Medica

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The Medical Plan Comparison (pdf) gives you a side-by-side look at how each plan option covers medical services including everything from office visits to lab and x-ray services to prescription drugs to hospital services and more.

Medical Plan Descriptions

The medical plan descriptions give you a look at how the plans work and where they are available.

Visit the Medica website for more information to help you select a medical plan or call Customer Service at 952-992-1814 or 877-252-5558; TTY users, please call 711.

Medica Elect/Essential

Base plan with low biweekly rates and out-of-pocket costs
Available for the Twin Cities and Duluth areas

Medica Elect/Essential combines two provider networks that include major care systems in the Twin Cities and Duluth areas. A care system includes the network of doctors, specialists, hospitals, and clinics from which you can select your primary care clinic (PCC).

You and your family members can choose separate primary care clinics from care systems in either the Elect or Essential network. Each primary care clinic has a PCC number (pdf) attached to it. You’ll need that 11-digit number when you enroll.

If you decide to change your clinic, just contact Medica’s member services at 952-992-1814 or 877-252-5558 by the 20th of the month. Your request to change will go into effect the first of the following month. You can change clinics more than one time per year.

Having a primary care clinic means your care is better coordinated. Your PCC will help you with referrals to specialists if that step is required by your care system. Some care systems allow you to directly access a specialist who is in your care system. You’ll receive the highest level of benefits by following your care system’s procedures. If you need to be referred to an out-of-network provider, you must also get Medica’s approval.

Medica Elect/Essential also includes in-network travel benefits and an out-of-network benefit that gives you flexibility as you use the plan.

Medica Choice Regional

Base plan with low biweekly rates and out-of-pocket costs
Available statewide only for Greater Minnesota, including Morris, Crookston, and Rochester

Medica Choice Regional uses the statewide Medica Choice network with over 13,000 physicians and more than 200 hospitals. You can see any provider who is part of the network. You won’t need to select a primary care clinic when you enroll, and you can see any specialist within the plan network without a referral from your primary care doctor.

Medica Choice Regional also includes in-network travel benefits and an out-of-network benefit that gives you flexibility as you use the plan.

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Medica ACO Plan

Available in the 13-county, Twin Cities metro area only

Medica ACO Plan is an Accountable Care Organization (ACO). Medica and the network of primary care and specialty providers work together to deliver coordinated health care and support to the member. You need to select one ACO option that you and your eligible family members will use for the year. You can see any primary care provider or specialist within the network without a referral.

Your ACO options include:

  • Fairview & North Memorial Vantage Plan with Medica (includes Boynton and University of Minnesota Physicians);
  • Inspiration Health by HealthEast with Medica;
  • Park Nicollet First with Medica; and
  • Ridgeview Community Network powered by Medica

Medica ACO Plan also includes in-network travel benefits and an out-of-network benefit that gives you flexibility as you use the plan.

Medica Choice National

Available statewide with national coverage when traveling or working outside the service area

Medica Choice National uses the statewide Medica Choice network with over 13,000 physicians and more than 200 hospitals. If you are traveling or working outside Minnesota, you also have access to national coverage with more than 659,000 physicians and health care providers through the United Healthcare Options PPO network.

Medica Choice National is an open-access network so you can see any provider who is part of the network. You won’t need to select a primary care clinic when you enroll, and you can see any specialist within the plan network without a referral from your primary care doctor.

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Medica HSA

Available statewide with national coverage when traveling or working outside the service area

Medica HSA is a high deductible plan with a health savings account. This plan is also open access and uses the statewide Medica Choice network and the national United Healthcare Options PPO network.

You receive a set amount of tax-free benefits dollars contributed to your HSA account by the University to offset the deductible. When you enroll during the year, the University’s contribution is pro-rated from your effective date of coverage and paid over the number of remaining pay periods in the year. However, the deductible amount is not pro-rated.

You own the HSA contributions and can decide whether to use them for current medical expenses or let the funds grow to cover medical expenses in retirement.

