Plan D - Medica Elect: $300-$35-25%

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Plan D - Medica Elect: $300-$35-25%

Care system network

With Medica Elect®, 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 D - Medica Elect: $300-$35-25%

Network Benefits
Annual Deductible $300 per person/ $600 per family for in-network services. $1,000 per person/ $2,000 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 Maximum $2,500 per person/ $5,000 per family for in-network services. $3,500 per person/ $5,000 per family for out-of-network services.
Primary Care Visit to Treat an Injury or an Illness $35 co-pay/ visit
Specialist Visit $35 co-pay/ visit
Other Practitioner Office Visit $35 co-pay/ visit for chiropractic care. $15 co-pay/ visit for convenience care.
Preventive Care/Screening/Immunization No charge.
Diagnostic Test (X-ray, blood work) No charge for lab services. 25% co-insurance after deductible for x-ray services.
Imaging (CT/PET scans, MRI) 25% co-insurance after deductible.
Outpatient Surgery 25% co-insurance after deductible for facility fee; 25% co-insurance after deductible for physician/surgeon fees.
Emergency Care $75 co-pay/ visit for emergency room services; 25% co-insurance after deductible for emergency medical transportation.
Urgent Care $35 co-pay/ visit
Hospital Stay 25% co-insurance after deductible for facility fee; 25% co-insurance after deductible for physician/surgeon fee.
Prescription Drugs
Generic $11/ prescription
Preferred Brand $45/ prescription
Non-preferred Brand $60/ prescription
Network Information
Network Type Care system network
Network Area Minnesota 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 Elect, 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 Elect network. Or you can all be in the same care system but choose different primary care clinics within that system. 

Medica Elect care systems:

  • Allina Health
  • Children's Health Network
  • Hennepin County Medical Center
  • Integrity Health Network
  • Lakeview Medical Care System
  • Minnesota Healthcare Network
  • Park Nicollet Health Services
  • Riverway/North Suburban Clinics
  • 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 D - Medica Elect: $300-$35-25%.

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

» Learn how to enroll in a primary care clinic.

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