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My Coverage

For Medica Advantage Solution H3632-001 (PPO) Members

Looking for a quick overview of your plan benefits?

Here's a summary of your plan benefits and common associated costs.

  • $0 copayment for primary care office visits
  • $35 copayment for specialist office visits
  • $90 emergency room copayment
  • $325 per day hospital inpatient copayment for Days 1-5
  • $0 copayment for Medicare-covered preventive services

For a complete record of your plan benefits and any plan notices, see your member plan documents.

Member plan documents


Plan Features

Primary Health System (PHS)

We encourage you to select a Primary Health System (PHS) from which you may receive care. A PHS is a group of network doctors and health care professionals who can help you manage your total health, from getting needed preventive screenings and care to coordinating care for multiple health conditions. Your PHS aims to help you achieve your health goals. You can still get care from other in-network doctors and health care professionals and you don’t need a referral for covered services.

You PHS is identified on your Medica ID card. You can change your PHS for any reason, at any time. Simply call Member Services at the number on the back of your Medica ID card and request to make a change to your PHS. 

Search all PHS providers

One Pass

Your plan includes a fitness benefit through One Pass with unlimited access to a national network of more than 20,000 fitness clubs, in-person, on-demand and live streaming fitness classes. A personalized, online brain training program to help improve memory, attention, focus and brain speed.  For more information visit or call 1-877- 504-6830 (TTY: 711), available Monday-Friday, 8 a.m.-9 p.m. (Central).

Over-the-Counter Drugs and Supplies Allowance

Your plan offers a benefit allowance you can use toward the purchase of eligible over-the-counter (OTC) health and wellness products. This quarterly allowance varies by plan. You can place orders online at or by phone. To see the list of available products, view the OTC Catalog.

OTC Catalog (PDF)

Dental, Hearing and Eyewear Reimbursement Offered

Advantage Solution offers reimbursement for non-Medicare covered dental services provided by any licensed dentist. This covers both preventive and restorative care.

Dental Reimbursement:

  • Annual reimbursement with the H3632-001 (PPO) plan is up to $750 per year
  • You can find the dental reimbursement forms in your 2021 Forms for Members booklet that came as a part of your new member kit, or you can call Medica Customer Service and ask for the form


  • $0 copay for annual routine hearing exam
  • Low copays ($549 or $799) for EPIC private label Vista hearing aids in various styles and colors
  • Extensive discounts for digital hearing aids from all major brands like Starkey, Beltone, Widex and many more
  • Free one-year supply of batteries
  • Follow-up care for one year with up to three exams to fit and evaluate your hearing aids at no cost for Reserve level hearing aids; $50 copay for Basic level hearing aids
  • Three-year extended repair/loss and damage warranty

Eyewear Reimbursement:

  • Medica Advantage Solution with CHI Health plans offer an allowance for prescription eyewear. Your annual reimbursement varies by plan. The H3632-001 (PPO) plan reimburses up to $150 per year
  • You can find the eyewear reimbursement forms in your 2021 Forms for Members booklet that came as a part of your new member kit, or you can call Medica Customer Service and ask for the form

Member forms

Health Advocacy and Nurse LineHealth Advocate

You and your family have a place to turn for trusted advice and information when you need it most. Through one simple call, you can consult with a nurse to get support for non-urgent illnesses or receive guidance on treatment options. You can also work with a personal health advocate who can help you with a variety of health and insurance-related issues. For more information, visit or call 1-866-668-6548 (TTY: 711), available 24 hours a day, 7 days a week (Central) .


Discount Programs

As a Medica Medicare member, you can get discounts on a variety of health and leisure goods and services through our value-added programs at no extra cost.

Discounts on value-added services

Healthy Savings Program®

Eligible members with certain health conditions may have access to the Healthy Savings Program®. This program helps you save 50% on fresh fruits and vegetables up to $65 per quarter at participating retail grocers. Scan your Healthy Savings card or bar code from the app at checkout to receive your savings. The large network of retailers includes Hy-Vee, Baker's, Walmart and many more.

About Healthy Savings Program

Preventive Care

Many preventive care services and screenings are covered at no cost to you when received from in-network providers. This includes immunizations such as flu and pneumonia shots.

About preventive care

Transportation Services

For Iowa and Nebraska plans

You are covered for up to 12 trips per calendar year for medical care within the plan service area using our Provide-A-RideSM program. A trip is considered one-way, non-emergency transportation by taxi to a plan approved health-related location. There is a maximum distance of 60 miles per one-way trip. Members can be picked up at home, school, work or shelter. Member can be dropped off at any location within 30 miles. To schedule a ride, please contact Medica Customer Service toll free at 1-866-398-7374 (TTY 711). Arrangements must be made 72 hours in advance. You can use our Provide-A-Ride app to track your rides.

About the Provide-A-Ride app


Last Updated: December 2020

Date: 5/28/2023 4:48:53 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB01