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Select your state and then your plan name (Care Type on your ID card) below to see your legal plan documents.
Premier ($125.00 monthly premium)
Annual notice of changes (PDF)
Evidence of coverage (PDF)
Core ($69.00 monthly premium)
Thrift ($34.00 monthly premium)
Enhanced with Rx ($202.50 monthly premium) Enhanced with Rx2 ($223.10 monthly premium) Enhanced with no Rx ($157.00 monthly premium)
Basic with Rx ($111.70 monthly premium) Basic with Rx2 ($143.20 monthly premium) Basic with no Rx ($79.00 monthly premium)
Value with Rx ($105.80 monthly premium) Value with no Rx ($67.00 monthly premium)
Thrift with Rx ($73.20 monthly premium) Thrift with no Rx ($34.00 monthly premium)
Standard with Rx ($30.90 monthly premium) Standard with no Rx ($0 monthly premium)
Premium with Rx ($250.60 monthly premium) Premium with no Rx ($189.00 monthly premium)
Core with Rx ($132.00 monthly premium) Core with no Rx ($79.00 monthly premium)
Standard with no Rx ($0 monthly premium)
Formulary (PDF)
Focus with Rx ($125.80 monthly premium) Focus with no Rx ($89.00 monthly premium)
Total with Rx ($241.70 monthly premium) Total with no Rx ($185.00 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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