Medica Essential


Medica Essential

Care system network

With Medica EssentialSM, you enroll in a primary care clinic. The clinic coordinates your care and will help you find a specialist when you need one. Whenever you need care, you’ll start at your primary care clinic.

Plan Highlights

  • Mid-size regional network of care systems
  • National network coverage when you travel
  • A medical home – you choose a primary care clinic/care system
  • Care is coordinated by your primary care clinic

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Benefit Summary for Medica Essential

Network Information
Network Type Care system network
Network Area Minnesota, eastern North Dakota and northwestern Wisconsin
Special Features You enroll in a primary care clinic. This clinic coordinates your overall care and is affiliated with a care system.
Referrals Needed You can see any provider within your care system without a referral. To receive care from a provider outside your care system, you must receive a referral from your primary care clinic.

How it Works

With Medica Essential, you enroll in a primary care clinic. You can change your primary care clinic as often as once a month.  Your clinic is affiliated with a care system, which is a group of primary care clinics, specialists and hospitals that work together to give you the care you need. So when you pick your primary care clinic, you’re also picking a care system. Each family member can choose a different care system within the Medica Essential network. Or you can all be in the same care system but choose different primary care clinics within that system.

Medica Essential care systems:

  • Altru Health System
  • Children's Health Network
  • Essentia Health - West Region
  • Fairview Physician Associates
  • HealthEast Care System
  • Integrity Health Network
  • St. Luke’s Care System

A few things to keep in mind:

  • Whenever you need care, you’ll always start at your primary care clinic.
  • For your highest level of benefits, get all of your care from providers in your care system.
  • If you can’t get the care you need within your care system, you can ask for a referral to see a provider in another care system. Learn more about referrals in this tip sheet.

» Find a physician or facility in the Medica Essential network.

» Learn how to enroll in a primary care clinic

» See a map of provider locations in the Essential network.

Sample Certificate of Coverage

You can view a sample 2018 coverage document (called a Certificate of Coverage), which shows examples of what an Essential plan may cover for fully insured members. To view this sample, choose the state your employer is based in, then choose “Small groups” if your company has 50 or fewer employees, or “Large groups” if your employer has 51 or more employees.

• Small groups: 2018 
• Large groups: 2018 
Large groups (Medica Health Plans HMO policy): 2018

• Small groups: 2018 
• Large groups: 2018 

NOTE: This is not your actual certificate of coverage. This is only an example of what services may be covered. For information about specific benefits or levels of coverage (such as copay, coinsurance or deductible amounts), please contact your employer.

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