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Employer-Provided plan FAQs

Get answers to common questions about employer provided health insurance. Find out about getting care, financial topics, benefits, coverage, and more.

Plan Overview

Your Employer-Provided health plan helps protect you from the potentially high costs of medical care. With health insurance, you’ll have a limit on your health care costs for covered services. Plus, you’ll get discounted fees from doctors, clinics, and hospitals.

Sign in for your plan details

Get personalized information and help

We’re here to make sure you’re in the know when it comes to your plan. When you sign into your account, you’ll find detailed information about:

  • Benefits and coverage
  • Prescription medications
  • Claim history
  • Network providers
  • And more

Getting Care

Is my doctor covered by my plan?

You can search for the doctors, specialists, and other providers covered by your specific plan.

What care options do I have?

Check out the programs and services covered by your specific plan.

Should I go to urgent care or the emergency room?

You’ll have to decide based on how you’re feeling. We can make that choice a little easier. 

Why do I need to stay in network?

Every health plan has a network of providers, clinics, pharmacies, and hospitals. When you pick a plan, you’re choosing your network. Your coverage depends on your provider being in your network.

Note: If you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you’re protected from surprise or balance billing. Read your rights

How do referrals work?

If you're a Medica Elect or Medica Essential member, you may need a referral for some care. A referral is a written recommendation from your primary care clinic to see a specialist outside your care system. It's important to know when you need a referral, this PDF details all you need to know.

Referrals (PDF)

How can I be sure to get the care I need?

We want you to be well-informed about your health care options, rights, and responsibilities. These guides can answer questions about your coverage — and help you find more information when you need it.

What type of wellness programs are offered by Medica?

View our general wellness offerings or sign in to see which wellness programs your plan offers. 

See what your plan offers

Benefits and Coverage

How can I find my benefits?

Sign in to see your specific plan benefits.

What’s an Explanation of Benefits (EOB)?

You can expect to receive an Explanation of Benefits (EOB) to explain who, when, and how much you may need to pay for health care services. It’s not a bill, but it does include a summary of services and how your plan covers them. 

What’s is my Summary of Benefits and Coverage (SBC) document?

It offers find important information about your plan’s benefits and coverage.


What’s the difference between a deductible, copay, and coinsurance? 

Your deductible is the amount you pay each year before your insurance starts to pay. A copay is flat fee you pay for some services and prescriptions. Coinsurance is a percentage of the charges for a health care service that you pay.

What are Flexible Spending Accounts (FSA), Health Savings Accounts (HSA), and Health Reimbursement Accounts (HRA)?

These are all designed to help you pay for (or pay you back) for medical expenses.

Will I receive a 1095-B IRS tax form for my Medica health coverage?

Health coverage information is no longer required by the Internal Revenue Service (IRS) to file a federal income tax return. As a result, most fully insured Medica members will no longer automatically receive a paper copy of the 1095-B form. If you'd like a 1095-B form for your records, contact Member Services at the number on the back of your Medica ID, use the Contact Form on Medica.com or email us at [email protected].

If you live in a state with laws that require coverage reporting (California, Washington, D.C., New Jersey, or Rhode Island), you will continue to receive a paper copy of the 1095-B form for state filing tax purposes. 

Additional Plan Details

How does my Member ID card work?

Here’s how to understand all the parts of your ID card.

Member ID card (PDF)