Order Plan Materials by Mail

For Medica Individual & Family Plans Members

Member Information

First name

Last name

Medica ID number

Where do I find this?

Group / Policy

Where do I find this?

Phone number

Street address

City

State

ZIP Code

Plan Materials

Select the materials you want sent to you via mail.

Which year's materials would you like to order?

2021

Information About Your Coverage

These documents tell you what services are covered under your plan, what you need to do to get covered services, and your rights and responsibilities.

"How to Get the Care You Need" booklet

Medica Privacy Notice

Policy of Coverage

Summary of Benefits and Coverage (SBC)

Plan Forms

Use the following forms to change your personal information or to request reimbursement of health care expenses.

Personal information change form

Eyewear claim form

Medical claim form