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2020 Elevate by Medica Plan Documents

To see your summary of benefits and coverage (SBC) and policy of coverage documents, select your state and plan below.

Looking for the 2019 documents?

Iowa Plans

Document Care Type
Summary of Benefits and Coverage (SBC) Bronze Copay (PDF)
Policy of Coverage
Bronze Copay (PDF)
Document Care Type  
Summary of Benefits and Coverage (SBC) Bronze HSA (PDF) Bronze HSA Plus (PDF)
Policy of Coverage
Bronze HSA (PDF) Bronze HSA Plus (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Gold Share (PDF) Bronze Share Plus (PDF)
Policy of Coverage Gold Share (PDF) Bronze Share Plus (PDF)

Nebraska Plans

Document Care Type
Summary of Benefits and Coverage (SBC) Bronze Copay (PDF)
Policy of Coverage
Bronze Copay (PDF)
Date: 10/28/2020 6:51:00 PM Version: 4.0.30319.42000 Machine Name: PWIM4-CDWEB01