INDIVIDUALS + FAMILIES
2022 Medica Health Plans for Iowa
Coverage that works for you
You want a plan to fit your budget. You want to choose your doctor. Make sure your prescriptions are covered. Find care to protect your family. We can help. We’re a nonprofit health plan that’s been around for nearly 50 years. And we serve more than 1 million people across 11 states.
But our relationship with you? Always strictly one-to-one.
And we get it: Your needs are unique. So take a look at what we offer here in Iowa.
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QUICK RESOURCES
Get a quote and see how much of a subsidy you qualify for. The subsidy rules have changed. If you didn't qualify for financial help last year, you may this year. Check out page 6 to learn more.
Check to see if your prescriptions are covered.
Search our formulary for your prescriptions and see how they’re covered.
Medica.com/IAPlans22
See if your doctor is in our network.
Check out pages 12-16 to see our available network searches.
Other questions? We're here to help. Call us at 1 (844) 752-6742 (TTY: 711 ) Monday-Friday 8 a.m.-8 p.m. and Saturday-Sunday 8 a.m.-5 p.m. CT. Email us at MedicaIndividualProducts@Medica.com. Visit us on the web at Medica.com/IAPlans22.
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Find your plan in a few simple steps On the next few pages, we've outlined your potential plan options and the steps you can take to find the best plan for you.
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TABLE OF CONTENTS
See how much you can save on your premium You may qualify for a subsidy even if you haven't qualified before.
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Consider your plan options Learn about our different plan types and choose the plan structure that best fits your budget and care needs. We have health plans made to work for everyone. Plan levels : Organized by Gold, Silver and Bronze plan levels. A way to identify which plans have a higher or lower base premium, and out-of-pocket costs. Plan types : Organized by Copay, Share, HSA, and Value plan types. Each is uniquely customized to meet your care needs while also lowering your costs. Check if your prescriptions are covered Search our drug list to make sure all of your prescription drugs are covered and find a pharmacy close to you.
Pages 8-9
Page 10
Review what's available in your county Some counties have several networks. Pick the one that works best for you.
Pages 12-16
Where you have to live The county you live in determines which plans you can sign up for. Some counties have more than one plan option. Use the maps to identify where you have to live to enroll in each plan. Where you can get care A plan's network tells you which doctors, hospitals, and facilities accept your insurance and can lower your care costs. Each plan differs by its network. Use the maps to identify where you can get care with each plan's network. If you're looking for a specific provider, Search the network using each plan's provider search listed on the following pages. You can see if the provider is in-network with a Medica plan offered in your county.
Pick your plan and enroll Put your chosen network and plan type together to find the best plan that works for you.
Pages 18-21
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You may now qualify for a subsidy, even if you haven't before. 80% of marketplace enrollees can now qualify for a plan that costs $10 or less a month.* You could save a lot on your health plan
Call 1 (844) 752-6742 to get a quote.
Or complete an application on Healthcare.gov.
SAVE ON YOUR PREMIUM
Depending on your household income and your household size, you can use a subsidy to lower your monthly premium. A premium is what you pay each month for your insurance.
SAVE ON YOUR CARE COSTS
You may also qualify for cost-sharing reduction plans that will lower your copays, deductible, and out-of-pocket maximum. If you're a member of a federally recognized American Indian tribe, you may qualify for additional cost-sharing reductions (not shown in this brochure).
*Source: https://www.hhs.gov/
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Our plans have everything you need
$0 routine care All of our plans have $0 preventive care and vaccines, including:
• • • • •
Mammograms
Annual immunizations Preventive screenings Preventive colonoscopies
And more
$0 care that travels with you virtually anywhere 2 All of our plans include $0 virtual care 1 . Common illness treated include: Acne, allergies, common cold, cough, fever, flu, headaches, rashes, sinus infection, sore throat, and UTI.
On-the-go access to your Member Account Enjoy all of these features online and through our mobile app.
• • • •
View all your benefits
Find providers in your network Download your ID card Review your plan materials
• Make and manage your premium payments • Access wellness programs and resources • Get quick answers to your questions and more
1 HSA plans will have $0 virtual care after the deductible is met 2 Not all email, telephone, or webcam visits are considered part of the member's $0 virtual care benefit. Members receiving services for ongoing treatment with their primary or specialty care doctor could be charged a copay or applicable deductible/coinsurance depending on their plan type. For more information, please refer to the plan's policy documents.
