Frequently Asked Questions
Q: What is My Plan by Medica?
A: My Plan by Medica is a new health care solution. It provides employers a way to offer more choices to their employees and employees a way to personalize their health plan to more closely meet their individual needs. With My Plan, an employer sets a defined budget for each of its employees to spend on healthcare coverage. Employees purchase a plan that fits their specific needs, choosing from a range of 20 different plan options.
Q: What is the minimum employer contribution?
A: The employer must contribute a minimum of 50% of the single premium for the MIC PP $2000-$30 plan, which is the mid-priced plan.
Q: How are the employer’s plan contributions determined?
A: Other than the minimum amount, the choice is entirely up to the employer based on the company’s overall budget goals. Q. Can the employer contribute to the premium based on a percent of each plan’s premium? Can the employer set different contribution amounts for different groups of employees? A. No. The contribution must be defined as a dollar amount, not a percentage, and must be equal for each employee. Q. Can the employer contribute different amounts for different tiers of coverage (i.e., a different amount for single, single plus one, and family coverage)? Yes. A single, defined contribution amount may be set for each different tier.
Q: Will my employees be able to see all 20 plan options if they want?
A: Employees take a My Plan survey to assess their unique needs as well as their own health and financial situation. Then My Plan provides them with the top 3 benefit plans that best match their needs. At any time, employees may also choose to see all 20 plans available.
Q: Will employees need to complete individual health questionnaires to apply for coverage?
A: No. Q. What is the process for obtaining this coverage? A. The employer completes a general questionnaire as part of the process of applying for this insurance coverage. If they are accepted for coverage, Medica requires 45 days to implement this program.
Q: How do employees complete their enrollment process?
A: myplanbymedica.com is a customized website and includes the My Plan Decision Support tool. This site is intuitive and easy to use as employees complete their plan selection and enrollment process. My Plan Advisors are also available to help answer questions about enrollment and plan selection.
Q: Once enrolled, how do members access information about their My Plan coverage?
A: My Plan members have access to information about Medica tools and resources, can view plan benefits, EOBs and account specific information on mymedica.com.
Q: What network(s) does this plan use?
A: My Plan by Medica utilizes a national network which provides coverage regardless of where the employee or dependent is located. Participants in Minnesota, North Dakota, South Dakota and western Wisconsin will use the Medica network. In all other areas of the country, participants will use the UHC (United HealthCare) network.
Q: Is coverage offered in all 50 states?
A: Yes.
Q: Do the plans have out-of-network coverage?
A: Yes, all 20 medical plans include out-of-network coverage.
Q: Can employees change their plan selection throughout the year?
A: Each year, employees have a choice in their plan selection. If their needs around coverage and cost changes, they have an opportunity to make an alternative plan selection at annual renewal. Changes may be made at times other than annual renewal only if the employee has a qualifying event allowing changes.
Q: How do the deductible and out-of-pocket maximums work?
A: The medical plan operates on a calendar year basis, so members satisfy their deductibles and out-of-pocket maximums within each calendar year.
Q: How are new hires, terminations and life events managed?
A: Doherty will manage new hires, terminations and life events through the My Plan Employer Portal.
Q: If the employer switches to My Plan mid-year, will the deductible and out-of-pocket expenses from the previous year transfer to My Plan?
A: Medica provides deductible and out-of-pocket credits just as they do for all business sold at times other than the calendar year.
Q: When does this plan renew?
A: January 1.
Q: Can the employer choose its own HSA vendor?
A: No. My Plan includes an integrated HSA with OptumHealth Financial Services.
Q: Does the employer have to contribute to the HSA?
A: Employers have the option to contribute to the employee’s HSA, but they are not required to do so.
