For Prime Solution (Cost) Members

Member plan documents

Select your state and then your plan name (Care Type on your ID card) below to see your legal plan documents.

Iowa

Medica Prime Solution Premier

(2021 $125.00 monthly premium)
(2022 $125.00 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory IA MN WI (PDF)

2022 View or print Prime Solution additional providers IA MN WI (insert) (PDF)

2021 Annual notice of changes (PDF)

2022 Annual notice of changes (PDF)

2021 Evidence of coverage (PDF)

2022 Evidence of coverage (PDF)

Medica Prime Solution Core

(2021 $69.00 monthly premium)
(2022 $69.00 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory IA MN WI (PDF)

2022 View or print Prime Solution additional providers IA MN WI (insert) (PDF)

2021 Annual notice of changes (PDF)

2022 Annual notice of changes (PDF)

2021 Evidence of coverage (PDF)

2022 Evidence of coverage (PDF)

Medica Prime Solution Thrift

(2021 $34.00 monthly premium)
(2022 $34.00 monthly premium)

Provider Directories

Search online directory 

2022 View or print Prime Solution provider directory IA MN WI (PDF)

2022 View or print Prime Solution additional providers IA MN WI (insert) (PDF)

2021 Evidence of coverage (PDF)

2022 Evidence of coverage (PDF)

2021 Annual notice of changes (PDF)

2022 Annual notice of changes (PDF)

Kansas

Medica Prime Solution Premier

Premier
(2021 $125.00 monthly premium)
(2022 $125.00 monthly premium)

Provider Directories

Search online directory 

2022 View or print Prime Solution provider directory KS NE OK (PDF)

2022 View or print Prime Solution additional providers KS, MO, NE, OK (insert) (PDF) 

2021 Evidence of coverage (PDF)

2022 Evidence of coverage (PDF)

2022 Annual notice of changes (PDF)

Medica Prime Solution Core

(2021 $69.00 monthly premium)
(2022 $69.00 monthly premium)

Provider Directories

Search online directory 

2022 View or print Prime Solution provider directory KS NE OK (PDF)

2022 View or print Prime Solution additional providers KS, MO, NE, OK (insert) (PDF) 

2021 Evidence of coverage (PDF)

2022 Evidence of coverage (PDF)

2022 Annual notice of changes (PDF)

Medica Prime Solution Thrift

(2021 $34.00 monthly premium)
(2022 $34.00 monthly premium)

Provider Directories

Search online directory 

2022 View or print Prime Solution provider directory KS NE OK (PDF)

2022 View or print Prime Solution additional providers KS, MO, NE, OK (insert) (PDF)

2021 Evidence of coverage (PDF)

2022 Evidence of coverage (PDF)

2022 Annual notice of changes (PDF)

Minnesota

Medica Prime Solution Enhanced

Enhanced with Rx
(2021 $202.50 monthly premium)
(2022 $215.90 monthly premium)

Enhanced with Rx2 
(2021 $223.10 monthly premium)
(2022 $229.30 monthly premium)

Enhanced with no Rx 
(2021 $157.00 monthly premium)
(2022 $157.00 monthly premium)

Provider Directories for all Enhanced plans

Search online directory

2022 View or print Prime Solution provider directory IA MN WI (PDF)

2022 View or print Prime Solution additional providers IA MN WI (insert) (PDF)

Pharmacy Directories for Rx and Rx2 plans

Search online pharmacy directory 

2022 View or print Prime Solution pharmacy directory (PDF)

Evidence of coverage documents

2021 Evidence of coverage with Rx (PDF)

2022 Evidence of coverage with Rx (PDF)

2021 Evidence of coverage with Rx2 (PDF)

2022 Evidence of coverage with Rx2 (PDF)

2021 Evidence of coverage with no Rx (PDF)

2022 Evidence of coverage with no Rx (PDF)

Annual notice of changes

2021 Annual notice of changes with Rx (PDF)

2022 Annual notice of changes with Rx (PDF)

2021 Annual notice of changes with Rx2 (PDF)

2022 Annual notice of changes with Rx2 (PDF)

2021 Annual notice of changes with no Rx (PDF)

2022 Annual notice of changes with no Rx (PDF)

Formulary (Drug List) 

2022 Formulary (PDF)

Medica Prime Solution Basic

Basic with Rx
(2021 $111.70 monthly premium)
(2022 $118.50 monthly premium)

Basic with Rx2 
(2021 $143.20 monthly premium)
(2022 $155.50 monthly premium)

