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2018 Engage by Medica

Engage by MedicaSM

Engage by Medica plans include:

  • Access to a localized network of doctors, clinics and hospitals
  • Coverage when you travel nationwide
  • Access to quick convenient 24/7 online care through virtuwell
  • 100% coverage of routine preventive exams
  • Gold, silver and bronze metal level plan options
  • Copay, copay plus, health savings account compatible or catastrophic plan options

2018 Plan Options at a Glance


Plans that are right for you

Copay Plus and Copay – For individuals and families

Network Benefits Gold Copay Plus Gold Copay
Deductible Individual: $1,000
Family MN: $1,000 per family member or $3,000 for family
Family WI: $3,000 shared family*
Individual: $750
Family MN: $750 per family member or $2,250 for family
Family WI: $2,250 shared family*
Out-of-pocket maximum Individual: $5,000
Family: $5,000 per family member or $10,000 for the entire family*
Individual: $6,000
Family: $6,000 per family member or $12,000 for the entire family*
Office visits Primary care: $30 copay
Urgent care: $30 copay
Specialty care: $30 copay
Primary care: $30 copay
Urgent care: $30 copay
Specialty care: $60 copay
Prescription drugs (Medica Drug List)

Preferred generic: $5 copay
Generic: $5 copay
Preferred brand: $35 copay
Non-preferred brand:$150 copay

Look up covered drugs

Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 30% coinsurance after deductible
Non-preferred brand: 50% coinsurance after deductible

Look up covered drugs

Other eligible health care services 30% coinsurance after deductible 30% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Minnesota SBC (PDF)
View Wisconsin SBC (PDF)
View Minnesota SBC (PDF)
View Wisconsin SBC (PDF)

*Cost Sharing Details:
In Minnesota: Family plans have an embedded deductible and out-of-pocket maximum.
In Wisconsin: Family plans have a non-embedded deductible and an embedded out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tip sheet (PDF)

Network Benefits Silver Copay
Deductible Individual: $3,500
Family MN: $3,500 per family member or $10,500 for the entire family
Family WI: $10,500 shared family*
Out-of-pocket maximum Individual: $7,000
Family: $7,000 per family member or $14,000 for the entire family*
Office visits Primary care: $30 copay
Urgent care: $30 copay
Specialty care: $60 copay
Prescription drugs (Medica Drug List)

Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 40% coinsurance after deductible
Non-preferred brand: 60% coinsurance after deductible

Look up covered drugs

Other eligible health care services 40% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Minnesota SBC (PDF)
View Wisconsin SBC (PDF)

*Cost Sharing Details:
In Minnesota: Family plans have an embedded deductible and out-of-pocket maximum.
In Wisconsin: Family plans have a non-embedded deductible and an embedded out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tip sheet (PDF)

Network Benefits Bronze Copay
Deductible Individual: $6,850
Family MN: $6,850 per family member or $13,700 for the entire family
Family WI: $13,700 shared family*
Out-of-pocket maximum Individual: $7,350
Family: $7,350 per family member or $14,700 for the entire family*
Office visits Primary care: $80 copay
Urgent care: $80 copay
Specialty care: $150 copay
Prescription drugs (Medica Drug List)

Preferred generic: $10 copay
Generic: $20 copay
Preferred brand: 50% coinsurance after deductible
Non-preferred brand: 70% coinsurance after deductible

Look up covered drugs

Other eligible health care services 50% coinsurance after deductible
Summary of Benefits and Coverage (SBC)

View Minnesota SBC (PDF)
View Wisconsin SBC (PDF)

*Cost Sharing Details:
In Minnesota: Family plans have an embedded deductible and out-of-pocket maximum.
In Wisconsin: Family plans have a non-embedded deductible and an embedded out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tip sheet (PDF)

Health Savings Account (HSA) Compatible – For individuals and families

Network Benefits Silver HSA  - Minnesota only
Deductible Individual: $2,000
Family: $4,000 shared family*
Out-of-pocket maximum Individual: $6,500
Family: $6,500 per family member or $13,000 for the entire family*
Office visits Primary, urgent, and specialty care: 40% coinsurance after deductible
Prescription drugs (Medica Drug List)

Preferred generic, generic, preferred brand, non-preferred brand : 40% coinsurance after deductible

Look up covered drugs

Other eligible health care services 40% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Minnesota SBC (PDF)

*Cost Sharing Details:
Family plans have a non-embedded deductible and an embedded out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tip sheet (PDF)

