For Healthcare Providers:

Medica

Medica offers four 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 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
  • 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
  • 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 Iowa
Specialty Networks
  • OptumHealth Complex Care Solution (for transplants)
  • CVS Caremark, (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
  • Travel benefit: Members access Private Healthcare Systems (PHCS) network, part of MultiPlan
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 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
  • OptumHealth Complex Care Solution (for transplants except liver provided at UnityPoint)
  • CVS Caremark (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
  • Travel benefit: Members access Private Healthcare Systems (PHCS) network, part of MultiPlan
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 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 - NE

Identification Card Example - IA

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 and Washington
Specialty Networks
  • OptumHealth Complex Care Solution (for transplants)
  • CVS Caremark (pharmacy network)
Network
  • Features UniNet Health providers
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. Medica may provide a travel, lodge and meal stipend for the patient and a companion during significant health care issue
  • Travel benefit: Members access Private Healthcare Systems (PHCS) network, part of MultiPlan
Claim Submission

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

Elevate by Medica

Elevate by Medica is an accountable care system product being offered in the individual and family business (IFB) market in Nebraska and Iowa. The network features Methodist Health System and Nebraska Medicine 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 - IA

Identification Card Example - NE

Availability
  • For Individual and Family Business (IFB)
  • Service area includes 2 counties in Nebraska (Douglas and Sarpy) and 2 counties in Iowa (Mills and Pottawattamie)
Specialty Networks
  • OptumHealth Complex Care Solution (for transplants)
  • CVS Caremark (pharmacy network)
Network
  • Nebraska Medicine
  • Methodist Health System
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. Medica may provide a travel, lodging and meal stipend for the patient and a companion during significant health care issue
  • Travel benefit: Members access Private Healthcare Systems (PHCS) network, part of MultiPlan
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

Product Information