Medica

Medica

Medica is non-profit organization that provides customers with the choice in

selecting physicians and other health care providers. The organization serves only in the upper Midwest area, mostly in Minnesota, western Wisconsin, and eastern North Dakota. Members may choose many hospitals, clinics, and pharmacies within the provider's networks for less expensive co-payments and visit to the clinics. The organization has the highest accreditation from NCQA for Medica commercial and Medicaid HMO plans. Medica is also part of a preferred provider organization (PPO), which is known as the Select Care plan. This way, the organization is able to attract another market segment that offers members more choices outside of the provider's networks. To help enhance more choices and convenience for members, the organization offers the add-on package called the Travelers' Benefits. Since it is inconvenience and costs a lot for many travelers who use their insurance outside of the networks, the organization offers a competitive advantage for consumers by offering the additional travel benefits with the plans. With the Travelers' Benefits, members can use their plans outside of the provider's networks when they are out of town; however, it costs a little more to have the add-on package with the regular membership plan.

To help provide health care at lower costs for members, Medica offers many different plans for different customers' need. The organization offers to sell to five types of insurance plans targeting different needs. Those plans are for customers such as big businesses that have 51 plus employees, small businesses that has 2-50 employees, individual and family plans, Medicare and Seniors, and TPA & Labor. To ensure that the needs had been met, the organization offers more plans for big business customers that have 51 plus employees two additional plans than the small business customers. With larger seniors population needing the health care plans; the organization also offers a couple additional plans to fit the needs. Depending on the plans that member choose and the plans that their employers choose to offer for their employees, members may end up paying for their health insurance differently and receiving different benefits.

Medica is an organization that provides the highest benefits and members pay less when they get care from within the provider's networks. There are a few tips for members who choose to use service out of networks. The costs that members have to pay within the provider's networks are mostly co-payments and discounted payments for visit to the clinics. Using care out side of the provider's networks, it could cost 5 to 25 times more for members and that is not unusual. Medica will pay for the Non-Network Provider Reimbursement Amount (NNPRA) and whatever left, members will pay out of pocket. The disadvantage of having Medica as a health care provider is that you only get the most within the networks. Another disadvantage is that when you get care out side of networks, there will be longer reimbursement process. This is because Medica operates as HMO and PPO health care provider