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.

Care outside of your plan’s service area

Another benefit with Medica Elect/Essential is a travel benefit that covers health care as in-network when you are traveling outside the plan’s service area, and you use a provider in Medica’s national network for urgent, chronic, or emergency needs. This also works for a dependent who is a college student living out of the plan’s service area.

Care outside of your plan’s network

You will have coverage if you receive care from a provider that’s out of the network. Coverage will be at a 70% coinsurance level after you pay a $600 per person/$1,200 per family deductible out of your pocket.

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. But it’s a good idea to work closely with your primary care doctor to coordinate your health care needs.

Care outside of your plan’s service area

Another benefit with Medica Choice Regional is a travel benefit that covers health care as in-network when you are traveling outside the plan’s service area, and you use a
provider in Medica’s national network for urgent, chronic, or emergency needs. This also works for a dependent who is a college student living out of the plan’s service area.

Care outside of your plan’s network

You will have coverage if you receive care from a provider that’s out of the network. Coverage will be at a 70% coinsurance level after you pay a $600 per person/$1,200 per family deductible out of your pocket.

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Medica ACO Plan

Available in the Twin Cities metro area; southern Minnesota and western Wisconsin; northern Minnesota, eastern North Dakota, and northwestern Wisconsin; and northwestern Minnesota and northeastern North Dakota

Medica ACO Plan is an Accountable Care Organization (ACO), which offers unique networks of providers in your area. Medica and the network of doctors, nurses, and health care providers work together to deliver coordinated health care, information, 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 in the network without a referral.

To be eligible for an ACO, you must live in one of the counties in their service area.

Twin Cities metro area

Your ACO options include:

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

You must live in one of these Minnesota counties to enroll in a Twin Cities ACO: Anoka, Carver, Chisago, Dakota, Hennepin, Isanti, McLeod, Ramsey, Scott, Sibley, Sherburne, Washington, or Wright.

Southern Minnesota and western Wisconsin
Your ACO option is Medica with Mayo Clinic Health System. You must live in one of these counties in
Minnesota or Wisconsin to enroll in this ACO:

  • Minnesota: Blue Earth, Dodge, Faribault, Fillmore, Freeborn, Goodhue, Houston, Le Sueur, Martin,Mower, Nicollet, Olmsted, Rice, Steele, Wabasha, Waseca, Watonwan, or Winona
  • Wisconsin: Barron, Chippewa, Dunn, or Eau Claire

Northern Minnesota, eastern North Dakota, and northwestern Wisconsin
Your ACO option is Essentia ChoiceCare with Medica. You must live in one of these counties in Minnesota, North Dakota, or Wisconsin to enroll in this ACO:

  • Minnesota: Becker, Carlton, Cass, Clay, Crow Wing, Hubbard, Itasca, Mahnomen, Norman, Pine, or St. Louis
  • North Dakota: Cass, Ransom, Richland, or Sargent
  • Wisconsin: Ashland, Bayfield, Douglas, Sawyer or Washburn

Northwestern Minnesota and northeastern North Dakota
Your ACO option is Altru & You with Medica. You must live in one of these counties in Minnesota or North Dakota to enroll in this ACO:

  • Minnesota: Kittson, Marshall, Pennington, Polk, Red Lake, or Roseau
  • North Dakota: Benson, Cavalier, Eddy, Grand Forks, Griggs, Nelson, Pembina, Pierce, Ramsey, Rolette, Steele, Towner, Traill, or Walsh

Care outside of your plan’s service area

Another benefit with Medica ACO Plan is a travel benefit that covers health care as in-network when you are traveling outside the plan’s service area, and you use a provider in Medica’s national network for urgent, chronic, or emergency needs.

Care outside of your plan’s network

You will have coverage if you receive care from a provider that’s out of the network. Coverage will be at a 70% coinsurance level after you pay a $600 per person/$1,200 per family deductible out of your pocket.

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Medica Choice National

Open accesss network 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 don’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. But it’s a good idea towork closely with your primary care doctor to coordinate your health care needs.

Care outside of your plan’s service area

Medica Choice National already includes travel benefits through the United Healthcare Options PPO national network if you are traveling or working outside Minnesota. You can also live outside the service area.

Care outside of your plan’s network

You will have coverage if you receive care from a provider that’s out of the network. Coverage will be at a 70% coinsurance level after you pay a $600 per person/$1,200 per family deductible out of your pocket.

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Medica Health Savings Account (HSA)

Open access network available statewide with national coverage when traveling or working outside the service area

Medica HSA is a high deductible plan that uses the statewide Medica Choice network with over 13,000 physicians and more than 200 hospitals and national coverage with more than 659,000 physicians and health care providers through the United Healthcare Options PPO network. It is an open access network so you can see any doctor, clinic, or facility that is part of the network.

You don’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. But it’s a good idea to work closely with your primary care doctor to coordinate your health care needs.

Health Savings Account

The University will contribute $750 to your HSA account for employee-only coverage and $1,500 for each tier with covered dependents. The funds are contributed over the 26 pay periods in 2017 for coverage effective January 1, 2017. When enrolling mid-year, the HSA amount will be prorated per pay period; however, the deductible amount is not prorated. The amount you receive depends on when your coverage becomes effective. The amount is contributed over the number of pay periods remaining in the year.

After your deductible is met, Medica HSA pays covered services at 90% coinsurance. 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 Optum Bank 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 Optum Bank. 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.

Care outside of your plan’s service area

Medica HSA already includes travel benefits through the United Healthcare Options PPO national network if you are traveling or working outside Minnesota. You can also live
outside the service area.

Care outside of your plan’s network

You will have coverage if you receive care from a provider that’s out of the network. Coverage will be at a 70% coinsurance level after the deductible.

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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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