Basic with no Rx 
(2021 $79.00 monthly premium)
(2022 $79.00 monthly premium)

Provider Directories for all Basic plans

Search online directory 

2022 View or print  Prime Solution provider directory IA MN WI (PDF)

2022 View or print Prime Solution additional providers IA MN WI (insert) (PDF)

Pharmacy Directories for Rx and Rx2 plans

Search online pharmacy directory 

2022 View or print Prime Solution pharmacy directory (PDF)

Evidence of coverage documents

2021 Evidence of coverage with Rx (PDF)

2022 Evidence of coverage with Rx (PDF)

2021 Evidence of coverage with Rx2 (PDF)

2022 Evidence of coverage with Rx2 (PDF)

2021 Evidence of coverage with no Rx (PDF)

2022 Evidence of coverage with no Rx (PDF)

Annual notice of changes documents

2021 Annual notice of changes with Rx (PDF)

2022 Annual notice of changes with Rx (PDF)

2021 Annual notice of changes with Rx2 (PDF)

2022 Annual notice of changes with Rx2 (PDF)

2021 Annual notice of changes with no Rx (PDF)

2022 Annual notice of changes with no Rx (PDF)

Formulary (Drug List)

2022 Formulary (PDF)

Medica Prime Solution Value

(2021 $105.80 Value with Rx monthly premium)
(Available for 2022 is the Basic plan with $118.50 monthly premium)

(2021 $67.00 Value plan monthly premium)
(Available for 2022 is the Basic plan with $79.00 monthly premium)

Provider Directories for all Value plans

Search online directory 

For the 2022 Prime Solution provider directory, see Medica Prime Solution Basic

Pharmacy Directories for Rx plan

Search online pharmacy directory 

For the 2022 Prime Solution pharmacy directory, see Medica Prime Solution Basic

Evidence of coverage documents

2021 Evidence of coverage with Rx (PDF)

2021 Evidence of coverage with no Rx (PDF)

Annual notice of changes

2021 Annual notice of changes with Rx (PDF)

2022 Annual notice of changes with Rx (PDF)

2021 Annual notice of changes with no Rx (PDF)

2022 Annual notice of changes with no Rx (PDF)

Formulary (Drug List) 

2022 Formulary (PDF)

Medica Prime Solution Thrift

Thrift with Rx
(2021 $73.20 monthly premium)
(2022 $78.40 monthly premium)

Thrift with no Rx 
(2021 $34.00 monthly premium)
(2022 $34.00 monthly premium)

Provider Directories for all Thrift plans

Search online directory

2022 View or print Prime Solution provider directory IA MN WI (PDF)

2022 View or print Prime Solution additional providers IA MN WI (insert) (PDF)

Pharmacy Directories for Rx plan

Search online pharmacy directory 

2022 View or print Prime Solution pharmacy directory (PDF)

Evidence of coverage documents

2021 Evidence of coverage with Rx (PDF)

2022 Evidence of coverage with Rx (PDF)

2021 Evidence of coverage with no Rx (PDF)

2022 Evidence of coverage with no Rx (PDF)

Annual notice of changes

2021 Annual notice of changes with Rx (PDF)

2022 Annual notice of changes with Rx (PDF)

2021 Annual notice of changes with no Rx (PDF)

2022 Annual notice of changes with no Rx (PDF)

Formulary (Drug List) 

2022 Formulary (PDF)

Medica Prime Solution Standard

Standard with Rx
(2021 $30.90 monthly premium)
(2022 $42.00 monthly premium)

Standard with no Rx
(2021 $0 monthly premium)
(2022 $0 monthly premium)

Provider Directories

Search online directory

2022 View or Print Prime Solution provider directory IA MN WI (PDF)

2022 View or print Prime Solution additional providers IA MN WI (insert) (PDF)

Pharmacy Directories for Rx plan

Search online pharmacy directory

2022 View or print Prime Solution pharmacy directory (PDF)

Evidence of coverage documents

2021 Evidence of coverage with Rx (PDF)

2022 Evidence of coverage with Rx (PDF)

2021 Evidence of Coverage no Rx (PDF)

2022 Evidence of Coverage no Rx (PDF)

Annual notice of changes

2021 Annual notice of changes no Rx (PDF) 

2022 Annual notice of changes no Rx (PDF)

2022 Annual notice of changes w/Rx (PDF)

Formulary (Drug List) 

2022 Formulary (PDF)

Missouri

Medica Prime Solution Premier

Premier (2022 $125.00 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory KS, MO, NE, OK (PDF)