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Here’s a breakdown of your plan options
Most networks will have a variety of levels and types for you to choose from.
We're here to help We know insurance is hard. If you need help choosing your plan, call a Medica Sales Consultant. They will help you find the plan that fits your health care needs and budget.
Call 1 (844) 752-6742
PLAN LEVELS
Bronze
Silver*
Gold
PREMIUMS Lower
PREMIUMS Moderate
PREMIUMS Higher
DEDUCT I BLES Higher
DEDUCT I BLES Moderate
DEDUCT I BLES Lower
*Depending on your income, you may qualify for silver Cost-Sharing Reduction plans which will also reduce your care costs. Visit Healthcare.gov for more information and to see if you qualify.
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PLAN TYPES
With a copay plan you will pay: • Primary care office visit copays • Specialty care office visit copays • Prescription copays
With a share plan you will pay: • The full cost of a primary care office visit until your deductible is met • The full cost of a specialty care office visit until your deductible is met • Prescription copays
With a value plan you will pay: • The full cost of a primary care office visit until your deductible is met • The full cost of a specialty care office visit until your deductible is met • The full cost of prescriptions until your deductible is met
With an HSA-compatible plan you will pay * : • The full cost of a primary care office visit until your deductible is met • The full cost of a specialty care office visit until your deductible is met • The full cost of prescriptions until your deductible is met.
* HSA-compatible plans are the only plans you can use an HSA (health savings account) for qualifying expenses. See page 18 for more details.
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Prescription Drug Coverage
Our list of covered drugs To help keep your costs low, our plans cover safe and effective drugs on Medica's List of Covered Drugs. Your cost will depend on which tier your drug belongs to.
$
TIER 1
Generic
$$
TIER 2
Preferred brand
$$$
TIER 3
Non-preferred brand
$$$$
TIER 4
Specialty
Insulin coverage You'll pay no more than $25 for insulin per prescription unit when you fill it at a network pharmacy.
90-day refill options Your doctor can prescribe 90-day supplies of certain medications. Talk to your doctor about this option for you. Once prescribed, pick it up at a network pharmacy – or have it sent through our mail- order pharmacy at no extra cost when you use standard shipping.
Search the drug list or find a pharmacy To apply your benefits to a prescription on our drug list, you need to visit a network pharmacy. Our network includes more than 68,000 pharmacies nationwide, including most major chains and thousands of independent pharmacies.
See what drugs are covered or find a network pharmacy by using Medica.com/IAPlans22.
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Now, let’s find you a network
Remember: Your benefits only apply when you go to an in-network provider. *
LOCAL CARE SYSTEM NETWORK
BROAD PROV IDER NETWORK
Plans with local networks offer benefits with specific care systems in your area. These plans are a better option if you want to get care from the select doctors and hospitals in-network with each plan.
Plans with broad networks give you the most options of doctors and hospitals. These plans are a better option if you want to use your benefits with a large number of doctors and hospitals in-network with each plan.
*Unless it's an emergency, air ambulance service, or certain out-of-network care at an in-network facility or pre-approved by Medica, there is no coverage if you visit a provider that is not in your plan's network. This means that your provider may require you to be responsible for the full cost of any care or supplies. Learn more at Medica.com/BalanceBill.
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LOCAL CARE SYSTEM NETWORK
Inspire by Medica SM (Inspire Network)
Where you have to live Benton, Black Hawk, Boone, Bremer, Buchanan, Butler, Cedar, Clayton, Dallas, Delaware, Dubuque, Fayette, Greene, Grundy, Iowa, Jackson, Jones, Linn, Marshall, Muscatine, Polk, Scott, Tama, Warren, or Woodbury county
What's in the network •
UnityPoint Health doctors, clinics, and hospitals
• 3,300+ primary and specialty care providers • 39+ hospitals
Featured health care systems: UnityPoint Health
Where you can get care Iowa and parts of some bordering states
Bronze Copay Preferred Primary Care Plan: Preferred Providers include UnityPoint primary care clinics.
Search the network You can find all Inspire health care facilities, systems, and providers here: Medica.com/FindInspireProviders.
Need complex care? You can get care for transplants, certain rare cancers, and other complex specialty care at Mayo Clinic using the Complex Specialty Care Program*.
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*Before you use the program, you need a referral from your network doctor and approval from Medica.
