$2,500 Elect Plan

Image

$2,500 Elect Plan

Care system network

With Medica Elect®, you enroll in a primary care clinic. The clinic coordinates your care and will help you find a specialist when you need one. Whenever you need care, you’ll start at your primary care clinic.

What are the features?

  • A medium-sized regional network 
  • Nationwide coverage when you travel
  • A medical home – you choose a primary care clinic and receive care from providers in your care system
  • Care is coordinated by your primary care clinic

How does it work?

With Medica Elect, you enroll in a primary care clinic. You can change your primary care clinic as often as once a month. Your clinic is affiliated with a care system, which is a group of primary care clinics, specialists and hospitals that work together to give you the care you need. So when you pick your primary care clinic, you're also picking a care system. Each family member can choose a different care system within the Medica Elect network. Or you can all be in the same care system but choose different primary care clinics within that system.

Medica Elect care systems:

  • Allina Health
  • Children's Health Network
  • Hennepin County Medical Center
  • Integrity Health Network
  • Lakeview Medical Care System
  • Minnesota Healthcare Network
  • Park Nicollet Health Services (Please note: The Park Nicollet First care system includes hundreds of doctors at more than 20 neighborhood Park Nicollet clinics and eight specialty centers. The network does NOT include the HealthPartners clinics.)
  • Riverway/North Suburban Clinics
  • St. Luke’s Care System

A few things to keep in mind:

  • Whenever you need care, you’ll always start at your primary care clinic.
  • For your highest level of benefits, get all of your care from providers in your care system.
  • If you can’t get the care you need within your care system, you can ask for a referral to see a provider in another care system. Learn more about referrals in this tip sheet.

» View the Summary of Benefits and Coverage for the $2,500 Elect Plan.

» Find a physician or facility in the Medica Elect network.

» See a map of provider locations in the Elect network.

How to Choose a Primary Care Clinic

With Medica Elect, you enroll in a primary care clinic (PCC). This clinic coordinates your overall care and will help you find a specialist when you need one. Whenever you need care (unless it's an emergency), always start at your primary care clinic.

Each family member on your plan can choose their own primary care clinic. For example, your child's PCC may be a pediatric clinic, while yours may be a family practice clinic.

When you enroll in your plan through the City of Saint Paul's enrollment system, you'll be asked to select your primary care clinic. 

» Find a physician or facility in the Medica Elect network.

Benefit Summary for $2,500 Elect Plan

Friendly reminder: coinsurance is your share of the costs of a covered health care service, calculated as a percentage. Coinsurance applies after you've met your deductible.
Network Benefits
Overall deductible $2,500 per person/ $3,500 per family in-network and $3,000 per person/ $5,500 per family for out-of-network services.
Out-of-pocket limit $3,500 per person/ $3,500 per family in-network. $5,000 per person/ $7,000 per family for out-of-network services.
If you visit a health care provider's office or clinic
Primary care visit 20% coinsurance
Chiropractic visit 20% coinsurance
Convenience care visit 20% coinsurance
Specialist visit 20% coinsurance
Preventive care/screening/immunization No charge. Deductible does not apply.
If you have a test
Diagnostic test - lab 20% coinsurance
Diagnostic test - x-ray 20% coinsurance
Imaging (CT/PET scans, MRI) 20% coinsurance
If you need drugs to treat your illness or condition
Generic drugs Retail: $10/ prescription Deductible does not apply. Mail order: $20/ prescription Deductible does not apply.
Preferred brand drugs Retail: $35/ prescription Deductible does not apply. Mail order: $70/ prescription Deductible does not apply.
Non-preferred brand drugs Retail: $50/ prescription Deductible does not apply. Mail order: $100/ prescription Deductible does not apply.
Specialty drugs Preferred: 20% coinsurance. No more than $200 copay/ prescription. Deductible does not apply. Non-Preferred: 30% coinsurance. Deductible does not apply.
If you have outpatient surgery
Facility fee (e.g., ambulatory surgery center) 20% coinsurance
Physician/surgeon fees 20% coinsurance
If you need immediate medical attention
Emergency room care 20% coinsurance
Emergency medical transportation 20% coinsurance
Urgent care 20% coinsurance
If you have a hospital stay
Facility fee (e.g., hospital room) 20% coinsurance
Physician/surgeon fees 20% coinsurance
Network information
Network type Care system network
Network area Minnesota and northwestern Wisconsin
Special features You enroll in a primary care clinic. This clinic coordinates your overall care and is affiliated with a care system.
Referrals needed You can see any provider within your care system without a referral. To receive care from a provider outside your care system, you must receive a referral from your primary care clinic.

Compare Plans

You can compare this plan side-by-side with up to two other plans to see the differences between their benefits.

Compare Plans
 
 

Enrollment Instructions

To enroll, log in to Employee Self Service (using a computer inside the City network) to enroll.

You'll need your City network (Active Directory, username and password.

mymedica.com

Once your plan starts, register on mymedica.com to manage your health plan. Order ID cards, find out what's covered, track your claims and more!

Visit mymedica.com

Additional Benefits from the City of Saint Paul

The City of Saint Paul offers a variety of non-medical employee benefits.

» Learn more about non-medical employee benefits.