You will receive a debit card from Wells Fargo to use to spend HSA dollars for pharmacy or medical expenses. You can request reimbursement of medical expenses once the account is opened and funds deposited. You can also make your own pre-tax contributions to the HSA and invest them in options from Wells Fargo. If you leave the University, you can transfer your account balances to another account.

Enrollment in Medica HSA means that you can only use the pre-tax health care FSA to cover out-of-pocket costs for eligible dental and vision expenses.

Important Notice: Due to federal law, if you have any other medical coverage, including any part of Medicare, or you are on a spouse’s plan that is not a high deductible health plan, you are not eligible to enroll in Medica HSA. However, if you are age 65 or older and delay taking Social Security benefits and Medicare Part A, you remain eligible for Medica HSA.

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Medical Plan Rates

If you have an appointment that is 75% time or greater, the University pays toward the cost of your rates. If your appointment is 50% to 74% time, you will pay the full cost of the rates.

If you earned the required number of wellness points for a $400 or $600 reduction, your cost is shown in the Your Rates column on the Wellness Program Achievement Rates chart. If you did not participate in or earn the required number of wellness points, your cost is shown in the Your Rates column on the Standard Rates chart.

2016 Wellness Program Achievement Rates Per Pay Period

Employee Only

Plan Total Employer Your Rates
Medica Elect/Essential (Base plan for Twin Cities & Duluth) $291.19 $268.72 $22.47
Medica Choice Regional (Base plan for Greater Minnesota) $291.19 $268.72 $22.47
Medica ACO Plan (For 13 Twin Cities counties only) $281.10 $259.94 $21.16
Medica Choice National $321.24 $268.72 $52.52
Medica HSA $291.51 $268.72 $22.79

Employee and Children

Plan Total Employer Your Rates
Medica Elect/Essential (Base plan for Twin Cities & Duluth) $504.77 $421.72 $83.05
Medica Choice Regional (Base plan for Greater Minnesota) $504.77 $421.72 $83.05
Medica ACO Plan (For 13 Twin Cities counties only) $486.38 $406.92 $79.46
Medica Choice National $555.76 $421.72 $134.04
Medica HSA $505.72 $421.72 $84.00

Employee and Spouse with or without Children

Plan Total Employer Your Rates
Medica Elect/Essential (Base plan for Twin Cities & Duluth) $754.96 $630.82 $124.14
Medica Choice Regional (Base plan for Greater Minnesota) $754.86 $630.82 $124.14
Medica ACO Plan (For 13 Twin Cities counties only) $728.93 $609.87 $119.06
Medica Choice National $832.78 $630.82 $201.96
Medica HSA $756.13 $630.82 $125.31

 

2016 Standard Rates Per Pay Period

Employee Only

Plan Total Employer Your Rates
Medica Elect/Essential (Base plan for Twin Cities & Duluth) $291.19 $253.34 $37.85
Medica Choice Regional (Base plan for Greater Minnesota) $291.19 $253.34 $37.85
Medica ACO Plan (For 13 Twin Cities counties only) $281.10 $244.56 $36.54
Medica Choice National $321.24 $253.34 $67.90
Medica HSA $291.51 $253.34 $38.17

Employee and Children

 Plan Total Employer Your Rates
Medica Elect/Essential (Base plan for Twin Cities & Duluth) $504.77 $406.34 $98.43
Medica Choice Regional (Base plan for Greater Minnesota) $504.77 $406.34 $98.43
Medica ACO Plan (For 13 Twin Cities counties only) $486.38 $391.54 $94.84
Medica Choice National $555.76 $406.34 $149.42
Medica HSA $505.72 $406.34 $99.38

Employee and Spouse with or without Children

 Plan Total Employer your rates
Medica Elect/Essential (Base plan for Twin Cities & Duluth) $754.96 $607.74 $147.22
Medica Choice Regional (Base plan for Greater Minnesota) $754.86 $607.74 $147.22
Medica ACO Plan (For 13 Twin Cities counties only) $728.93 $586.79 $142.14
Medica Choice National $832.78 $607.74 $225.04
Medica HSA $756.13 $607.74 $148.39

If you have questions about your plan options, call 4-UOHR (612-624-8647 or 800-756-2363) and select option 1 or send an email to benefits@umn.edu.

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