Medica Insure
Medica Insure is available for Medica individual and family business (IFB) members in Nebraska and Iowa and features a tiered network. It provides access to one of Nebraska and Iowa's largest provider networks, Midlands Choice. Members do not have benefits for out-of-network providers. To verify which providers are included in this product's network, see the provider directory on Medica.com.
Tier 1 – Preferred Providers - Includes the following health care systems, and other providers:
- Avera Health
- Boys Town
- Bryan Health
- CHI Health*
- Children's Hospital and Medical Center and Children's Physicians
- Genesis Health System
- Great River Health System
- Mary Lanning Health Care
- Mercy Iowa City PHO
- Methodist Health System
- Nebraska Medicine
- UnityPoint Health
- University of Iowa
*Nebraska locations only; does not include CHI Health Corporate – Iowa
Tier 2 – Standard Providers - All other Midlands Choice providers practicing in Nebraska and Iowa
Identification Card Example
Availability
- For Individual and Family Business(IFB)
- Service area includes all counties in Nebraska and Iowa
Specialty Networks
- Behavioral Health: Optum
- Chiropractic: Optum
- OptumHealth Complex Care Solution (for transplants)
- Express Scripts (pharmacy network)
Benefits
- Comprehensive coverage for preventive and other care needs
- All essential health benefits covered.
- This product is a tiered provider product with Preferred Tier (Tier 1) and a Standard Tier (Tier 2) providers
- Mayo Clinic Centers of Excellence program allows patients to receive care at Mayo Clinic. Medica may provide a travel, lodging and meal stipend for the patient and a companion during significant health care issues
Claim Submission
Medical claims should be submitted to:
Medica
PO Box 21051
Eagan, MN 55121-0051
Electronic pay ID: 12422
Medica Behavioral Health claims should be submitted to:
Medica
PO Box 30757
Salt Lake City, UT 84130
Electronic pay ID: 87726
Medica Chiropractic claims should be submitted to:
Medica
PO Box 212
Minneapolis, MN 55440-0212
Electronic pay ID: 41161
Inspire by Medica
Inspire by Medica is a care system product being offered in the individual and family business(IFB) market in Iowa. The Inspire network features UnityPoint Health providers and other providers aligned with UnityPoint Health. No referral is needed to see in-network specialists. Members do not have benefits for out-of-network providers. To verify which providers are included in this product's network, see the provider directory on Medica.com.
Identification Card Example
Availability
- For Individual and Family Business(IFB)
- Service area includes the following Iowa counties: Benton, Black Hawk, Boone, Bremer, Buchanan, Butler, Cedar, Clayton, Dallas, Delaware, Dubuque, Fayette, Greene, Grundy, Iowa, Jackson, Jones, Linn, Marshall, Muscatine, Polk, Scott, Tama, Warren and Woodbury
Specialty Networks
- Behavioral Health: Optum
- Chiropractic: Optum
- OptumHealth Complex Care Solution (for transplants except liver provided at UnityPoint)
- Express Scripts (pharmacy network)
Benefits
- Comprehensive coverage for preventive and other care needs
- All essential health benefits covered
- Mayo Clinic Centers of Excellence program allows patients to receive care at Mayo Clinic and/or the University of Iowa. Medica may provide a travel, lodging and meal stipend for the patient and a companion during significant health care issue
Claim Submission
Medical claims should be submitted to:
Medica
PO Box 21051
Eagan, MN 55121-0051
Electronic pay ID: 12422
Medica Behavioral Health claims should be submitted to:
Medica
PO Box 30757
Salt Lake City, UT 84130
Electronic pay ID: 87726
Medica Chiropractic claims should be submitted to:
Medica
PO Box 212
Minneapolis, MN 55440-0212
Electronic pay ID: 41161
Empower by Medica
Empower by Medica is an accountable care system product being offered in the Individual and Family Business (IFB) market in Johnson county in Iowa. The network features University of Iowa Health Care providers. No referral is needed to see in -network specialists. Members do not have benefits for out-of-network providers. To verify which providers are included in this product's network, see the provider directory on Medica.com.
Identification Card Example
Availability
- For Individual and Family Business (IFB)
- Service area is Johnson county in Iowa
Specialty Networks
- Behavioral Health: Optum
- Chiropractic: Optum
- OptumHealth Complex Care Solution (for transplants)
- Express Scripts (pharmacy network)
Network
- University of Iowa Hospitals & Clinics
Benefits
- Comprehensive coverage for preventive and other care needs
- All essential health benefits covered
- Mayo Clinic Centers of Excellence program allows patients to receive care at Mayo Clinic.
Claim Submission
Medical claims should be submitted to:
Medica
PO Box 21051
Eagan, MN 55121-0051
Electronic pay ID: 12422
Medica Behavioral Health claims should be submitted to:
Medica
PO Box 30757
Salt Lake City, UT 84130
Electronic pay ID: 87726
Medica Chiropractic claims should be submitted to:
Medica
PO Box 212
Minneapolis, MN 55440-0212
Electronic pay ID: 41161
Medica Choice National
Medica Choice National provides access to a large, national network with thousands of providers. Plus, the freedom to see any network provider at any time, including direct access to specialists. Medica Choice National provides single health plan for employers with employees located both locally and across the country. It is available to employers headquartered in Nebraska and Iowa.
Identification Card Example
Highlights
- Available for both self-insured and fully insured employer groups.
- Allows members open access to providers across the nation.
- Comprises Medica Choice National, Midlands Choice network in Nebraska and Iowa, and the First Health network outside of Nebraska and Iowa.
Specialty Networks
- Chiropractic: Optum
- Behavioral Health: Optum
- OptumHealth Complex Care Solution (for transplants)
- Express Scripts (pharmacy network)
- Specialty Pharmacy: Accredo
Claim Submission
Medical claims should be submitted to:
Medica
PO Box 211435
Eagan, MN 55121
Electronic pay ID: 71890
Medica Behavioral Health claims should be submitted to:
Medica
PO Box 30757
Salt Lake City, UT 84130
Electronic pay ID: 87726
Medica Chiropractic claims should be submitted to:
Medica
PO Box 212
Minneapolis, MN 55440-0212
Electronic pay ID: 41161
Medica Administrative Resources
The Medica Administrative Manual is a resource for physicians and healthcare providers that provides accurate and timely information about Medica products, programs, policies and procedures. The manual contains specific Qualified Health Plan(QHP) requirements, including the QHP requirements for Indian Health Care Providers. Midlands Choice providers shall comply with the Medica Administrative Manual when providing services to Medica members.
The manual may be found on the Medica.com website in the “For Providers” section under Administrative Resources or by clicking on the links below:
Medica Administrative Manual
Qualified Health Plan(QHP) Requirements
Product Information