Network Benefits Bronze HSA Plus - Wisconsin only Bronze HSA
Deductible Individual: $2,600
Family: $5,200 shared family*
Individual: $6,000
Family MN: $6,000 per family member or $12,000 for the entire family
Family WI: $12,000 shared family*
Out-of-pocket maximum Individual: $6,650
Family: $6,650 per family member or $13,300 for the entire family*
Individual: $6,650
Family: $6,650 per family member or $13,300 for the entire family*
Office visits Primary, urgent, and specialty care: 40% coinsurance after deductible Primary, urgent, and specialty care: 20% coinsurance after deductible
Prescription drugs (Medica Drug List)

Preferred generic, generic, preferred brand, non-preferred brand : 40% coinsurance after deductible

Look up covered drugs

Preferred generic, generic, preferred brand, non-preferred brand : 20% coinsurance after deductible

Look up covered drugs

Other eligible health care services 40% coinsurance after deductible 20% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Wisconsin SBC (PDF) View Minnesota SBC (PDF)
View Wisconsin SBC (PDF)

*Cost Sharing Details:
In Minnesota: Family plans have an embedded deductible and out-of-pocket maximum.
In Wisconsin: Family plans have a non-embedded deductible and an embedded out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tip sheet (PDF)

Cost Sharing Reduction (CSR) – For individuals and families who meet certain income requirements

Network Benefits Silver Copay 94% CSR Silver Copay 87% CSR Silver Copay 73% CSR
Deductible Individual: $100
MN Family: $100 per family member or $300 for the entire family
WI Family: $300 shared family*
Individual: $500
MN Family: $500 per family member or $1,500 for the entire family
WI Family: $1,500 shared family*
Individual: $2,500
MN Family: $2,500 per family member or $7,500 for the entire family
WI Family: $7,500 shared family*
Out-of-pocket maximum Individual: $1,000
Family: $1,000 per family member or $2,000 for the entire family*
Individual: $2,000
Family: $2,000 per family member or $4,000 for the entire family*
Individual: $5,850
Family: $5,850 per family member or $11,700 for the entire family*
Office visits Primary care: $30 copay 
Urgent care: $30 copay
Specialty care: $60 copay
Primary care: $30 copay 
Urgent care: $30 copay
Specialty care: $60 copay
Primary care: $30 copay
Urgent care: $30 copay
Specialty care: $60 copay
Prescription drugs (Medica Drug List)

Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 5% coinsurance after deductible
Non-preferred brand: 25% coinsurance after deductible

Look up covered drugs

Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 20% coinsurance after deductible
Non-preferred brand: 40% coinsurance after deductible

Look up covered drugs

Preferred generic: $5 copay
Generic: $10 copay
Preferred brand: 30% coinsurance after deductible
Non-preferred brand: 50% coinsurance after deductible

Look up covered drugs

Other eligible health care services 5% coinsurance after deductible 20% coinsurance after deductible 30% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Minnesota SBC (PDF)
View Wisconsin SBC (PDF)
View Minnesota SBC (PDF)
View Wisconsin SBC (PDF)
View Minnesota SBC (PDF)
View Wisconsin SBC (PDF)

*Cost Sharing Details:
In Minnesota: Family plans have an embedded deductible and out-of-pocket maximum.
In Wisconsin: Family plans have a non-embedded deductible and an embedded out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tip sheet (PDF)

Network Benefits Silver HSA 94% CSR - Minnesota only Silve HSA 87% CSR - Minnesota only Silver HSA 73% CSR - Minnesota only
Deductible Individual: $200
Family: $400 shared family*
Individual: $300
Family: $600 shared family*
Individual: $1,300
Family: $2,600 shared family*
Out-of-pocket maximum Individual: $2,300
Family: $2,300 per family member or $4,600 for the entire family*
Individual: $2,450
Family: $2,450 per family member or $4,900 for the entire family*
Individual: $5,850
Family: $5,850 per family member or $11,700 for the entire family*
Office visits Primary, urgent and specialty care: 5% coverage after deductible Primary, urgent and specialty care: 20% coverage after deductible Primary, urgent and specialty care: 30% coverage after deductible
Prescription drugs (Medica Drug List)

Preferred generic, generic, preferred brand and non-preferred brand: 5% coinsurance after deductible

Look up covered drugs

Preferred generic, generic, preferred brand and non-preferred brand: 20% coinsurance after deductible

Look up covered drugs

Preferred generic, generic, preferred brand and non-preferred brand: 30% coinsurance after deductible

