Medical Plan Information
2021 Networks and Contributions
2020 Networks and Contributions
The premium amounts shown above will be deducted from each of your first two paycheck per month.
Enrolling in a Medical Plan
Most regular, full-time employees may enroll for benefit coverage to be effective on the first of the month following the first day of employment. Waiting periods and participation start dates can be found in the policy or collective bargaining agreement governing your employment.
Other employees may become eligible to enroll in the medical plan and HRA/VEBA due to provisions of the Affordable Care Act. If this applies to you, plan and enrollment information will be provided at the time you become eligible.
If you have questions on your eligibility for the medical plan, please contact the Benefits Office.
The City of Minneapolis Medical Plan features one plan design with a choice of provider networks. The plan provides coverage for a wide range of covered services including physician services, hospital services and prescription drugs.
- Eligible preventive services are paid at 100%. Other covered services are subject to an annual deductible.
- The annual deductible is $2,000 for an individual and $4,000 for a family. A deductible is a fixed dollar amount you pay for covered services before your medical plan pays for anything during the plan year. Prescriptions are not counted toward the annual deductible.
- You will pay co-insurance of 20% of the cost for covered services received from network providers after you have met your deductible. Coinsurance is a percentage amount that you pay after a service has been provided and a claim has been processed.
- The out-of-pocket maximum is $3,000 for an individual and $6,000 for a family. An out-of-pocket maximum is the maximum limit of deductible, prescription co-pays, and coinsurance for covered services that you could pay each year. If you reach the out of pocket maximum, the City of Minneapolis Medical Plan will pay 100% of charges for covered services for the remainder of the calendar year.
- When you fill prescriptions at a retail pharmacy that participates in your provider network, you will be responsible to pay the pharmacy a copayment that varies depending on the category your medication is in:
- Generic: $10 copayment
- Preferred brand: $25 copayment
- Non-preferred brand: $50 copayment
Provider Network Options
When you enroll, you must select one provider network from the available options to provide care for you and all dependents covered by your plan.
Medica Choice® Passport
Consider selecting Medica Choice Passport if it's important to you to be able to see a wide range of providers without a referral.
- Choice Passport is Medica's largest network and includes more than 95% of Minnesota hospitals and physicians. The Mayo Clinic is included in this network.
- You do not need a referral to see specialists in the network.
- You do not need to designate a primary care clinic to enroll.
Consider selecting the Medica Elect network if you'd prefer to designate a primary care provider to coordinate any specialty care you may need. Here is a list of primary care clinics as of 1/1/20. 2020 primary care provider list.
- You must designate a primary care clinic from a participating care system when you enroll.
- All family members must enroll in the Medica Elect network, but each may designate a different primary care clinic or care system within the network. You can change your primary care clinic designation as often as once a month by calling Medica Customer Service
- All of the Medica Elect care systems require a primary physicians referral in order for you to see specialists or facilities outside the care system.
Accountable Care Organizations (ACOs)
Consider selecting one of the ACO networks listed below if you already use the providers that participate and would like to receive more personalized care and services at a lower cost. With the ACOs, you don't need to designate a primary care clinic or get a referral for specialty care, but you must get all your care from the ACO in order to receive in-network benefits.
VantagePlus with MedicaSM (ACO)
- Includes physicians from M Health Fairview (the new name representing all of Fairview, HealthEast and many University of Minnesota Physician sites), North Memorial Health, and many popular independent clinics.
- Special features include a personal welcome call for new members, a single phone number for questions about your coverage or your care, same-day appointments for primary care, a 24/7 nurse line, and unique programs to help improve your overall health and wellness.
- Please note that Fairview will be closing a number of clinics in 2020. This FAQ has information about which clinics are closing.
Park Nicollet First with MedicaSM (ACO)
- Includes more than 20 neighborhood Park Nicollet clinics offering primary care, urgent care and specialty care, plus access to Park Nicollet Methodist Hospital, St. Francis Regional Medical Center and other network providers.
- Special features include same-day primary care appointments plus weekend and evening hours, 24/7 online diagnosis and treatment for 60 common conditions at virtuwell.com, a text message service to guide you to and through appointments, valet parking at selected locations, and discounts at Park Nicollet Health & Care Stores and Park Nicollet pharmacies.
Ridgeview Community Network® powered by Medica (ACO)
- Includes all Ridgeview Clinics; Catalyst Medical Clinic; Lakeview Clinic, Ltd.; OBGYN West, South Lake Pediatrics; Wayzata Children's Clinic; and Western OBGYN, a division of Ridgeview Clinics; plus 150+ specialty care partnerships; and six hospitals (Abbott Northwestern Hospital, Hennepin County Medical Center, Ridgeview Medial Center in Waconia, Ridgeview Sibley Medical Center in Arlington, Ridgeview Le Sueur Medical Center in Le Sueur, and Children's Hospital and Specialty Clinics).
- Special features include a navigator to answer questions about network providers, community services and wellness programs, six urgent care locations, same-day primary care appointments, a 24/7 nurse and advisor line, free local home delivery of prescriptions from partner pharmacies, access to online care, and free meet-and-greet provider visit.
For more information on your plan and network options, review the Health Plan Resource Website
Summary of Benefits and Coverage (SBC)
As part of the Patient Protection and Affordable Care Act (PPACA) employers are required to provide a standard Summary of Benefits and Coverage (SBC) for each plan.
Last updated Nov 9, 2020