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2018 Medica Connect

Medica ConnectSM

Plan Highlights

Medica Connect plans include:

  • Access to a large tiered network of doctors, clinics and hospitals
  • Nationwide coverage when you travel
  • Access to Mayo Clinic through the Centers of Excellence program
  • 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 individual and families

With a copay plus or copay plan, your benefits will vary depending on the provider you visit. 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 Tier 1 – Preferred providers.

Network Benefits Gold Copay Plus Gold Copay
Deductible Tier 1
Individual: $1,000
Family: $3,000 shared family*
Tier 2
Individual: $1,500
Family: $4,500 shared family*
Tier 1 
Individual: $750
Family: $2,250 shared family*
Tier 2 
Individual: $1,500
Family: $4,500 shared family*
Out-of-pocket maximum Tier 1
Individual: $5,000
Family: $5,000 per family member or $10,000 for the entire family*
Tier 2
Individual: $7,000
Family: $7,000 per family member or $14,000 for the entire family*
Tier 1 
Individual: $6,000
Family: $6,000 per family member or $12,000 for the entire family*
Tier 2 
Individual: $7,000
Family: $7,000 per family member or $14,000 for the entire family*
Office visits Tier 1
Primary care: $30 copay
Urgent care: $30 copay
Specialty care: $30 copay
Tier 2
Primary care: $60 copay
Urgent care: $60 copay
Specialty care: $120 copay
Tier 1
Primary care: $30 copay
Urgent care: $30 copay
Specialty care: $60 copay
Tier 2
Primary care: $60 copay
Urgent care: $60 copay
Specialty care: $120 copay
Prescription drugs (Medical Drug List)

Tier 1 and 2
Preferred generic: $5 copay
Generic: $5 copay
Preferred brand: $35 copay
Non-preferred brand:$150 copay

Look up covered drugs

Tier 1 and 2
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 Tier 1 and 2
30% coinsurance after deductible
Tier 1 and 2
30% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Kansas SBC (PDF)
View Kansas 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

Tier 1
Individual: $3,500
Family: $10,500 shared family*
Tier 2
Individual: $4,500 
Family: $13,500 shared family*

Out-of-pocket maximum Tier 1
Individual: $7,000
Family: $7,000 per family member or $14,000 for the entire family*
Tier 2
Individual: $7,350
Family: $7,350 per family member or $14,700 for the entire family*
Office visits  Tier 1
Primary care: $30 copay
Urgent care: $30 copay
Specialty care: $60 copay
Tier 2
Primary care: $60 copay
Urgent care: $60 copay
Specialty care: $120 copay
Prescription drugs (Medica Drug List)

Tier 1 and Tier 2
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 Tier 1 and Tier 2
40% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Kansas 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 Tier 1 and Tier 2
Individual: $6,850
Family: $13,700 shared family*
Out-of-pocket maximum Tier 1 and Tier 2
Individual: $7,350
Family: $7,350 per family member or $14,700 for the entire family*
Office visits Tier 1
Primary care: $80 copay
Urgent care: $80 copay
Specialty care: $150 copay
Tier 2
Primary care: $120 copay
Urgent care: $120 copay
Specialty care: $225 copay
Prescription drugs (Medica Drug List)

Tier 1 and Tier 2
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 Tier 1 and Tier 2
50% coinsurance after deductible
Summary of Benefits and Coverage (SBC) View Kansas 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

With an HSA-compatible plan, your benefits are the same for network (tier 1 and 2) providers.

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 Kansas SBC (PDF) View Kansas 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

With a CSR plan, your benefits are the same for network (tier 1 and 2) providers.

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 Kansas SBC (PDF) View Kansas SBC (PDF)
View Kansas 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

With a catastrophic plan, your benefits are the same for network (tier 1 and 2) providers.

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 Kansas 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)

Things to note:
Tier 1- Preferred and Tier 2 - Standard are network providers
. Services received from tier 1 network providers will cross accumulate to your tier 1 and tier 2 network deductible and out-of-pocket maximum. Services received from tier 2 network providers will only accumulate to your tier 2 network deductible and out-of-pocket maximum. However, you're not required to pay more than your tier 2 amounts.

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 more information visit deltadentalks.com.


2018 Network Information


Who and Where Your Care Comes From

 

Find a Physician or Facility

Medica Connect is a broad tiered network that provides access to most doctors and hospitals across Kansas as well as parts of bordering states. The network includes:

Tier 1 – Preferred Providers

32,000+ Primary and specialty care doctors
30+ Online and convenience care clinics
240+ Hospitals

Tier 2 – Standard Providers
At this time, all providers in the Connect Tiered network are considered Tier 1 (Preferred) providers. Providers may shift to Tier 2 (Standard) providers throughout the year. 

It’s important to confirm that your provider is in your plan’s network before your first and each subsequent visit.

Search for a physician, clinic or hospital

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

 

 

Centers of Excellence Program featuring Mayo Clinic

This program allows members to receive care for certain transplants, rare cancers and other complex medical conditions at Mayo Clinic. An allowance for transportation, lodging and living expenses for the patient and one travel companion is included.

 




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


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Plan Documents

Date: 12/14/2018 10:48:20 PM Version: 4.0.30319.42000 Machine Name: PWIM4-CMSWEB01