Plan C - Medica Essential - $1,000-$35-25%


Plan C - Medica Essential - $1,000-$35-25%

Care system network

With Medica EssentialSM, you enroll in a primary care clinic. The clinic coordinates your care and will help you find a specialist when you need one. Whenever you need care, you’ll start at your primary care clinic.

Plan highlights

  • Mid-size regional network of care systems
  • National network coverage when you travel
  • A medical home – you choose a primary care clinic/care system
  • Care is coordinated by your primary care clinic

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Benefit Summary for Plan C - Medica Essential - $1,000-$35-25%

Network Benefits
Overall deductible $1,000 per person/ $2,750 per family for in-network services. $2,500 per person/ $7,000 per family for out-of-network services. Deductible does not apply to preventive care, co-pay services, hospice, lab, or prescription drugs from in-network providers or well child or prenatal care from out-of-network providers.
Out-of-pocket limit $3,500 per person/ $7,000 per family for in-network services. $6,000 per person/ $12,000 per family for out-of-network services.
If you visit a health care provider's office or clinic
Primary care visit $35 co-pay/ visit
Chiropractic visit $35 co-pay/ visit for chiropractic care. $15 co-pay/ visit for convenience care.
Convenience care visit
Specialist visit $35 co-pay/ visit
Preventive care/screening/immunization No charge.
If you have a test
Diagnostic test - lab No charge for lab services. 25% co-insurance after deductible for x-ray services.
Diagnostic test - x-ray
Imaging (CT/PET scans, MRI) 25% co-insurance after deductible.
If you need drugs to treat your illness or condition
Generic drugs $11/ prescription
Preferred brand drugs $60/ prescription
Non-preferred brand drugs 25% co-insurance after deductible for facility fee; 25% co-insurance after deductible for physician/surgeon fees.
Specialty drugs
If you have outpatient surgery
Facility fee (e.g., ambulatory surgery center)
Physician/surgeon fees
If you need immediate medical attention
Emergency room care
Emergency medical transportation
Urgent care
If you have a hospital stay
Facility fee (e.g., hospital room)
Physician/surgeon fees
Network information
Network type Care system network
Network area Minnesota, eastern North Dakota and northwestern Wisconsin
Special features You enroll in a primary care clinic. This clinic coordinates your overall care and is affiliated with a care system.
Referrals needed You can see any provider within your care system without a referral. To receive care from a provider outside your care system, you must receive a referral from your primary care clinic.

How it works

With Medica Essential, you enroll in a primary care clinic. You can change your primary care clinic as often as once a month.  Your clinic is affiliated with a care system, which is a group of primary care clinics, specialists and hospitals that work together to give you the care you need. So when you pick your primary care clinic, you’re also picking a care system. Each family member can choose a different care system within the Medica Essential network. Or you can all be in the same care system but choose different primary care clinics within that system.

Medica Essential care systems:

  • Altru Health System
  • Children's Health Network
  • Essentia Health - West Region
  • Fairview Physician Associates
  • HealthEast Care System
  • Integrity Health Network
  • St. Luke’s Care System

A few things to keep in mind:

  • Whenever you need care, you’ll always start at your primary care clinic.
  • For your highest level of benefits, get all of your care from providers in your care system.
  • If you can’t get the care you need within your care system, you can ask for a referral to see a provider in another care system. Learn more about referrals in this tip sheet.

» View Summary of Benefits and Coverage for Plan C - Medica Essential: $1,000-$35-25%.

» Find a physician or facility in the Medica Essential network.

» Learn how to enroll in a primary care clinic

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