LOCAL CARE SYSTEM NETWORK
Medica with CHI Health SM (CHI Health Network)
Where you have to live Harrison or Pottawatomie county
What's in the network • CHI Health doctors, clinics, and hospitals • 3,800+ primary and specialty care providers • 30+ hospitals
Where you can get care Southwestern Iowa and Nebraska
Featured health care system: CHI Health
Search the network You can find all CHI Health health care facilities, systems, and providers here: Medica.com/FindCHIHealthProviders.
Need complex care? You can get care for transplants, certain rare cancers, and other complex specialty care at Mayo Clinic using the Complex Specialty Care Program*.
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LOCAL CARE SYSTEM NETWORK
Elevate by Medica SM (Elevate Network)
What's in the network •
Where you have to live Cass, Mills, Montgomery, Pottawattamie, or Shelby county
Nebraska Health Network doctors, clinics, and hospitals
• 4,200+ primary and specialty care providers • 11+ hospitals
Where you can get care Council Bluffs and Omaha metro
Featured health care systems: Methodist Health System Nebraska Medicine
Search the network You can find all Elevate health care facilities, systems, and providers here: Medica.com/FindElevateProviders.
Need complex care? You can get care for transplants, certain rare cancers, and other complex specialty care at Mayo Clinic using the Complex Specialty Care Program*.
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*Before you use the program, you need a referral from your network doctor and approval from Medica.
LOCAL CARE SYSTEM NETWORK
Empower by Medica SM (Empower Network)
Where you have to live Johnson county
What's in the network •
University of Iowa Health Care doctors, clinics, and hospitals
• 1,400+ primary and specialty care providers • 1 hospital Featured health care systems: UI Stead Family Children's Hospital UI Roy J. and Lucille A. Carver College of Medicine UI Physicians
Where you can get care Iowa City metro
Search the network You can find all Empower health care facilities, systems, and providers here: Medica.com/FindEmpowerProviders.
Need complex care? You can get care for transplants, certain rare cancers, and other complex specialty care at Mayo Clinic using the Complex Specialty Care Program*.
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BROAD PROV IDER NETWORK
Medica Insure SM (Insure Network)
Where you have to live Any county in Iowa
What's in the network •
Doctors, clinics, and hospitals at many health care systems
Where you can get care Iowa and parts of bordering states
• 17,700+ primary and specialty care providers • 270+ hospitals
Featured health care systems: Avera Health Boys Town Bryan Health CHI Health Children’s Hospital & Medical Center
Children’s Physicians Genesis Health System Great River Health System Mary Lanning Health Care Mercy Iowa City PHO Methodist Health System
Nebraska Medicine UnityPoint Health University of Iowa
Search the network You can find all Insure health care facilities, systems, and providers here: Medica.com/FindInsureProviders.
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Extras that make your plan better These extra resources can help you to stay healthy. And you can get a lot at no additional cost.
Personal Health Advocate Your advocate can help you find doctors, estimate costs, andmake informed health care decisions. This is no additional cost, confidential service.
24/7 NurseLine Get 24/7 answers for non-urgent care questions at no additional cost. The nurses will help answer questions about symptoms, medications, and health conditions, and offer self-care tips. They can even help you find the best location for accessing care.
Online health program with reward opportunities You'll get access to programs to motivate and support a healthy lifestyle at no additional cost. Stay active, eat healthy, manage stress, and find direction for your life. And the more you participate, the more chances you have to earn prizes in reward drawings.
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WE LOVE OUR PLANS AND THINK YOU WI LL TOO!
Now it's time to pick your plan
We're here if you need extra help. Call a Medica Sales Consultant and they can guide you through the process. 1 (844) 752-6742
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Ready to enroll?
Your personal checklist
Open Enrollment Period This is the time each year when anyone can enroll in a plan. Open enrollment starts Nov. 1, 2021 and ends Jan. 15, 2022. For coverage that starts January 1, 2022, members must enroll by Dec. 15, 2021. For coverage that starts February 1, 2022, members must enroll by Jan. 15, 2022. There are two enrollment periods when you can buy a plan. Special Enrollment Period If you experience a life event like getting married, losing employer-sponsored coverage, or having a baby, you likely qualify for a Special Enrollment Period to enroll in a health plan. You typically have 60 days from the event to take action and enroll.
Gather this information for each person applying before you start your application: { Social Security number and date of birth (everyone in the household, not just those applying)
{ Current insurance information { Payment information to pay your
first month's premium and sign up for automatic payment
{ Tobacco use status
Applying on the Marketplace? Gather this information too.
