Forms
Summary of Benefits and Coverage - Choice Passport Network
$1,500 CoPay Summary and Coverage - Choice Passport Network
$3,200 HSA Summary and Coverage - Choice Passport Network
$4,500 HSA Summary and Coverage - Choice Passport Network
$6,350 HSA Summary and Coverage - Choice Passport Network
Summary of Benefits and Coverage - Park Nicollet/Health Partners Network (Minnesota Residents Only*)
$1,500 CoPay Summary and Coverage - Park Nicollet/Health Partners
$3,200 HSA Summary and Coverage - Park Nicollet/Health Partners
$4,500 HSA Summary and Coverage - Park Nicollet/Health Partners
$6,350 HSA Summary and Coverage - Park Nicollet/Health Partners
*Minnesota Residents choose between networks at the time they choose their plan. To learn more about the networks, visit our Network Page
Medica Insurance Company
Phone: 855-727-5178
www.medica.com