Medica Solo | Minnesota Most Affordable Health Insurance

PLAN HIGHLIGHTS	LOW DEDUCTIBLE OPTION	MIDDLE DEDUCTIBLE	HIGH DEDUCTIBLE
ANNUAL DEDUCTIBLE The deductible is subject to a "cost of living" increase on an annual basis, in an amount no greater than the Consumer Price Index, which is the federal measure of the rate of inflation.	$3,000* 612-991-3546 for paper application	$6,000*	$9,000*
ANNUAL OUT-OF-POCKET MAXIMUM FOR COVERED MEDICAL SERVICES AND SUPPLIES* The out-of-pocket maximum is subject to a "cost of living" increase on an annual basis, in an amount no greater than the Consumer Price Index, which is the federal measure of the rate of inflation.	Equal to deductible. Coverage is generally 100% after deductible.*
OFFICE VISITS For non-preventive office visits in any setting (e.g., physician, mental health, chiropractor). Your co pay applies toward your deductible and out-of-pocket maximum.	$30 co pay paid by you, with any remainder paid by Medica for each of the first three visits per calendar year. After third visit, deductible applies.*	$40 co pay paid by you, with any remainder paid by Medica for each of the first three visits per calendar year. After third visit, deductible applies.*	$50 co pay paid by member, with any remainder paid by Medica for each of the first three visits per calendar year. After third visit, deductible applies.*
PREVENTIVE CARE (includes routine physicals, cancer screening and one refractive eye exam per calendar year)	$200 first dollar (cumulative), then applies to deductible.*
URGENT CARE VISIT Your co pay applies toward your deductible and out-of-pocket maximum.	For first visit each calendar year, $100 co pay paid by you, with any remainder paid by Medica; subsequent visits apply to the deductible.
EMERGENCY ROOM VISIT Your co pay applies toward your deductible and out-of-pocket maximum.	For first visit each calendar year, $200 co pay paid by you, with any remainder paid by Medica; subsequent visits apply to the deductible.* Co pay applies to facility charges only; professional fees apply toward the deductible.*
PRESCRIPTION DRUGS Deductible does not apply.	$5 generic co pay/$50 single-source brand-name formulary co pay / $90 brand-name non-formulary co pay. You pay the difference when a generic is available and is not chosen. Specialty drug coinsurance paid by you: 20% formulary/ 40% non-formulary. Specialty drug maximum paid by you per script: $200 formulary / $400 non-formulary. No coverage at out-of-network pharmacies. Several categories of drugs are excluded, including infertility and erectile dysfunction.
EYEWEAR Eyeglasses and contact lenses.	Maximum of $50 covered per calendar year.
INPATIENT AND OUT PATIENT LAB AND X-RAY SERVICES	100% after deductible.*
INPATIENT AND OUTPATIENT HOSPITAL SERVICES
AMBULANCE
MEDICAL SUPPLIES
CHIROPRACTIC, OCCUPATIONAL, PHYSICAL AND SPEECH THERAPY
HOME HEALTH CARE UP TO $25,000 PER CALENDAR YEAR
MENTAL HEALTH CARE
SUBSTANCE ABUSE
SKILLED NURSING FACILITY SERVICES (limited to 120 days per calendar year)
PRENATAL CARE	100%*
WELL-CHILD SERVICES TO AGE 6, IMMUNIZATIONS TO AGE 18	100%*
MATERNITY LABOR, DELIVERY AND POST PARTUM CARE	No coverage.
LIFETIME MAXIMUM	$5 Million

* You receive the highest level of benefits and the lowest out-of-pocket costs when you use a network provider. If you choose to receive services from a non-network provider, you will be responsible for the deductible and the difference between Medica's reimbursement (generally based on a fee schedule) and the non-network provider's billed charges. The difference between Medica's non-network reimbursement amount and the non-network provider's billed charges does not apply to your deductible or your out-of-pocket maximum.

Pre-existing conditions that you had within the first six months before your enrollment date may not be covered during the first 18 months following your enrollment date. However, if you have maintained continuous health care coverage, the pre-existing limitation applies during the first 12 months following your enrollment date. In addition, this 12-month period may be reduced by the amount of time you maintained qualifying coverage before your enrollment date.

Medica Solo covers all but a co pay for the first three times you are sick and have an office visit. Your office visit co pay applies to the doctor’s charge, but other charges for services received that day, such as for lab work or x-rays, will apply toward your deductible. If you’re 19–29 years old, Medica Solo costs about $59–$87 per month, depending on your health and the annual deductible you choose: $3,000, $6,000, or $9,000. Co pays apply to your deductible. If your annual expenses exceed your deductible, the plan kicks in and pays 100%, up to $5 million over your lifetime. See Plan Highlights for more details on the following:

DOCTORS

The plan pays $200 right away for a year of physicals and routine care. If you get sick, your copay depends on your plan: $30, $40, or $50 for each visit (up to 3 times a year).

EMERGENCIES

You pay $100 for your first urgent care visit and $200 for your first visit to the ER.

Prescriptions

Generics save you money. The generic drug co pay is $5, while brand-name drugs cost $50–$90, or more. There is a $2,000 annual maximum benefit for prescription drugs.

SPECS

The plan pays $50 a year for glasses and contacts.

Medica Solo Highlights

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