{ Driver's license, Tribal ID, Green Card, or other ID { Last year's tax forms (1040-EZ or 1040) { Two most recent pay stubs { Documents for other sources of income (Social Security, Unemployment, self-employment, etc.) { W-2 form or Employer Tax ID Number
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Here’s how to sign up
Visit Medica.com/FindPlan . You'll need to create an account. Then follow the steps to see if you qualify for a subsidy, shop and compare plans, and enroll. You can also create an application and come back to it later. Online with Medica
Call 1 (844) 752-6742 (TTY: 711 ). AMedica Sales Consultant can help you explore, compare plans, and enroll in coverage over the phone. Over the phone
On the Marketplace
If you work with a licensed agent, they're your best resource to help choose and enroll in a plan. With your agent
Visit Healthcare.gov . You'll need to create an account. Then follow the steps to see if you qualify for a subsidy, pick your plan, and enroll.
After you enroll, we will review your application and setup your policy. You will receive your ID card and welcome kit 7-10 business days after we process your first month's premium payment.
Working with a sales consultant or agent to complete your application? Make sure you include their agent (NPN) number on your application.
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Relax, enjoy your plan, and don't worry about losing coverage You can sign up for automatic payments while you enroll. You can also sign up after you enroll through your member account. Visit Medica.com/SignIn.
What to do after you enroll: You can take a few steps now, before your coverage starts.
Create your member account Then, you’ll be able to find everything you need online. • View all your benefits • Find providers in your network • Download your ID card • Review your plan materials • Make and manage your premium payments • Access wellness programs and resources • Get quick answers to your questions and more Visit Medica.com/SignIn to create your online account. Or download our Mobile app by searching "My Medica" in the app store.
Pay your premium You need to make your first month
premium payment before your coverage can start. You have three payment options: • Pay online. Sign into your member account to pay with your bank account or credit card. • Over the phone. Call Member Services at 1 (800) 918-6165. • Mail it. We’ll send you a letter with instructions on how to send in your payment. Review your plan materials After we get your first payment, we’ll mail your ID card and welcome kit. These materials will tell you all you need to know about getting care through your network, your benefits, and all the other programs and savings that are part of your plan.
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What else you need to know
Eligibility and requirements To qualify for a Medica plan, you must be a resident of Iowa, and not eligible for or enrolled in Medicare. You also must live within your selected network’s service area to enroll in and remain in the plan. Understanding benefits and coverage details This brochure is a brief overview of the plans. For complete benefit details, limitations, and exclusions please see a Medica Individual and Family insurance policy. This can be found by visiting Medica.com/ IAPlans22 or request a paper copy by calling 1 (844) 752-6742 (TTY: 711 ). Prior approvals and excluded services Some services and procedures require prior approval fromMedica before they are covered. Services not covered include, but are not limited to, custodial care, adult eyewear, most dental services, cosmetic services, refractive eye surgery, those received while on military duty and services that are investigational or not medically necessary. For a complete list, see aMedica Individual and Family insurance policy available on Medica.com/ IAPlans22 or call 1 (844) 752-6742 (TTY: 711 ). Pediatric dental is not covered These policies do not include pediatric dental services. Pediatric dental is an essential health benefit that can be purchased as a standalone product through the Marketplace. For more information visit Healthcare.gov. Member Complex Case Management We have services and programs designed to help members with certain health conditions manage their overall care and treatment. Find more information about the programs and services available by visiting Medica. com/IAPlans22. Health Savings Account The Silver HSA and Bronze HSA plans can be paired with a health savings account (HSA) - which is a special savings account for IRS-approved medical expenses. Generally, CSR plans cannot be paired with an HSA. Learn more about the benefits of an HSA or how to open an account by visiting Medica.com/HSA.
