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2020 Member Plan Documents

For Medica Prime Solution (Cost) Members

Select your state and then your plan name (Care Type on your ID card) below to see your legal plan documents.

Looking for 2021 documents?

Iowa

Minnesota

Enhanced with Rx ($199.80 monthly premium)
Enhanced with Rx2 ($231.10 monthly premium)
Enhanced with no Rx ($157.00 monthly premium)

Provider Directories for all Enhanced plans
Pharmacy Directories for Rx and Rx2 plans
Evidence of coverage documents
Annual notice of changes
Formulary Directory

Basic with Rx ($104.40 monthly premium)
Basic with Rx2 ($132.90 monthly premium)
Basic with no Rx ($79.00 monthly premium)

Provider Directories for all Basic plans
Pharmacy Directories for Rx and Rx2 plans
Evidence of coverage documents
Annual notice of changes documents
Formulary Directory

Nebraska

North Dakota & South Dakota

Premium with Rx ($239.60 monthly premium)
Premium with no Rx ($189.00 monthly premium)

Provider Directories for all Premium plans
Pharmacy Directories for Rx plan
Evidence of coverage documents
Annual notice of changes with Rx
Formulary Directory

Wisconsin

Group Prime Solution Documents

Order Materials by Mail

The easiest way to access your plan materials is to view or download them at the links above. If you prefer, we are able to send materials to you via mail.

Order plan materials by mail



Last Updated: September 2020

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Date: 1/23/2021 5:01:56 PM Version: 4.0.30319.42000 Machine Name: PWIM4-CDWEB01