Members

2021 Medica Quest Plan Documents

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

Oklahoma 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)

Document	Care Type
Summary of Benefits and Coverage (SBC)	Silver Copay (94% AV Level) – (PDF)	Silver Copay (87% AV Level) – (PDF)	Silver Copay (73% AV Level) – (PDF)
Policy of Coverage	Silver Copay (94% AV Level) – (PDF)	Silver Copay (87% AV Level) – (PDF)	Silver Copay (73% AV Level) – (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)	Silver Copay Limited (PDF)	Bronze Copay Limited (PDF)	Bronze Share Plus Limited (PDF)	Bronze HSA Limited (PDF)	Bronze Value Limited (PDF)
Policy of Coverage	Gold Share Limited (PDF)	Silver Copay Limited (PDF)	Bronze Copay Limited (PDF)	Bronze Share Plus Limited (PDF)	Bronze HSA Limited (PDF)	Bronze Value Limited (PDF)

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

Document	Care Type
Summary of Benefits and Coverage (SBC)	Bronze Value (PDF)
Policy of Coverage	Bronze Value (PDF)

Contact Us

1-888-592-8211 (TTY: 711)

8 a.m. – 6 p.m. (Central) Monday – Friday

Closed 8 – 9 a.m. Thursdays

About Your Coverage

Plan documents

Resources

About health savings accounts

bookletHow to Get the Care You Need