Medica Plan Options

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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.

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

  • Elect/Essential combines two provider networks that include 20 major care systems in the Twin Cities and Duluth areas
  • You and your family members choose primary care clinics (PCCs) from either the Elect or Essential care systems. You’ll need the PCC number (pdf) when you enroll
  • To change your clinic, contact Medica’s member services by the 20th of the month. Your change becomes effective the first of the following month
  • Your PCC will help you with referrals to specialists if required by 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

  • This plan includes a travel benefit that covers health care as in-network when you are traveling outside the plan’s service area
  • You must 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

  • 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
  • You can see any specialist within the plan network without a referral from your primary care doctor

Care outside of your plan’s service area

  • This plan includes a travel benefit that covers health care as in-network when you are traveling outside the plan’s service area
  • You must 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
  • The ACOs have the lowest rates, low copays, and high member satisfaction

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

Medica ACO Service Area Map. See below for coverage specifics.

Twin Cities metro area
Your ACO options include:

  • VantagePlus with Medica (includes Fairview, HealthEast, North Memorial, and many more independent clinics including Boynton Health and University of Minnesota Physicians);
  • Park Nicollet First with Medica; and
  • Ridgeview Community Network powered by Medica

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

Southern Minnesota and western Wisconsin
Your ACO option is Medica CompleteHealth (featuring care at Mayo Clinic). You must live or work 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 Choice Care with Medica. You must live or work 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 or work 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

  • This plan includes a travel benefit that covers health care as in-network when you are traveling outside the plan’s service area
  • You must 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 Choice National

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

  • Choice National uses the statewide Medica Choice network with over 13,000 physicians and more than 200 hospitals
  • If traveling or working outside Minnesota, have access to national coverage with more than 659,000 health care providers through the United Healthcare Options PPO network.
  • You don’t need to select a primary care clinic when you enroll
  • You can see any specialist within the plan network without a referral from your primary care doctor
  • Choice National has high rates and copays

Care outside of your plan’s service area

  • Choice National 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
  • HSA uses the statewide Medica Choice network with over 13,000 physicians and more than 200 hospitals
  • If traveling or working outside Minnesota, have access to national coverage with more than 659,000 health care providers through the United Healthcare Options PPO network.
  • You don’t need to select a primary care clinic when you enroll
  • You can see any specialist within the plan network without a referral from your primary care doctor

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 for the year
  • 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
  • Medica HSA pays covered services at 90% coinsurance after your deductible is met
  • 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 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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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 total cost of the rates.

If you earned the required number of wellbeing points for a $400 or $600 reduction, your cost is shown in the Employee Cost column on the Wellbeing Program Achievement Rates chart.

If you are a new employee or did not participate in or earn the required number of wellbeing points, your cost is shown in the Employee Cost column on the Standard Rates chart.

2018 Wellbeing Program Achievement Rates Per Pay Period

Employee Only

Plan Employee Cost U Contribution Total Cost
Medica Elect/Essential (Twin Cities & Duluth Base Plan) $22.95 $271.91 $294.86
Medica Choice Regional (Greater Minnesota Base Plan) $22.95 $271.91 $294.86
Medica ACO Plan (Crookston area, Duluth area & parts of northeastern
Minnesota, Rochester area, Twin Cities metro area)
$12.69 $271.91 $284.60
Medica Choice National $53.39 $271.91 $325.30
Medica HSA $23.30 $271.91 $295.21

Employee and Children

Plan Employee Cost U Ccontribution Total Cost
Medica Elect/Essential (Twin Cities & Duluth Base Plan) $84.30 $426.87 $511.17
Medica Choice Regional (Greater Minnesota Base Plan) $84.30 $426.87 $511.17
Medica ACO Plan (Crookston area, Duluth area & parts of northeastern
Minnesota, Rochester area, Twin Cities metro area)
$65.63 $426.87 $492.50
Medica Choice National $135.96 $426.87 $562.83
Medica HSA $85.28 $426.87 $512.15

Employee and Spouse with or without Children

Plan Employee Cost U Contribution Total Cost
Medica Elect/Essential (Twin Cities & Duluth Base Plan) $125.99 $638.47 $764.46
Medica Choice Regional (Greater Minnesota Base Plan) $125.99 $638.47 $764.46
Medica ACO Plan (Crookston area, Duluth area & parts of northeastern
Minnesota, Rochester area, Twin Cities metro area)
$99.83 $638.47 $728.30
Medica Choice National $204.83 $638.47 $843.30
Medica HSA $127.19 $638.47 $765.66

2018 Standard Rates Per Pay Period

Employee Only

Plan Employee Cost U Contribution Total Cost
Medica Elect/Essential (Twin Cities & Duluth Base Plan) $38.33 $256.53 $294.86
Medica Choice Regional (Greater Minnesota Base Plan) $38.33 $256.53 $294.86
Medica ACO Plan (Crookston area, Duluth area & parts of northeastern
Minnesota, Rochester area, Twin Cities metro area)
$28.07 $256.53 $284.60
Medica Choice National $68.77 $256.53 $325.30
Medica HSA $38.68 $256.53 $295.21

Employee and Children

 Plan Employee Cost U Contribution Total Cost
Medica Elect/Essential (Twin Cities & Duluth Base Plan) $99.68 $411.49 $511.17
Medica Choice Regional (Greater Minnesota Base Plan) $99.68 $411.49 $511.17
Medica ACO Plan (Crookston area, Duluth area & parts of northeastern
Minnesota, Rochester area, Twin Cities metro area)
$81.01 $411.49 $492.50
Medica Choice National $151.34 $411.49 $562.83
Medica HSA $100.66 $411.49 $512.15

Employee and Spouse with or without Children

 Plan Employee Cost U Contribution Total Cost
Medica Elect/Essential (Twin Cities & Duluth Base Plan) $149.07 $615.39 $764.46
Medica Choice Regional (Greater Minnesota Base Plan) $149.07 $615.39 $764.46
Medica ACO Plan (Crookston area, Duluth area & parts of northeastern
Minnesota, Rochester area, Twin Cities metro area)
$122.91 $615.39 $728.30
Medica Choice National $227.91 $615.39 $843.30
Medica HSA $150.27 $615.39 $765.66

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

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