Medical Plan Descriptions - Under Age 65

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

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

Medica Elect/Essential

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 (xlsx) 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 family deductible out of your pocket.

Medica Choice Regional

Available statewide for Greater Minnesota only, 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 family deductible out of your pocket.

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 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 within 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 one of these ACOs: 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 family deductible out of your pocket.

Medica Choice National

Open access 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 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
Medica Choice National already includes travel benefits through United Healthcare Options PPO national network when you are traveling or working outside Minnesota. You can also live out 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 family deductible out of your pocket.

Medica HSA

Open access network 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. It 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 HSA 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. But it's a good idea to work closely with your primary care doctor to coordinate your health care needs.

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

The University does not make a direct contribution to your HSA; instead, the rates are adjusted to account for that. You have the option to make your own pre-tax contributions to the HSA and invest them in accounts with Optum Bank. If you do, you will have a special debit card to spend HSA dollars for pharmacy or medical expenses. After leaving the University any balance in the account can remain with Optum Bank, or you can move the funds to a personal HSA.

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 United Healthcare Options PPO national network when you are traveling or working outside Minnesota. You can also live out 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 the deductible.