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2018 Inspire by Medica

Inspire by MedicaSM

Inspire by Medica plans include:

  • Access to a localized network of doctors, clinics and hospitals
  • Nationwide coverage when you travel
  • Access to quick convenient 24/7 online care
  • 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
Deductible Individual: $1,000
Family: $3,000 shared family*
Out-of-pocket maximum Individual: $5,000
Family: $5,000 per family member or $10,000 for the entire family*
Office visits Primary care: $30 copay
Urgent care: $30 copay
Specialty: $30 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

Other eligible health care services 30% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Iowa 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 Silver Copay
Deductible Individual: $3,500
Family: $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: $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 Iowa 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 Copay
Deductible Individual: $6,850
Family: $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: $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 Iowa 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)

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

Network Benefits Bronze HSA Plus   Bronze HSA
Deductible Individual: $2,600
Family: $5,200 shared family*
Individual: $6,000
Family: $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 Iowa SBC (PDF) View Iowa 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)

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
Family: $300 shared family*
Individual: $500
Family: $1,500 shared family*
Individual: $2,500
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 Iowa SBC (PDF) View Iowa SBC (PDF)
View Iowa 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 after deductible
Specialty care: 0% coinsurance after deductible
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 Iowa 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 benefit that can be purchased as a stand-alone product through Delta Dental. For information visit deltadentalia.com.


2018 Network Information


Who and Where Your Care Comes From

 

Find a Physician or Facility

The Inspire network is the large care system-based network that provides access to UnityPoint Health doctors plus others across Iowa. The network includes:
3,300+ Primary and specialty care doctors
7+ Online and convenience care clinics
39+ Hospitals

You're free to see any providers, 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, hospital or pharmacy

Need help with your search?

If you're looking for something specific, try these keywords to help narrow your search:

- Clinical/Medical Social Worker
- Mh/Cd Outpatient Facility
- Multispecialty
- Other Mental Health
- Psychology
- Psychiatry

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

 

Virtual Care When you Need it, Where you Need it

UnityPoint Health Virtual Care allows you to access care when it's most convenient for you  - home, office or on the go. You can have a virtual visit consult to diagnose and treat a variety of medical issues through secure video on your computer or phone. It's patient-centric health care that you've come to trust from UnityPoint Health, where and when you need it.


 

Centers of Excellence Program

This program allows members to receive care for certain transplants, rare cancers and other complex medical conditions at the University of Iowa Hospital or Mayo Clinic. Medica and your provider will help you find the best location for your service. An allowance for transportation, lodging and living expenses for the patient and one travel companion is included.

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.





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


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Plan Documents

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