For Healthcare Providers:

Medica

Medica offers three individual and family business(IFB) health plan products in Iowa and Nebraska.

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 can also access out-of-network providers but may have higher deductibles and coinsurance than for in-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
  • Bryan Health
  • CHI Health*
  • Great Plains Health
  • Mary Lanning Health Care
  • Methodist Health System
  • UnityPoint Health

*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 the following Iowa counties: Adair, Adams, Allamakee, Appanoose, Audubon, Buena Vista, Calhoun, Carroll, Cass, Cerro Gordo, Chickasaw, Clarke, Clinton, Crawford, Davis, Decatur, Des Moines, Floyd, Franklin, Fremont, Guthrie, Hamilton, Hancock, Hardin, Henry, Howard, Humboldt, Ida, Jasper, Jefferson, Johnson, Keokuk, Kossuth, Lee, Louisa, Lucas, Madison, Mahaska, Marion, Mills, Mitchell, Monona, Monroe, Montgomery, Page, Palo Alto, Pocahontas, Poweshiek, Ringgold, Sac, Shelby, Story, Taylor, Union, Van Buren, Wapello, Washington, Wayne, Webster, Winnebago, Winneshiek, Worth and Wright
Specialty Networks
  • Chiropractic, behavioral health and transplants are included in the Midlands Choice network.
  • CVS Caremark, (pharmacy network)
Benefits
  • Comprehensive coverage for preventive and other care needs
  • All essential health benefits covered.
National Provider Network
  • Network benefits can be accessed nationwide by seeing a provider in the Medica Insure Travel Program when traveling outside all counties in Iowa and Nebraska.
Claim Submission

Claims should be submitted to:
Medica
PO Box 981647
El Paso, TX 79998-1647
Electronic pay ID: 12422

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 can also access out-of-network providers but may have higher deductibles than for in-network providers. To verify which providers are included in this product's network, see the provider directory on Medica.com.

Identification Card Example(effective starting with 1/1/18 dates of service)

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
  • Chiropractic, behavioral health and transplants are included in the Inspire network.
  • CVS Caremark (pharmacy network)
Benefits
  • Comprehensive coverage for preventive and other care needs
  • All essential health benefits covered
National Provider Network
  • Network benefits can be accessed nationwide by seeing a provider in the Inspire by Medica Travel Program when traveling outside all counties in Iowa and Illinois.
Claim Submission

Claims should be submitted to:
Medica
PO Box 981647
El Paso, TX 79998-1647
Electronic pay ID: 12422

Medica with CHI Health

Medica with CHI Health is an accountable care system product being offered in the individual and family business (IFB) market in Nebraska and Iowa.The network features UniNet Health providers, including CHI Health.No referral is needed to see in-network specialists. Members can also access out-of-network providers but may have higher deductibles than for in-network providers. To verify which providers are included in this product's network, see the provider directory on Medica.com.

Identification Card Example - NE(effective starting with 1/1/18 dates of service)

Identification Card Example - IA(effective starting with 1/1/18 dates of service)

Availability
  • For Individual and Family Business(IFB)
  • Service area includes Harrison and Pottawattamie counties in Iowa and the following counties in Nebraska: Buffalo, Burt, Butler, Cass, Colfax, Cuming, Dodge, Douglas, Fillmore, Hall, Johnson, Lancaster, Nance, Nemaha, Nuckolls, Otoe, Pawnee, Saline, Sarpy, Saunders, Seward, Thayer or Washington
Specialty Networks
  • Behavioral health and transplants are included in the UniNet network
  • Chiropractic uses the Midlands Choice network
  • CVS Caremark (pharmacy network)
Network
  • Features UniNet Health providers
Benefits
  • Comprehensive coverage for preventive and other care needs
  • All essential health benefits covered
National Provider Network
  • Network benefits can be accessed nationwide by seeing a provider in the Medica with CHI Health Travel Program when traveling outside all counties in Nebraska and the following counties in Iowa: Adair, Adams, Audubon, Boone, Buena Vista, Calhoun, Carroll, Cass, Cherokee, Clay, Crawford, Dallas, Dickinson, Emmet, Fremont, Greene, Guthrie, Humboldt, Ida, Kossuth, Lyon, Madison, Mills, Monona, Montgomery, O’ Brien, Osceola, Page, Palo Alto, Plymouth, Pocahontas, Ringgold, Sac, Shelby, Sioux, Taylor, Union, Webster and Woodbury
Claim Submission

Claims should be submitted to:
Medica
PO Box 981647
El Paso, TX 79998-1647
Electronic pay ID: 12422

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