialty care: 0% coinsurance after deductible 
Prescription drugs (Medica Drug List) Preferred generic, generic, preferred brand, non-preferred brand: 0% coinsurance after deductible
Other eligible health care services 0% coinsurance after deductible
Summary of Benefits and Coverage (SBC)

View Iowa SBC (PDF)
View Nebraska SBC (PDF)

**Cost Sharing Details:
Family plans have an embedded individual deductible and out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tipsheet

Note: Tier 1- Preferred and Tier 2 - Standard are network providers. Services received from tier 1 network providers will cross accumulate to your tier 1 and tier 2 network deductible and out-of-pocket maximum. Services received from tier 2 network providers will only accumulate to your tier 2 network deductible and out-of-pocket maximum. However, you're not required to pay more than your tier 2 amounts.


2018 Network Information


Who and Where Your Care Comes From

 

Find a Physician or Facility

Medica Insure is a broad tiered network that provides access to most doctors and hospitals throughout Iowa, Nebraska, South Dakota, as well as parts of bordering states. The network includes:

Tier 1 - Preferred Providers
6,400+ Primary and specialty care doctors
20+ Online convenience care clinics
97+ Hospitals

Including the following health care systems, and other providers: Avera Health, Bryan Health, CHI Health, Great Plains Health, Mary Lanning Health Care, Methodist Health System and UnityPoint Health

Tier 2 - Standard Providers
7,200+ Primary and specialty care doctors
35+ Online and convenience care clinics
170+ Hospitals

Search for a physician, clinic or hospital

Find a travel program provider 

Pharmacy Search Information
Our pharmacy network includes more than 64,000 pharmacies nationwide including most major chains and thousands of Independent pharmacies.

Search for a network pharmacy

 

 

Centers of Excellence Program featuring Mayo Clinic

This program allows members to receive care for certain transplants, rare cancers and other complex medical conditions at Mayo Clinic. An allowance for transportation, lodging and living expenses for the patient and one travel companion is included.

 

2018 Health and Wellness


These health and wellness extras are standard with any plan you choose

 

 

Health Advocate – Your Health Care Lifeline

Need help navigating the world of health insurance and medical care? Health Advocate is there for you 24/7. Get help making appointments with hard-to-reach doctors, resolving medical claims and getting answers to questions about medical treatment. You can even get help with health care issues facing your parents and parents-in-law. Health Advocate is an independent and confidential service.

 

 

24/7 NurseLine™

As part of the Health Advocate services offered with this product, you receive 24/7 access to highly trained nurses to help answer questions about symptoms, medications and health conditions, and other self-care tips for non-urgent concerns.

 

 

 

Healthy Living with Medica – Daily Health Rewarded

Personalized health and well-being programs, gym membership discounts, special offers for personal trainers sessions, and rewards for making healthy choices — Healthy Living offers all this and more! It’s a web-based tool whose two-week programs will motivate and support you to make the changes you want in your health and life — get fit, eat healthier, manage stress, sleep better and find direction for your life. Earn points as you participate that you can redeem for discounts, be entered into raffles or you can use to donate to charities.


Mayo Clinic® is an independent, nonprofit healthcare provider offering network access to its providers and health services. Mayo, Mayo Clinic, Mayo Clinic Health System and the triple-shield logo are registered trademarks and service marks of Mayo Clinic.

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