2022 View or print Prime Solution additional providers KS, MO, NE, OK (insert) (PDF)

2022 Evidence of coverage (PDF)

Medica Prime Solution Core

Core (2022 $69.00 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory KS, MO, NE, OK (PDF)

2022 View or print Prime Solution additional providers KS, MO, NE, OK (insert) (PDF)

2022 Evidence of coverage (PDF)

Medica Prime Solution Thrift

Thrift (2022 $34.00 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory KS, MO, NE, OK (PDF)

2022 View or print Prime Solution additional providers KS, MO, NE, OK (insert) (PDF)

2022 Evidence of coverage (PDF)

Nebraska

Medica Prime Solution Standard

(2022 $0.00 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory KS, MO, NE, OK (PDF)

2022 View or print Prime Solution additional providers KS, MO, NE, OK (insert) (PDF)

2022 Evidence of coverage (PDF)

Medica Prime Solution Core

(2021 $69.00 monthly premium)
(2022 $69.00 monthly premium)

Provider Directories

Search online directory 

2022 View or print Prime Solution provider directory KS NE OK (PDF)

2022 View or print Prime Solution additional providers KS, MO, NE, OK (insert) (PDF)

2021 Evidence of coverage (PDF)

2022 Evidence of coverage (PDF)

2021 Annual notice of changes (PDF)

2022 Annual notice of changes (PDF)

Medica Prime Solution Premier

(2021 $125.00 monthly premium)
(2022 $125.00 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory KS NE OK (PDF)

2022 View or print Prime Solution additional providers KS, MO, NE, OK (insert) (PDF)

2021 Evidence of coverage (PDF)

2022 Evidence of coverage (PDF)

2021 Annual notice of changes (PDF)

2022 Annual notice of changes (PDF)

Medica Prime Solution Thrift

(2021 $34.00 monthly premium)
(2022 $34.00 monthly premium)

Provider Directories

Search online directory 

2022 View or print Prime Solution provider directory KS NE OK (PDF)

2022 View or print Prime Solution additional providers KS, MO, NE, OK (insert) (PDF)

2021 Evidence of coverage (PDF)

2022 Evidence of coverage (PDF)

2021 Annual notice of changes (PDF)

2022 Annual notice of changes (PDF)

North Dakota & South Dakota

Medica Prime Solution Premier

Premier with Rx
(2021 $250.60 monthly premier)
(2022 $253.80 monthly premier)

Premier with no Rx
(2021 $189.00 monthly premier)
(2022 $189.00 monthly premier)

Provider Directories for all Premier plans

Search online directory

2022 View or print Prime Solution provider directory ND SD (PDF) 

Pharmacy Directories for Rx plan

Search online pharmacy directory

2022 View or print Prime Solution pharmacy directory (PDF)

Evidence of coverage documents

2021 Evidence of coverage with Rx (PDF)

2022 Evidence of coverage with Rx (PDF)

2021 Evidence of coverage with no Rx (PDF)

2022 Evidence of coverage with no Rx (PDF)

Annual notice of changes with Rx

2021 Annual notice of changes with Rx (PDF)

2022 Annual notice of changes with Rx (PDF)

2021 Annual notice of changes with no Rx (PDF)

2022 Annual notice of changes with no Rx (PDF)

Formulary (Drug List) 

2022 Formulary (PDF)

Medica Prime Solution Core

Core with Rx
(2021 $132.00 monthly premium)
(2022 $139.70 monthly premium)

Core with no Rx 
(2021 $79.00 monthly premium)
(2022 $79.00 monthly premium)

Provider Directories for all Core plans

Search online directory

2022 View or print Prime Solution provider directory ND SD (PDF)

Pharmacy Directories for Rx plan

Search online pharmacy directory

2022 View or print Prime Solution pharmacy directory (PDF)

Evidence of coverage documents

2021 Evidence of coverage with Rx (PDF)

2022 Evidence of coverage with Rx (PDF)

2021 Evidence of coverage with no Rx (PDF)

2022 Evidence of coverage with no Rx (PDF)

Annual notice of changes

2021 Annual notice of changes with Rx (PDF)

2022 Annual notice of changes with Rx (PDF)

2021 Annual notice of changes with no Rx (PDF)

2022 Annual notice of changes with no Rx (PDF)

Formulary (Drug List) 

2022 Formulary (PDF)

Medica Prime Solution Thrift

Thrift with Rx
(2021 $73.20 monthly premium)
(2022 $78.40 monthly premium)

