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Access Your Plan Materials and Member Forms

All plan materials are member forms are available on our website. Need a hard copy? Many of your materials can be downloaded at the links below and printed wherever it's convenient for you.

Information About Your Coverage

These documents tell you what services are covered under your plan, what you need to do to get covered services, and your rights and responsibilities.


Member Forms

Claims

Use these forms to tell us about other insurance you have or to request reimbursement of health care expenses.

Financial Accounts

Find forms for your flexible spending account, health reimbursement account or health savings account on MyMedica.com.

MyMedica.com log in


Continuity of Care

Use this form to request continuity of care with a specific physician.

Continuity of Care Form (DOC)


Coordination of Benefits

Use this form to let us know if you're insured by more than one health plan.

Replacement ID Card

Use this online form to order a replacement ID card. We will send it to the address we have on file for you.

Order ID Card form


Primary Care Clinic Change

Use this online form to change your primary care clinic. Medica Elect and Medica Essential members only.

Primary Care Clinic Change Request form



Plan Materials by Mail

If you are unable to print the above documents yourself, you may order them to be sent by mail. Please allow 10 business days for processing.

Order Plan Materials by Mail form

 


 

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