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Select your area and then your plan name (Care Type on your ID card) to see your legal plan documents and other plan information.
H6154-001 (HMO-POS) ($0 monthly premium)
Evidence of coverage (PDF)
Annual notice of changes (PDF)
Formulary (PDF)
H8889-001 (PPO) ($105.00 monthly premium)
H8889-003 (PPO) ($199.00 monthly premium)
H8889-005 (PPO) ($49.00 monthly premium)
H6154-002 (HMO-POS) ($59.00 monthly premium)
H6154-003 (HMO I-SNP) ($66.00 monthly premium)
H6154-004 (HMO I-SNP) ($16.00 monthly premium)
H8889-002 (PPO) ($99.00 monthly premium)
H8889-004 (PPO) ($120.00 monthly premium)
H0798-001 (HMO) ($0 monthly premium)
H3632-001 (PPO) ($39.00 monthly premium)
To get a copy of your Evidence of Coverage (EOC) or other plan documents, contact the Medica Customer Service phone number on the back of you Medica ID card
The easiest way to access your plan materials is to view or download them at the links above. If you prefer, we are able to send materials to you via mail.
Order plan materials by mail
Last Updated: October 2020
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