University of Minnesota
Office of Human Resources
http://www.umn.edu/ohr
612-625-2016

Medical Plan Descriptions for 2015

Medical Plan Rates

PlanContact

Medica Elect/Essential

Base plan for Twin Cities and Duluth

Medica Elect/Essential, the base plan for Duluth and the Twin Cities area, is a combination of two networks, each of which includes major care systems. Each care system includes a comprehensive network of physicians, specialists and other types of care providers, clinics, and hospitals. You have low biweekly rates and reasonable out-of-pocket costs with the base plan. The out-of-network benefit and in-network travel benefit give you additional flexibility as you use the plan.

You will need to select a primary care clinic (PCC) when you enroll in this plan. Family members may select their own primary care clinics. You and your family members can choose separate primary care clinics from care systems in either the Elect or Essential networks. Clinics can be changed monthly. When you contact Medica’s member services by the 20th of the month, the change goes into effect the first of the following month.

Your PCC will work with you to coordinate your care including, when appropriate, referral to specialists. Each care system establishes its own access procedures for seeing specialists. Some require a referral from your primary care clinic; others allow you to directly access a specialist affiliated with your care system. You must follow your care system’s access procedures to receive the highest level of benefits. To be referred to an out-of-network provider and obtain the highest level of benefits, you also need Medica’s approval.

952-992-1814
877-252-5558

800-855-2880 (TTY)

Medica website

Medica Choice Regional

Base plan for Greater Minnesota, including Morris, Crookston, and Rochester

Medica Choice Regional is the base plan for Greater Minnesota including Crookston, Morris, and Rochester. It is an open access plan that uses the statewide Medica Choice network. You have low biweekly rates and reasonable out-of-pocket costs with the base plan. The out-of-network benefit and in-network travel benefit give you additional flexibility as you use the plan.

You have access to any provider who is part of the network, and you do not need to select a primary care clinic when you enroll. You can see any specialist within the plan network without getting a referral from your primary care doctor.

952-992-1814
877-252-5558

800-855-2880 (TTY)

Medica website

Medica ACO Plan

Twin Cities Only 

Medica ACO Plan is available to you if you live in the 11-county, Twin Cities metro area. In an ACO, Medica and the network of primary care and specialty providers work together to deliver coordinated health care and support to the member. You will have benefits that are slightly higher and biweekly rates that are slightly lower than the base plan.

Your ACO options include Fairview & North Memorial Vantage Plan with Medica (including Boynton and UMP); Inspiration Health by HealthEast with Medica; Park Nicollet First with Medica; and Ridgeview Connect with Medica. You need to select one ACO for your entire family. ACO enrollments are for a full year, so mid-year changes cannot be made. You don’t need a referral to see any primary care provider or specialist within the network. The out-of-network benefits and in-network travel benefit give you additional flexibility.

If you are planning on traveling or living out of the Minnesota area for three or more months you should not enroll in the Medica ACO Plan.

952-992-1814
877-252-5558

800-855-2880 (TTY)

Medica website

Medica Choice National

Medica Choice National is an open access plan with a statewide network of over 13,000 physicians and more than 200 hospitals. You also have national coverage access to more than 600,000 physicians and health care providers through United Healthcare Options PPO network when traveling or working outside the service area.

You have access to any network provider without a referral, and you do not need to select a primary care clinic when you enroll. The out-of-network benefit gives you additional flexibility in selecting a provider.

952-992-1814
877-252-5558

800-855-2880 (TTY)

Medica website

Medica HSA

Medica HSA is a high deductible plan that allows you to make decisions about how you spend your health care dollars. The University contributes a set amount of taxfree benefits dollars to your HSA account to offset the deductible. After your deductible is met, Medica HSA pays covered services at 90% coinsurance. However, as in all UPlan medical options, your in-network preventive care—your routine physical, hearing and eye exams, well child care, prenatal care, and immunizations—is covered at 100%.

Medica HSA also uses the Medica Choice statewide network and the United Healthcare Options PPO national network with the same provider access described in Medica Choice National.

The University will contribute $750 to your HSA account for employee-only coverage and $1,500 for each tier with covered dependents. The funds are contributed over the 26 pay periods in 2015 for coverage effective January 1, 2015. When enrolling mid-year, the HSA amount will be prorated monthly; however, the deductible amount is not prorated. The amount you receive depends on when coverage becomes effective and is contributed over the number of pay periods remaining in the year. While the HSA amount is tax-sheltered from federal and state taxes in most states (including Minnesota), for federal reporting the amount the University contributes to your HSA will be shown on your pay statement.

Enrollment in Medica HSA means that you are not eligible to participate fully in a health care Flexible Spending Account. You may only use the pre-tax FSA plan to cover out-of-pocket costs for eligible dental and vision expenses.

Your HSA account is open once funds are received by Wells Fargo. You can only request reimbursement of medical expenses incurred from the date the account is opened.

You will have a special debit card to spend HSA dollars for pharmacy or medical expenses. You pay the doctor or pharmacy until the annual deductible is met, and you can be reimbursed from the health savings account as funds are available. After the deductible is satisfied, Medica pays 90 percent.

You own the HSA contributions and can decide whether to use them for current expenses or let the funds grow to cover medical expenses in retirement. You can also make your own pre-tax contributions to the HSA and invest them in options from Wells Fargo. If you leave the University, the account balances are portable.

Due to federal law, if you have any other medical coverage, including any part of Medicare, you are not eligible to enroll in Medica HSA. However if you are age 65 or older and delay taking Social Security benefits and Medicare Part A, you remain eligible for Medica HSA.

952-992-1814
877-252-5558

800-855-2880 (TTY)

Medica website