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2021 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.

Iowa

Minnesota

Enhanced with Rx ($202.50 monthly premium)
Enhanced with Rx2 ($223.10 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 (Drug List)

Basic with Rx ($111.70 monthly premium)
Basic with Rx2 ($143.20 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 (Drug List)

Thrift with Rx ($73.20 monthly premium)
Thrift with no Rx ($34.00 monthly premium)

Provider Directories for all Thrift plans
Pharmacy Directories for Rx plan
Evidence of coverage documents
Annual notice of changes
Formulary (Drug List)

Standard with Rx ($30.90 monthly premium)
Standard with no Rx ($0 monthly premium)

Provider Directories
Pharmacy Directories for Rx plan
Evidence of coverage documents
Annual notice of changes
Formulary (Drug List)

Nebraska

North Dakota & South Dakota

Wisconsin

Kansas

Group Prime Solution Documents

Provider Directories
Pharmacy Directories
Evidence of Coverage (EOC)

To get a copy of your Evidence of Coverage (EOC) or other plan documents, contact the Medica Customer Service phone number on the back of you Medica ID card

Formulary (PDF)

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: October 2020

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