Look up covered drugs

Other eligible health care services 5% coinsurance after deductible 20% coinsurance after deductible 30% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Minnesota SBC (PDF) View Minnesota SBC (PDF) View Minnesota SBC (PDF)

*Cost Sharing Details:
Family plans have a non-embedded deductible and an embedded out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tip sheet (PDF)

Catastrophic – For individuals and families under age 30 or those with an eligible exemption

Network Benefits Catastrophic
Deductible Individual: $7,350
Family: $7,350 per family member or $14,700 for the entire family*
Out-of-pocket maximum Individual: $7,350
Family: $7,350 per family member or $14,700 for the entire family*
Office Visits Primary care: $30 copay for the first 3 visits per person per calendar year. After 3rd, 0% coinsurance after deductible
Urgent care: 0% coinsurance
Specialty care: 0% coinsurance
Prescription drugs (Medica Drug List)

Preferred generic, generic, preferred brand, non-preferred brand : 0% coinsurance after deductible

Look up covered drugs

Other eligible health care services 0% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Minnesota SBC (PDF)
View Wisconsin SBC (PDF)

*Cost Sharing Details:
Family plans have an embedded deductible and out-of-pocket maximum.

Learn the difference between embedded and non-embedded in this tip sheet (PDF)

Note: Pediatric Dental is Not Covered
These policies do not include pediatric dental services. Pediatric dental is an essential health benefit that can be purchased as a stand-alone product through Delta Dental. For information visit deltadentalmn.org (Minnesota policies) or deltadentalwi.com (Wisconsin policies).


2018 Network Information


Who and Where Your Care Comes From

 

Find a Physician or Facility

Engage by Medica is a large care system-based network that provides access to Mayo Clinic Health System doctors plus others in northern Iowa, southern Minnesota and western Wisconsin. The network includes:
12,000+ Primary and specialty care doctors
60+ Online and convenience care clinics
28+ Hospitals

Including the following health care systems, and other providers: Black River Memorial Hospital - Black River Falls, Wisconsin, Krohn Clinic - Black River Falls, Wisconsin, Mayo Clinic Health System, Owatonna Hospital, St. Elizabeth Medical Center, United Memorial Hospital - Blue Earth, Minnesota, Winneshiek Medical Center - Decorah, Iowa  and Winona Health Services.

You’re free to see any provider, but you receive your highest level of benefits and typically the lowest out-of-pocket costs when you see network providers.

Search for a physician, clinic or hospital

Search for a behavioral health provider

Find a travel program provider

 

Find a Network Pharmacy

Our pharmacy network includes more than 64,000 pharmacies nationwide including most major chains and thousands of Independent pharmacies.

Search for a network pharmacy

 

Direct Access to Mayo Clinic Care

All network providers have direct access to Mayo Clinic resources and expertise locally. If your provider determines that more specialized care is needed, they will make the appropriate arrangements, for that care in the location most convenient to you.


 

Virtual Care

Secure, 24/7 care via phone or video. Board-certified physicians and nurse practitioners diagnose and treat minor illnesses.

 

2018 Health and Wellness


These health and wellness extras are standard with any plan you choose

 

 

Health Advocate – Your Health Care Lifeline

Need help navigating the world of health insurance and medical care? Health Advocate is there for you 24/7. Get help making appointments with hard-to-reach doctors, resolving medical claims and getting answers to questions about medical treatment. You can even get help with health care issues facing your parents and parents-in-law. Health Advocate is an independent and confidential service.

 

 

24/7 NurseLine™

As part of the Health Advocate services offered with this product, you receive 24/7 access to highly trained nurses to help answer questions about symptoms, medications and health conditions, and other self-care tips for non-urgent concerns.

 

 

 

Healthy Living with Medica – Daily Health Rewarded

Personalized health and well-being programs, gym membership discounts, special offers for personal trainers sessions, and rewards for making healthy choices — Healthy Living offers all this and more! It’s a web-based tool whose two-week programs will motivate and support you to make the changes you want in your health and life — get fit, eat healthier, manage stress, sleep better and find direction for your life. Earn points as you participate that you can redeem for discounts, be entered into raffles or you can use to donate to charities.


Mayo Clinic® is an independent, nonprofit healthcare provider offering network access to its providers and health services. Mayo, Mayo Clinic, Mayo Clinic Health System and the triple-shield logo are registered trademarks and service marks of Mayo Clinic.




Medica is a Qualified Health Plan issuer in the Health Insurance Marketplace.


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Plan Documents

Wisconsin

Product Brochure (PDF)
Engage Flier (PDF)
Application – apply at Healthcare.gov

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