Thrift with no Rx
(2021 $34.00 monthly premium)
(2022 $34.00 monthly premium)

Provider Directories for all Thrift plans

Search online directory

2022 View or print Prime Solution provider directory ND SD (PDF)

Pharmacy Directories for Rx plan

Search online pharmacy directory

2022 View or print Prime Solution pharmacy directory (PDF)

Evidence of coverage documents

2021 Evidence of coverage with Rx (PDF)

2022 Evidence of coverage with Rx (PDF)

2021 Evidence of coverage with no Rx (PDF)

2022 Evidence of coverage with no Rx (PDF)

Annual notice of changes

2021 Annual notice of changes with Rx (PDF)

2022 Annual notice of changes with Rx (PDF)

2021 Annual notice of changes with no Rx (PDF)

2022 Annual notice of changes with no Rx (PDF)

Formulary (Drug List) 

2022 Formulary (PDF)

Medica Prime Solution Standard

Standard with no Rx
(2021 $0 monthly premium)
(2022 $0 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory ND SD (PDF)

2021 Evidence of coverage (PDF)

2022 Evidence of coverage (PDF)

2022 Annual notice of changes (PDF)

Medica Prime Solution Standard with Rx - SD Only

Standard with Rx
(2021 $30.90 monthly premium)
(2022 $42.00 monthly premium)

Standard with no Rx
(2021 $0 monthly premium)
(2022 $0 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory ND SD (PDF)

Pharmacy Directories for Rx Plan

Search online pharmacy directory

2022 View or print Prime Solution pharmacy directory (PDF)

Evidence of coverage documents

2021 Evidence of coverage with Rx (PDF)

2022 Evidence of coverage with Rx (PDF)

2021 Evidence of coverage with no Rx (PDF)

2022 Evidence of coverage with no Rx (PDF)

Annual notice of changes documents

2022 Annual notice of changes with Rx (PDF)

2022 Annual notice of changes no Rx (PDF)

Formulary (Drug List) 

2022 Formulary (PDF)

Oklahoma

Medica Prime Solution Premier

Premier (2022 $125.00 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory KS, MO, NE, OK (PDF)

2022 View or print Prime Solution additional providers KS, MO, NE, OK (insert) (PDF)

2022 Evidence of coverage (PDF)

Medica Prime Solution Core

Core (2022 $69.00 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory KS, MO, NE, OK (PDF)

2022 View or print Prime Solution additional providers KS, MO, NE, OK (insert) (PDF)

2022 Evidence of coverage (PDF)

Medica Prime Solution Thrift

Thrift (2022 $34.00 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory KS, MO, NE, OK (PDF)

2022 View or print Prime Solution additional providers KS, MO, NE, OK (insert) (PDF)

2022 Evidence of coverage (PDF)

Wisconsin

Medica Prime Solution Standard

Standard (2022 $0.00 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory IA, MN, WI (PDF)

2022 View or print Prime Solution additional providers IA MN WI (insert) (PDF)

2022 Evidence of coverage (PDF)

2022 Wisconsin Addendum to the Evidence of Coverage (PDF)

Medica Prime Solution Focus

Focus with Rx
(2021 $125.80 monthly premium)
(2022 $131.90 monthly premium)

Focus with no Rx
(2021 $89.00 monthly premium)
(2022 $79.00 monthly premium)

Provider Directories for all Focus plans

Search online directory

2022 View or print Prime Solution provider directory IA MN WI (PDF)

2022 View or print Prime Solution additional providers IA MN WI (insert) (PDF)

Pharmacy Directories for Rx plan

Search online pharmacy directory

2022 View or print Prime Solution pharmacy directory (PDF)

Evidence of coverage documents

2021 Evidence of coverage with Rx (PDF)

2022 Evidence of coverage with Rx (PDF)

2021 Evidence of coverage with no Rx (PDF)

2022 Evidence of coverage with no Rx (PDF)

2021 Wisconsin Addendum to the Evidence of Coverage (PDF)

2022 Wisconsin Addendum to the Evidence of Coverage (PDF)

Annual notice of changes

2021 Annual notice of changes with Rx (PDF)

2022 Annual notice of changes with Rx (PDF)

2021 Annual notice of changes with no Rx (PDF)

2022 Annual notice of changes with no Rx (PDF)

Formulary (Drug List) 

2022 Formulary (PDF)

Medica Prime Solution Total

Total with Rx
(2021 $241.70 monthly premium)
(2022 $249.80 monthly premium)

