Order Materials by Mail

For Medica Medicare Members

Before you get started, grab your Medica ID card. You’ll need it to complete this form.

If you need multiple Evidence of Coverage (EOC) documents, you’ll need to submit a separate request for each one. IMPORTANT: If you ask for a provider directory, pharmacy directory, formulary, or other material as part of your first EOC request, you don’t need to ask for the same material again in future EOC requests.

Fields marked with an asterisk * are required

Plan Materials

Member Information

Where do I find my care type?

Medica Advantage Solution, Medica Advantage, or Medica Advantage Dual Materials Requested (2025)

Select the material(s) below that you need to receive by mail using your CMS code found on the front of your Medica ID card. Click here for help finding your CMS code on your Medica ID card.

If you have a Medicare plan sponsored by an employer, select the Group plan option for material(s) you are requesting.

Provider directory (average page count: 436 pages)
Please select one if needed.

Pharmacy Directory (average page count: 108 pages)
Please select one if needed.

Formulary (average page count: 144 pages)
Please select one if needed.

Catalogs (average page count: 28 pages)
Please select one if needed. If your employer offers OTC benefits, please select Medica Group Advantage Solution (PPO).

Forms (average page count: 1 page)
Please select one if needed.

Medica Advantage Solution or Medica Advantage Materials Requested (2024)

Select the material(s) below that you need to receive by mail using your CMS code found on the front of your Medica ID card. Click here for help finding your CMS code on your Medica ID card.

If you have a Medicare plan sponsored by an employer, select the Group plan option for material(s) you are requesting.

Provider directory (average page count: 436 pages)
Please select one if needed.

Pharmacy Directory (average page count: 108 pages)
Please select one if needed.

Formulary (average page count: 144 pages)
Please select one if needed.

Catalogs (average page count: 28 pages)
Please select one if needed. If your employer offers OTC benefits, please select Medica Group Advantage Solution (PPO).

Forms (average page count: 1 page)
Please select one if needed.

Medica Prime Solution Materials Requested (2025)

Select the material(s) below that you need to receive by mail using your Group number found on the front of your Medica ID card. Click here for help finding your Group Number on your Medica ID card.

If you have a Medicare plan sponsored by an employer, select the Group plan option for material(s) you are requesting.

EOC (average page count: 198 pages)

Please select one if needed.

Provider Directory (average page count: 436 pages)

Please select one if needed.

Pharmacy directory (average page count: 108 pages)
Please select one if needed.

Formulary (average page count: 144 pages)
Please select one if needed.

Catalogs (average page count: 28 pages)
Please select one if needed. If your employer offers OTC benefits, please select Medica Group Prime Solution w/Rx (Cost).

Forms (average page count: 1 page)
Please select one if needed.

Medica Prime Solution Materials Requested (2024)

Select the material(s) below that you need to receive by mail using your Group number found on the front of your Medica ID card. Click here for help finding your Group Number on your Medica ID card.

If you have a Medicare plan sponsored by an employer, select the Group plan option for material(s) you are requesting.

EOC (average page count: 198 pages)

Please select one if needed.

Provider Directory (average page count: 436 pages)

Please select one if needed.

Pharmacy directory (average page count: 108 pages)
Please select one if needed.

Formulary (average page count: 144 pages)
Please select one if needed.

Catalogs (average page count: 28 pages)
Please select one if needed. If your employer offers OTC benefits, please select Medica Group Prime Solution w/Rx (Cost).

Forms (average page count: 1 page)
Please select one if needed.