Tip Sheets and Videos

These tip sheets can help you get the most value from your health plan. Use them to find answers to your questions about your individual or family plan, your benefits and how to get the care you need.

How Your Plan Works

• Advance Premium Tax Credit (APTC) – (PDF)
  Learn APTC and how they can help lower your health care costs.
• Breaking Down Your Medica Invoice (PDF)
  A key to your invoice and your options for paying.
• Deductibles, Copays and Coinsurance (PDF)
  Learn more about these terms and how they determine your out-of pocket costs.
• Health Savings Account (HSA) – (PDF)
  Learn about HSAs, how they work and the benefits of having one.
• How to Read Your Summary of Benefits and Coverage (SBC) – (PDF)
  Use this tip sheet to help you understand important information found in your SBC.
• Out-of-network Care – No Benefits (PDF)
  For plans with no out-of-network benefits. See how much more it costs to visit providers outside your plan's network.
• Out-of-network Care – With Benefits (PDF)
  For plans with out-of-network benefits. See how much more it costs to visit providers outside your plan's network.
• Reading Your Explanation of Benefits (EOB) – (PDF)
  Learn about what an EOB is and how it helps you understand your health services received.
• Understanding Medica Tiered Networks & Benefits (PDF)
  Learn what a tiered network is and how the provider or facility you visit determines your out-of pocket costs. Medica Connect and Medica Insure are tiered network plans.
• Understanding Your ID Card (PDF)
  Learn how to read your Medica ID card.
• Who to Contact When You Have Questions About Your Policy (PDF)
  Use this chart to help you understand who to contact when you have questions about your Medica policy.
• Your Pharmacy Benefits (PDF)
  Your plan covers a variety of prescription drugs and includes options for filling your prescriptions. Read more to learn how your pharmacy benefits work.

Getting Care

• Finding a Network Provider (PDF)
  Learn how to use the online search tool to find a network provider, so you can get the most out of your health care benefits.
• Preventive Care (PDF)
  Learn the difference between preventive and non-preventive care. In addition, see a full list of the preventive care services covered under Affordable Care Act on the U.S. Department of Health & Human Services website. 
  List of covered preventive services
• When and Where to Get Care (PDF)
• Explore your options for getting care and find out which types of illnesses each facility treats.
• Virtual Care (PDF)
  Use this tip sheet to understand how you can use virtual care to connect with a provider online to save time and possibly money.

Complex Specialty Care

For Inspire by Medica℠  members only

• Complex Specialty Care (PDF)
  Learn more about the care and services available through the Complex Specialty Care program featuring the University of Iowa Hospital and Mayo Clinic.

For Empower by Medica members only

• Complex Specialty Care (PDF)
  Learn more about the care and services available through the Complex Specialty Care program featuring the University of Iowa Hospital and Mayo Clinic.

For Bold by M Health Fairview and Medica members only

• Complex Specialty Care (PDF)
  Learn more about the care and services available through the Complex Specialty Care program featuring M Health Fairview.

For all other Individual and Family Plan members

• Complex Specialty Care (PDF)
  Learn more about the care and services available through the Complex Specialty Care program featuring Mayo Clinic.

Understanding Your Policy

• Coordination of Benefits (COB) – (PDF)
  Learn who is responsible for payments and how to coordinate reimbursements for services.
• Medical Necessity and Prior Authorization (PA) Timeframes and Responsibilities (PDF)
  Find out more about prior authorization and if your services or supplies require it.
• Premium Payment Grace Period (PDF)
  Learn about grace periods and why it is important to make sure your premium payments are paid on time.
• Premium Refunds (PDF)
  Learn how an overpayment may affect your plan.
• Requesting Prescription Drug Exceptions (PDF)
  Find out how and when you can request an exception to your prescription drug coverage.
• Retroactive Denials (PDF)
  Learn what retroactive denials are and how to avoid them.
• Submitting a Claim (PDF)
  Learn how to submit your claims for benefits from network and out-of-network providers.

Tools, Programs & Resources

• Healthy Living with Medica (PDF)
  Read about the wellness resources and tools available with your plan to help you keep your health on track each and every day.
• Secure Member Site (PDF)
  Overview of the resources available to you through your secure member site and how to register.
• Health Advocate Tip Sheet (PDF)
  Learn how you can consult with a nurse for non-urgent illnesses or work with a personal health advocate who can help you understand health care issues like how to read your invoice or how to schedule an appointment with a doctor who is difficult to get into.