Plan C - VantagePlus with Medica - $1,250-$35-25%

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Plan C - VantagePlus with Medica - $1,250-$35-25%

Accountable Care Organization network

VantagePlus has the physicians you know and trust from Fairview, HealthEast, North Memorial and many popular independent clinics. As one of the largest accountable care organizations in Minnesota, VantagePlus provides access to more than 3,500 primary and specialty care physicians, 650 clinics and 12 hospitals.

When you become a member, we’ll welcome you by phone and answer any questions you have. From there, just one phone number connects you to all of your coverage and care resources – from answers to benefit questions to scheduling appointments and more. You also have access to a team of doctors, nurses, nutritionists, health coaches, social workers and others who work together to make sure you get the care and support you need.

If you’re away from home and get sick or hurt, we’ve got you covered. When you travel outside the Medica service area (Minnesota, North Dakota, South Dakota and western Wisconsin) you can get network coverage by visiting a provider in the Travel Program Network. This nationwide network is one of the largest in the country. If you have children attending college outside the service area, they can use this network, too.

Plan Highlights

  • A personal welcome call for new members.
  • One phone number for questions about your coverage or your care.
  • More convenient ways to receive care. Make a same-day, evening or weekend appointment, or get an online diagnosis and treatment for certain conditions in less than an hour.
  • A 24/7 nurse line for quick answers to questions about your health.
  • Unique wellness programs, including:
         - A free wellness assessment (a $200 value) and discounts on nutrition
           consults, personal training, wellness coaching and more at HealthEast
           Ways to Wellness.
         - A 12-week Well Together program designed by Fairview and the Forest
           Lake YMCA to give you the personalized support you need to achieve
           your health and wellness goals (a $900 value for just $139).
         - Online tools and resources to help you take steps to improve your
           health while earning gifts cards with My Health Rewards by Medica®.
  • A three-month supply of medication for just two copays when you fill your prescription at a Fairview, HealthEast or North Memorial pharmacy (for pharmacy plans with a copay).
  • Dedicated help from a specialized pharmacist to make sure your medications are best for you and your conditions, lifestyle and budget.

Compare Plans

You can compare this plan side-by-side with up to two other plans to see the differences between their benefits.

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Benefit Summary for Plan C - VantagePlus with Medica - $1,250-$35-25%

Network Benefits
Overall deductible $1,250 per person/ $3,500 per family for in-network services. $2,500 per person/ $7,000 per family for out-of-network services.
Out-of-pocket limit $4,000 per person/ $8,000 per family for in-network services. $7,000 per person/ $14,000 per family for out-of-network services.
If you visit a health care provider's office or clinic
Primary care visit $35 copay/visit. Deductible does not apply.
Chiropractic visit $35 copay/visit. Deductible does not apply.
Convenience care visit $15 copay/visit. Deductible does not apply.
Specialist visit $35 copay/visit. Deductible does not apply.
Preventive care/screening/immunization No charge. Deductible does not apply.
If you have a test
Diagnostic test - lab No charge. Deductible does not apply.
Diagnostic test - x-ray 25% co-insurance
Imaging (CT/PET scans, MRI) 25% coinsurance
If you need drugs to treat your illness or condition
Generic drugs Retail: $11/prescription. Deductible does not apply. Mail order: $22/prescription. Deductible does not apply.
Preferred brand drugs Retail: $45/prescription. Deductible does not apply. Mail order: $90/prescription. Deductible does not apply.
Non-preferred brand drugs Retail: $60/prescription. Deductible does not apply. Mail order: $120/prescription. Deductible does not apply.
Specialty drugs Preferred: 20% coinsurance. No more than $200 copay/ prescription. Deductible does not apply. Non-preferred: 40% coinsurance. Deductible does not apply.
If you have outpatient surgery
Facility fee (e.g., ambulatory surgery center) 25% coinsurance
Physician/surgeon fees 25% coinsurance
If you need immediate medical attention
Emergency room care $75 copay/visit. Deductible does not apply.
Emergency medical transportation 25% coinsurance
Urgent care $35 copay/visit. Deductible does not apply.
If you have a hospital stay
Facility fee (e.g., hospital room) 25% coinsurance
Physician/surgeon fees 25% coinsurance
Network information
Network type Accountable Care Organization network
Network area Twin Cities metro area
Special features Same-day primary care appointments; unique wellness programs to help you focus on the areas you want to improve.
Referrals needed See any primary or specialty care provider in the VantagePlus network.

How it works

VantagePlus with Medica is an accountable care organization (ACO). In an ACO, groups of doctors, nurses and other health care providers work together with your health plan to provide coordinated care. You can see any primary or specialty care provider in the VantagePlus network. Some specialty clinics require a primary care visit first for tests and to help guide your care. You have access to all University of Minnesota Physician specialists; however, University of Minnesota primary care clinics are not in the VantagePlus network.

» View the Summary of Benefits and Coverage for Plan C - VantagePlus with Medica - $1,250-$35-25%.

» Find a physician or facility in the VantagePlus network.
» See a map of provider locations in the VantagePlus network.


Information sharing

One of the unique features of an ACO plan is how Medica works with your provider to coordinate your health care. By sharing member information with each other, Medica and your ACO can help you get the care you need and deliver programs and services to help you get and stay healthy. If you or your dependents don’t want Medica and the ACO to share your information with each other:

» Complete this form
» Or call Customer Service at 952-945-8000 or 800-952-3455

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