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2019 Medica Individual Choice Official Documents

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

Looking for the 2018 official documents?

North Dakota Plans

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

North Dakota Rate Increase Justification 2019: These ACA-compliant policies received a weighted average premium increase of 26.0%. These adjustments were made based on historical claim information, projected cost increases, and relative risk assessments by plan.

Wisconsin Plans

Document Care Type    
Summary of Benefits and Coverage (SBC) Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Policy of Coverage
Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Document Care Type  
Summary of Benefits and Coverage (SBC)
Bronze HSA Plus (PDF)
Bronze HSA (PDF)
Policy of Coverage
Bronze HSA Plus (PDF)
Bronze HSA (PDF)
Date: 8/25/2019 2:42:42 AM Version: 4.0.30319.42000 Machine Name: PWIM4-CMSWEB01