Medica Customer service: (952) 945-8000 or 1-800-952-3455
Enrolling in a Medical Plan
Most regular, full-time employees may enroll for benefits the first of the month following 30 days of employment. Waiting periods and participation start dates can be found in the policy or collective bargaining agreement governing your employment.
Because of the Affordable Care Act, there are newly eligible employees able to enroll in the City of Minneapolis medical plan and the HRA/VEBA. Plan and enrollment information will be provided if applicable. If you have questions on your eligibility for the medical plan, please contact the Benefits Office.
The City’s medical plan is insured by Medica. There is one plan design with a choice of three provider networks. The medical plan offers a wide range of covered services including physician and hospital services and prescription drugs.
- Eligible Preventive services are paid at 100%; other covered services are subject to an annual deductible.
- The annual deductible, the amount you pay before the medial plan starts contributing, is $2,000 for an individual and $4,000 for a family.
- You will pay a co-insurance of 20% for covered services after you meet your deductible.
- The out-of-pocket maximum, the total amount of charges for covered services you pay each year in deductibles, prescription co-pays, and coinsurance, is $3,000 for an individual and $6,000 for a family
- The prescription drug co-payments are as follows:
- Tier 1 is the lowest copayment option. Most generic drugs will be included in this tier.
- Tier 2 is a higher copayment option. Many brand-name drugs are covered in this tier. Choose a drug from this category if an appropriate alternative for your condition is not available in Tier 1.
- Tier 3 is the highest copayment option. The covered medications in this category are usually brand-name medications that are typically more costly.
When you enroll, you must select one provider network from the three available options. Medica Elect and Medica Essential are smaller networks that require you to designate a primary care clinic from participating care system and get a referral for any care you receive outside that care system. Medica Choice Passport is a large network that does not require referrals within the network. Generally speaking, you can’t change networks once you are enrolled, so it’s important to choose the best network for your needs.
Medica Elect and Medica Essential
The Medica Elect and Medica Essential are two different provider networks, but both have these features:
- Primary clinics, specialists and hospitals are organized into care systems designed to provide all or most of the care you might need.
- You must designate a primary care clinic when you enroll.
- All family members must enroll in the same network, but each family member may designate a different primary care clinic within your selected network.
- All of the care systems require a primary physician’s referral in order for you to see specialists or facilities outside the care system.
- You do not need a referral for urgent care centers, emergency room care, mental health or substance abuse care or an annual eye exam by an optometrist or ophthalmologist within your selected network.
Medica Choice Passport
Consider selecting Medica Choice Passport if it’s important to you to be able to see a wide range of providers without a referral. Greater flexibility makes this network a more expensive option.
- Choice Passport is Medica’s largest network and includes more than 95% of Minnesota hospitals and physicians. The Mayo Clinic is included in this network.
- You do not need a referral to see specialists in the network.
- You do not need to designate a primary care clinic to enroll.
For more information on your plan and network options, review the Health Plan Resource Website.
Monthly Premiums for 2016
Premiums for medical insurance will be deducted from the first and second paycheck of each month. For example, if you are enrolled in Medical Essential Wellness with Family Coverage with a premium of $159.00/month, you will have $79.50 deducted from the first and second paycheck of each month.
Changing Your Medical Plan Elections
You can change plan elections during open enrollment or if a change in status occurs.
All of the City plans include employer contributions to a Health Reimbursement Arrangement Plan (HRA) that is funded by a “voluntary employees’ beneficiary association” (VEBA) trust. The HRA/VEBA is designed to offset out-of-pocket costs for deductibles and coinsurance. Learn more about HRA/VEBA accounts.
As part of the Patient Protection and Affordable Care Act (PPACA) employers are required to provide a standard Summary of Benefits and Coverage for each plan. These documents are listed below.
Last updated Mar 20, 2016