Medica Customer service: (952) 945-8000 or 1-800-952-3455
The City’s medical plan is insured by Medica. There is one plan design with a choice of three provider networks: Medica Elect, Medica Essential or Medica Choice.
The medical plan offers a wide range of covered services including physician and hospital services and prescription drugs.
- Eligible Preventive services are paid at 100%; other covered services are subject to an annual deductible.
- The annual deductible, the amount you pay before the medial plan starts contributing, is $2,000 for an individual and $4,000 for a family.
- You will pay a co-insurance of 20% for covered services after you meet your deductible.
- The out-of-pocket maximum, the total amount of charges for covered services you pay each year in deductibles, prescription co-pays, and coinsurance, is $3,000 for an individual and $6,000 for a family
- The prescription drug co-payments are as follows:
- Tier 1 is the lowest copayment option. Most generic drugs will be included in this tier. It is possible that in the future selected brand-name drugs will be included as well.
- Tier 2 is a higher copayment option. Many brand-name drugs are covered in this tier. Choose a drug from this category if an appropriate alternative for your condition is not available in Tier 1.
- Tier 3 is the highest copayment option. The covered medications in this category are usually brand-name medications that are typically more costly.
When you enroll in the City’s medical plan, you must select one of these networks: Medica Elect, Medica Essential or Medica Choice. You cannot change your network once the plan year starts, so it’s important to choose the best network for your needs at the time of enrollment.
Medica Elect and Medica Essential
The Medica Elect and Medica Essential are two different provider networks, but both have these features:
- Primary clinics, specialists and hospitals are organized into care systems designed to provide all or most of the care you might need
- You must designate a primary care clinic when you enroll.
- All family members must enroll in the same network, but each family member may designate a different primary care clinic within your selected network.
- All of the care systems require a primary physician’s referral in order for you to see specialists or facilities outside the care system.
- With the exception of Allina, all participating Elect and Essential cares systems allow you to see a specialist inside the care system without a referral. The Allina care system requires you to obtain a referral in order to see a specialist within the Allina care system.
- You do not need a referral for urgent care centers, mental health or substance abuse care or an annual eye exam by an optometrist or ophthalmologist within your selected network.
Consider selecting Medica Choice if it’s important to you to be able to see a wide range of providers without a referral. Greater flexibility makes Medica Choice a more expensive option.
- Choice is Medica’s largest network and includes more than 95% of Minnesota hospitals and physicians. The Mayo Clinic was recently added to this network.
- You do not need a referral to see specialists in the network.
- You do not need to designate a primary care clinic to enroll.
For more information on your plan and network options, review the Health Plan Resource Website.
Enrolling in a Medical Plan
Most full-time employees and their eligible dependents may enroll for benefits the first of the month following 30 days of employment. Certain part-time employees are also eligible to participate in the medical plan. Eligibility and contribution requirements for part-time employees are based on the governing policy or collective bargaining agreement.
Changing Your Medical Plan Elections
You can change plan elections during open enrollment or if a change in status occurs.
All of the City plans include employer contributions to a Health Reimbursement Arrangement Plan (HRA) that is funded by a “voluntary employees’ beneficiary association” (VEBA) trust. The HRA/VEBA is designed to offset out-of-pocket costs for deductibles and coinsurance.
Learn more about HRA/VEBA accounts.
As part of the Patient Protection and Affordable Care Act (PPACA) employers are required to provide a standard Summary of Benefits and Coverage for each plan. These documents are listed below.
Last updated Jan. 10, 2014