Deductible & out-of-pocket maximum details The deductible and out-of-pocket maximum are subject to a “cost of living” increase on a yearly basis. This increase is tied to the Consumer Price Index and/or may result from adjustments needed to keep plans within the range for a given metal level; metal levels (e.g., Gold, Silver, Bronze) must always be in compliance with the Affordable Care Act (ACA) for Qualified Health Plans (QHPs). Cost Share Reduction plans You may be able to receive help paying your health insurance premium or qualify for plans with reduced deductibles and copays. Plans with reduced deductibles and copays are called Cost Share Reduction (CSR) plans. You can get this assistance if you get health insurance through the Marketplace, your income is below a certain level, and you choose a health plan from the Silver plan category. Reduced cost sharing is not available with a Catastrophic plan. If you’re a member of a federally recognized tribe, you may qualify for additional cost-sharing benefits. To see if you’re eligible, please visit Healthcare.gov . Receiving care outside your network Unless it's an emergency, air ambulance service, or certain out-of-network care at an in-network facility or pre-approved by Medica, there is no coverage if you visit a provider that is not in your plan's network. This means that your provider may require you to be responsible for the full cost of any care or supplies. Learn more at Medica.com/BalanceBill. Medica privacy notice Medica takes its responsibility of protecting your personal information seriously. Where possible, Medica de-identifies or encrypts personal information. We use and disclose personal information only to the extent necessary to conduct treatment, payment and health care operations, or to comply with legal, regulatory or accreditation requirements. Medica’s full Privacy Notice is available upon request by calling 1 (844) 752-6742 (TTY: 711 ) or by going to Medica.com/Privacy .
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Discrimination is Against the Law
Medica complies with applicable Federal civil rights laws and will not discriminate against any person on the basis of race, color, national origin, age, disability or sex. Medica:
• Provides free aids and services to people with disabilities to communicate effectively with us, such as: TTY communication and written information in other formats (large print, audio, other formats). • Provides free language services to people whose primary language is not English, such as: Qualified interpreters and information written in other languages.
If you need these services, call the number included in this document or on the back of your Medica ID card. If you believe that Medica has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with: Civil Rights Coordinator, Mail Route CP250, PO Box 9310, Minneapolis, MN 55443-9310, 952-992-3422 (phone/fax), TTY 711, civilrightscoordinator@medica.com. You can file a grievance in person or by mail, fax, or email. You may also contact the Civil Rights Coordinator if you need assistance with filing a complaint. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue, SW Room 509F, HHH Building, Washington, D.C. 20201, 800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
If you want free help translating this information, call the number included in this document or on the back of your Medica ID card.
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Si desea asistencia gratuita para traducir esta información, llame al número que figura en este documento o en la parte posterior de su tarjeta de identificación de Medica. Yog koj xav tau kev pab dawb kom txhais daim ntawv no, hu rau tus xov tooj nyob hauv daim ntawv no los yog nyob nraum qab ntawm koj daim npav Medica ID. 如果您需要免費翻譯此資訊，請致電本文檔中或者在您的 Medica ID 卡背面包含的號碼。 Nếuquývịmuốn trợgiúpdịch thông tinnàymiễnphí, hãygọi vàosốcó trong tài liệunàyhoặcởmặt sau thẻ IDMedicacủaquývị. Odeeffannoo kana gargaarsa tolaan akka isinii hiikamu yoo barbaaddan, lakkoobsa barruu kana keessatti argamu ykn ka dugda kaardii Waraqaa Eenyummaa Medica irra jiruun bilbila’a. إذاكنتتريدمساعدةمجانيةفيترجمةهذهالمعلومات،فاتصلعلى الرقمالواردفيهذهالوثيقةأوعلىظهربطاقةتعريفميديكاالخاصةبك. Если Вы хотите получить бесплатную помощь в переводе этой информации , позвоните по номеру телефона , указанному в данном документе и на обратной стороне Вашей индентификационной карты Medica. ຖ້າທ່ານຕ້ອງການຄວາມຊ່ວຍເຫຼືອໃນການແປຂໍ້ມູນນີ້ຟຣີ , ໃຫ້ໂທຫາເລກໝາຍ ທີ່ມີຢູ່ໃນເອກະສານນີ້ ຫຼື ຢູ່ດ້ານຫຼັງຂອງບັດ Medica ຂອງທ່ານ.
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You’re not just covered, you’re cared for.
Connect with us
Call us at 1 (844) 752-6742 (TTY: 711 ) Monday-Friday 8 a.m.-8 p.m. and Saturday-Sunday 8 a.m.-5 p.m. CT. Email us at MedicaIndividualProducts@Medica.com. Visit us on the web at Medica.com/IAPlans22. Follow us on social media with the handle @Medica4Me.
Medica is a Qualified Health Plan issuer in the Health Insurance Marketplace. MayoClinic ® is an independent, nonprofit health care provider offering network access to its providers and health services. Mayo, MayoClinic, MayoClinic Health Systemand the tripleshield logo are registered trademarks and servicemarks ofMayoClinic. All other trademarks are the property of their respective owners. © 2021 Medica | IFB1000889-7-00521A
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