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2021 Medica with Healthier You 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?

Kansas 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)  Silver Share (PDF) Bronze Share Plus (PDF)
Policy of Coverage
Gold Share (PDF) Silver Share (PDF) Bronze Share Plus (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Bronze Value (PDF) 
Policy of Coverage
Bronze Value (PDF)
Date: 3/25/2023 6:41:01 PM Version: 4.0.30319.42000 Machine Name: PWIM4-CDWEB01