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2021 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 2020 documents?

Iowa Plans

Document Care Type
Summary of Benefits and Coverage (SBC) Silver Copay (PDF) Bronze Copay (PDF)
Policy of Coverage
Silver Copay (PDF) Bronze Copay (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Bronze HSA (PDF)
Policy of Coverage
Bronze HSA (PDF)

Nebraska Plans

Document Care Type
Summary of Benefits and Coverage (SBC) Silver Copay (PDF) Bronze Copay (PDF)
Policy of Coverage
Silver Copay (PDF) Bronze Copay (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Bronze HSA (PDF) 
Policy of Coverage
Bronze HSA (PDF)
Date: 3/25/2023 7:02:43 PM Version: 4.0.30319.42000 Machine Name: PWIM4-CDWEB01