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2018 Medica with CHI Health

Medica with CHI Health

Plan Highlights

Medica with CHI Health plans include:

  • Access to localized network of doctors, clinics and hospitals
  • Nationwide coverage when you travel
  • 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

Network Benefits Gold Copay Plus
Deductible Individual: $1,000
Family: $3,000 shared family
Out-of-pocket maximum Individual: $5,000
Family: $5,000 per family member or $10,000 for the entire family*
Office visits Primary care: $30  copay
Urgent care: $30  copay 
Specialty care: $30 copay
Prescription drugs (Medica Drug List) Preferred generic: $5 copay
Generic: $5 copay
Preferred brand: $35 copay
Non-preferred brand:$150 copay
Other eligible health care services 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 Individual: $3,500
Family: $10,500 shared family
Out-of-pocket maximum Individual: $7,000
Family: $7,000 per family member or $14,000 for the entire family*
Office visits 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: 40% coinsurance after deductible
Non-preferred brand: 60% coinsurance after deductible
Other eligible health care services 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 Individual: $6,850
Family: $13,700 shared 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: $80 copay
Urgent care: $80 copay
Specialty care: $150 copay
Prescription drugs (Medica Drug List) 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 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

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 those who qualify who meet certain income requirements

Network Benefits Silver Copay 94% CSR Silver Copay 87% CSR Silver Copay 73% CSR
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

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


2018 Network Information


Who and Where Your Care Comes From

 

Find a Physician or Facility

Medica with CHI Health is a large care system-based network that provides access to CHI Health doctors plus others in southwestern Iowa and southeastern to central Nebraska.  The network includes:
1,400+ Primary and specialty care doctors
8+ Convenience care clinics
30+ Hospitals

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 network providers.

Search for a physician, clinic, hospital or pharmacy 

Find a travel program provider 

 

 

Virtual Care

Secure, 24/7 care via phone or video. Board-certified physicians and nurse practitioners diagnose and treat minor illnesses.

 

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.


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