Total with no Rx
(2021 $185.00 monthly premium)
(2021 $185.00 monthly premium)

Provider Directories for all Total plans

Search online directory

2022 View or print Prime Solution provider directory IA MN WI (PDF)

2022 View or print Prime Solution additional providers IA MN WI (insert) (PDF)

Pharmacy Directories for Rx plan

Search online pharmacy directory

2022 View or print Prime Solution pharmacy directory (PDF)

Evidence of coverage documents

2021 Evidence of coverage with Rx (PDF)

2022 Evidence of coverage with Rx (PDF)

2021 Evidence of coverage with no Rx (PDF)

2022 Evidence of coverage with no Rx (PDF)

2021 Wisconsin Addendum to the Evidence of Coverage (PDF)

2022 Wisconsin Addendum to the Evidence of Coverage (PDF)

Annual notice of changes

2021 Annual notice of changes with Rx (PDF)

2022 Annual notice of changes with Rx (PDF)

2021 Annual notice of changes with no Rx (PDF)

2022 Annual notice of changes with no Rx (PDF)

Evidence of coverage Wisconsin Rider

2021 Evidence of coverage – Wisconsin Rider (H2450-040 & H2450-041) with Rx (PDF)

2022 Evidence of coverage – Wisconsin Rider (H2450-040 & H2450-041) with Rx (PDF)

2021 Evidence of coverage – Wisconsin Rider (H2450-040 & H2450-041) with no Rx (PDF)

2022 Evidence of coverage – Wisconsin Rider (H2450-040 & H2450-041) with no Rx (PDF)

Formulary (Drug List) 

2022 Formulary (PDF)

Medica Prime Solution Thrift

Thrift with Rx
(2021 $73.20 monthly premium)
(2022 $78.40 monthly premium)

Thrift with no Rx
(2021 $34.00 monthly premium)
(2022 $34.00 monthly premium)

Provider Directories for all Thrift plans

Search online directory

2022 View or print Prime Solution provider directory IA MN WI (PDF)

2022 View or print Prime Solution additional providers IA MN WI (insert) (PDF)

Pharmacy Directories for Rx plan

Search online pharmacy directory

2022 View or print Prime Solution pharmacy directory (PDF)

Evidence of coverage documents

2021 Evidence of coverage with Rx (PDF)

2022 Evidence of coverage with Rx (PDF)

2021 Evidence of coverage with no Rx (PDF)

2022 Evidence of coverage with no Rx (PDF)

2021 Wisconsin Addendum to the Evidence of Coverage (PDF)

2022 Wisconsin Addendum to the Evidence of Coverage (PDF)

Annual notice of changes

2021 Annual notice of changes with Rx (PDF)

2022 Annual notice of changes with Rx (PDF)

2021 Annual notice of changes with no Rx (PDF)

2022 Annual notice of changes with no Rx (PDF)

Formulary (Drug List) 

2022 Formulary (PDF)

Wyoming

Medica Prime Solution Premier

Premier (2022 $189.00 monthly premium)

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory ND SD WY (PDF)

2022 Evidence of coverage (PDF)

Medica Prime Solution Core

Core (2022 $79.00 monthly premium)

Provider Directories

Search online directory 

2022 View or print Prime Solution provider directory ND SD WY (PDF)

2022 Evidence of coverage (PDF)

Medica Prime Solution Thrift

Thrift (2022 $34.00 monthly premium)

Provider Directories

Search online directory 

2022 View or print Prime Solution provider directory ND SD WY (PDF)

2022 Evidence of coverage (PDF)

Group Prime Solution Documents

Medica Group Prime Solution

Provider Directories

Search online directory

2022 View or print Prime Solution provider directory for KS, MO, NE, OK (PDF)

2022 View or print Prime Solution additional providers KS, NE, SD, ND (insert) (PDF)

2022 View or print Prime Solution provider directory for MN, WI, IA (PDF)

2022 View or print Prime Solution additional providers IA MN WI (insert) (PDF)

2022 View or print Prime Solution provider directory for ND, SD, WY (PDF)

Pharmacy Directories

2022 View or print Prime Solution with Part D Coverage plans (PDF)

Evidence of Coverage (EOC)

To get a copy of your Evidence of Coverage (EOC) or other plan documents, contact the Medica Customer Service phone number on the back of you Medica ID card 

2022 Formulary (PDF)

Order Materials by Mail

The easiest way to access your plan materials is to view or download them at the links above. If you prefer, we are able to send materials to you via mail.

Order plan materials by mail

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Last Updated: December 2021
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