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2020 Elevate by Medica Plan Documents

To see your summary of benefits and coverage (SBC) and policy of coverage documents, select your state and plan below.

Looking for the 2021 plan documents?

Iowa Plans

Document Care Type
Summary of Benefits and Coverage (SBC) Bronze Copay (PDF)
Policy of Coverage
 Bronze Copay (PDF)
Document Care Type  
Summary of Benefits and Coverage (SBC) Bronze HSA (PDF) Bronze HSA Plus (PDF)
Policy of Coverage
 Bronze HSA (PDF) Bronze HSA Plus (PDF)
Catastrophic
Summary of Benefits and Coverage (PDF)
Policy of Coverage (PDF)
Document Care Type        
Summary of Benefits and Coverage (SBC) Gold Share Limited (PDF) Bronze Copay Limited (PDF) Bronze HSA Limited (PDF) Bronze HSA Plus Limited (PDF) Bronze Share Plus Limited (PDF)
Policy of Coverage
 Gold Share Limited (PDF) Bronze Copay Limited (PDF) Bronze HSA Limited (PDF) Bronze HSA Plus Limited (PDF) Bronze Share Plus Limited (PDF)
Document Care Type        
Summary of Benefits and Coverage (SBC) Gold Share Zero (PDF) Bronze Copay Zero (PDF) Bronze HSA Zero (PDF) Bronze HSA Plus Zero (PDF) Bronze Share Plus Zero (PDF)
Policy of Coverage
 Gold Share Zero (PDF) Bronze Copay Zero (PDF) Bronze HSA Zero (PDF) Bronze HSA Plus Zero (PDF) Bronze Share Plus Zero (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Gold Share (PDF) Bronze Share Plus (PDF)
Policy of Coverage Gold Share (PDF) Bronze Share Plus (PDF)

Nebraska Plans

Document Care Type
Summary of Benefits and Coverage (SBC) Bronze Copay (PDF)
Policy of Coverage
 Bronze Copay (PDF)
Document Care Type  
Summary of Benefits and Coverage (SBC) Bronze HSA (PDF)  Bronze HSA Plus (PDF)
Policy of Coverage
 Bronze HSA (PDF) Bronze HSA Plus (PDF)
Catastrophic
Summary of Benefits and Coverage (PDF)
Policy of Coverage (PDF)
Document Care Type        
Summary of Benefits and Coverage (SBC) Gold Share Limited (PDF) Bronze Copay Limited (PDF) Bronze HSA Limited (PDF) Bronze HSA Plus Limited (PDF) Bronze Share Plus Limited (PDF)
Policy of Coverage
 Gold Share Limited (PDF) Bronze Copay Limited (PDF) Bronze HSA Limited (PDF) Bronze HSA Plus Limited (PDF) Bronze Share Plus Limited (PDF)
Document Care Type        
Summary of Benefits and Coverage (SBC) Gold Share Zero (PDF) Bronze Copay Zero (PDF) Bronze HSA Zero (PDF) Bronze HSA Plus Zero (PDF) Bronze Share Plus Zero (PDF)
Policy of Coverage
 Gold Share Zero (PDF) Bronze Copay Zero (PDF) Bronze HSA Zero (PDF) Bronze HSA Plus Zero (PDF) Bronze Share Plus Zero (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Gold Share (PDF) Silver Share (PDF) Bronze Share Plus (PDF)
Policy of Coverage Gold Share (PDF) Silver Share (PDF) Bronze Share Plus (PDF)

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