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2021 Medica Insure 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) Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Policy of Coverage
Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Bronze HSA (PDF) 
Policy of Coverage
Bronze HSA (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Silver Share Bronze Share Bronze Share Plus (PDF)
Policy of Coverage Silver Share Bronze Share Bronze Share Plus (PDF)

Nebraska Plans

Document Care Type    
Summary of Benefits and Coverage (SBC) Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Policy of Coverage
Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Bronze HSA (PDF) 
Policy of Coverage
Bronze HSA (PDF)
Document Care Type    
Summary of Benefits and Coverage (SBC) Gold Share (PDF) Bronze Share (PDF) Bronze Share Plus (PDF)
Policy of Coverage
Gold Share (PDF) Bronze Share (PDF) Bronze Share Plus (PDF)
Date: 3/28/2023 4:21:30 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB01