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2021 Select 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 2020 documents?

Kansas Plans

Document Care Type
Summary of Benefits and Coverage (SBC) Bronze HSA (PDF)
Policy of Coverage
Bronze HSA (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Bronze Value (PDF)
Policy of Coverage
Bronze Value (PDF)

Missouri Plans

Document Care Type
Summary of Benefits and Coverage (SBC) Bronze HSA (PDF) 
Policy of Coverage
Bronze HSA (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Bronze Value (PDF)
Policy of Coverage
Bronze Value (PDF)
Date: 7/31/2021 9:22:48 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB02