Choosing a health insurance plan is important. And that goes double for family and individual coverage. It’s a choice you want to make sensibly. So you want a plan that fits your family’s life, and your own personal style. Here in Wisconsin, you’re in luck. Say “hello” to Medica. With Medica, you choose from a wide variety of plans to find the one that works for your needs. And just like your favorite pair of shoes – a Medica plan feels right, fits good. And that’s the way it should be. Medica plans are available as a one-person or family plan through the Health Insurance Marketplace, or directly from Medica. Your insurance agent can assist you in either situation.
Plan Overviews
As a cooperative, CGHC is governed by a Board of Directors elected by their members and operated for the mutual benefit of their members. Also, any earnings they make are returned to members in the forms of lower prices and improved services. This level of cooperation builds a strong bond between the people in the cooperative.
At Common Ground Healthcare Cooperative, members come first and they are committed to providing trusted and understandable information. That’s why they make our health insurance plans simple to use and easy to understand.
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- Wisconsin Copay Plans
- Wisconsin Copay Plus Plan
- Wisconsin HSA - Compatible Plans
- Wisconsin Catastrophic
- 2017 Out-Of-Network Details
|
Bronze |
Silver | Gold | |
|---|---|---|---|
|
Deductible
|
Individual plan: $6,850 Family Plan: $13,700 shared family |
Individual Plan: $2,600 Family Plan: $7,800 shared family |
Individual Plan: $300 Family Plan: $900 |
|
Out-of-Pocket Maximum
|
Individual Plan: $7,150 Family Plan: $7,150 per family member¹, or $14,300 for the entire family |
Individual Plan: $5,750 Family Plan: $5,750 per family member¹, or $11,500 for the entire family |
Individual Plan: $5,000 Family Plan: $5,000 per family member¹, or $10,000 for the entire family |
| Preventative Care | 100% coverage (deductible does not apply) | 100% coverage (deductible does not apply) |
100% coverage (deductible does not apply) |
|
Primary Care |
$80 copay | $30 copay | $30 copay |
| Urgent Care | $80 copay | $30 copay | $30 copay |
| Specialty Care |
$150 copay |
$60 copay | $60 copay |
| Prescription Drugs |
Preferred generic: $10 copay Non-preferred generic: $20 copay Preferred brand: 50% coverage after deductible Non-preferred brand: 30%coverage after deductible |
Preferred generic: $5 copay Non-preferred generic: $10 copay Preferred brand: 60% coverage after deductible Non-preferred brand: 40%coverage after deductible |
Preferred generic: $5 copay Non-preferred generic: $10 copay Preferred brand: 70% coverage after deductible Non-preferred brand: 50%coverage after deductible |
| Convenience Care Visit | $20 copay | $20 copay | 70% coverage after deductible |
| Emergency Room | 50% coverage after deductible | 60% coverage after deductible | 70% coverage after deductible |
| Hospital Services | 50% coverage after deductible | 60% coverage after deductible | 70% coverage after deductible |
| Enhanced Imaging Services |
50% coverage after deductible |
60% coverage after deductible |
70% coverage after deductible |
| Ambulance | 50% coverage after deductible | 60% coverage after deductible | 70% coverage after deductible |
| Surgery | 50% coverage after deductible | 60% coverage after deductible | 70% coverage after deductible |
| Home Health Care | 50% coverage after deductible | 60% coverage after deductible | 70% coverage after deductible |
| Lab and X-ray Services |
50% coverage after deductible | 60% coverage after deductible | 70% coverage after deductible |
| Maternity | 50% coverage after deductible | 60% coverage after deductible | 70% coverage after deductible |
| Other Eligible Health Care Services | 50% coverage after deductible | 60% coverage after deductible | 70% coverage after deductible |
| ¹Per Member: Family plan has an embedded individual out-of-pocket maximum. This means each covered family member only needs to satisfy their individual out-of-pocket maximum, not the entire family amount, before receiving 100% coverage. | |||
|
Gold |
|
|---|---|
|
Deductible
|
Individual plan: $1,000 Family Plan: $3,000 shared family |
|
Out-of-Pocket Maximum
|
Individual plan: $4,000 Family plan: $4,000 per family member¹, or $8,000 for the entire family |
| Preventative Care | 100% coverage (deductible does not apply) |
|
Primary Care |
$30 copay |
| Urgent Care | $30 copay |
| Specialty Care |
$30 copay |
| Prescription Drugs |
Preferred generic: $5 copay Non-preferred generic: $5 copay Preferred brand: $35 copay Non-preferred brand: $150 copay |
| Convenience Care Visits | $20 copay |
| Lab and X-ray services | $30 copay per day. Copay waived if services performed during an office visit |
| Emergency Room | $150 copay |
| Hospital Services |
$250 copay per day for the first five days; then 100% coverage (deductible does not apply) |
| Enhanced Imaging Services | $150 copay per service |
| Ambulance | 75% coverage after deductible |
| Surgery | 75% coverage after deductible |
| Home Health Care | 75% coverage after deductible |
| Maternity | 75% coverage after deductible |
| ¹Per Member: Family plan has an embedded individual out-of-pocket maximum. This means each covered family member only needs to satisfy their individual out-of-pocket maximum, not the entire family amount, before receiving 100% coverage. | |
|
Bronze |
Silver | |
|---|---|---|
|
Deductible
|
Individual plan: $1,300 Family plan: $3,900 shared family |
Individual plan: $6,400 Family plan: $12,800 shared family |
|
Out-of-Pocket Maximum
|
Individual plan: $6,400 Family plan: $6,400 per family member¹, or $12,800 for the entire family |
Individual plan: $5,500 Family plan: $5,500 per family member¹, or $11,000 for the entire family |
| Preventative Care | 100% coverage (deductible does not apply) | 100% coverage (deductible does not apply) |
|
Primary Care |
100% coverage after deductible | 60% coverage after deductible |
| Urgent Care | 100% coverage after deductible | 60% coverage after deductible |
| Specialty Care |
100% coverage after deductible |
60% coverage after deductible |
| Prescription Drugs |
Preferred generic: 100% coverage after deductible Non-preferred generic: 100% coverage after deductible Preferred brand: 100% coverage after deductible Non-preferred brand: 100% coverage after deductible |
Preferred generic: 60% coverage after deductible Non-preferred generic: 60% coverage after deductible Preferred brand: 60% coverage after deductible Non-preferred brand: 60%coverage after deductible |
| Convenience Care Visit | 100% coverage after deductible | 60% coverage after deductible |
| Emergency Room | 100% coverage after deductible | 60% coverage after deductible |
| Hospital Services | 100% coverage after deductible | 60% coverage after deductible |
| Enhanced Imaging Services |
100% coverage after deductible |
60% coverage after deductible |
| Ambulance | 100% coverage after deductible | 60% coverage after deductible |
| Surgery | 100% coverage after deductible | 60% coverage after deductible |
| Home Health Care | 100% coverage after deductible | 60% coverage after deductible |
| Lab and X-ray Services |
100% coverage after deductible | 60% coverage after deductible |
| Maternity | 100% coverage after deductible | 60% coverage after deductible |
| Other Eligible Health Care Services | 100% coverage after deductible | 60% coverage after deductible |
|
Bronze |
|
|---|---|
|
Deductible
|
Individual plan: $7,150 Family Plan: $7,150 per family member¹, or $14,300 for the entire family |
|
Out-of-Pocket Maximum
|
Individual Plan: $7,150 Family Plan: $7,150 per family member¹, or $14,300 for the entire family |
| Preventative Care | 100% coverage (deductible does not apply) |
|
Primary Care |
$30 copay first 3 visits per person per calendar year. After 3rd, 100% coverage after deductible |
| Prescription Drugs |
Preferred generic: 100% coverage after deductible Non-preferred generic: 100% coverage after deductible Preferred brand: 100% coverage after deductible Non-preferred brand: 100% coverage after deductible |
| Convenience Care Visit | $20 copay first 3 visits per person per calendar year. After 3rd visit, 100% coverage after deductible |
| Specialty Care Office Visits | 100% coverage after deductible |
| Urgent Care Visits | |
| Enhanced Imaging Services | |
| Ambulance | |
| Surgery | |
| Home Health Care | |
| Lab and X-ray Services |
|
| Hospital Services | |
| Maternity | |
| Other Eligible Health Care Services | |
| ¹Per Member: This plan has an embedded individual deductible and out-of-pocket maximum. This means each covered family member only needs to satisfy their individual deductible and out-of-pocket maximum not the entire family amount before receiving benefits. | |
|
Copay Plus,Copay, HSA-Compatible and Catastrophic Plans |
|
|---|---|
|
Deductible
|
Individual plan: $10,000 Family Plan: $20,000 |
|
Out-of-Pocket Maximum
|
There is no maximum for out-of-network services |
| Benefit Coverage | 50% coverage after deductible |
|
Other Details |
If you visit an out-of-network health care provider, certain services may be excluded or limited. Please see a Medica Individual Choice policy on medica.com for details. |
Medica is a proud provider in the following Wisconsin counties:
Ashland, Barron, Bayfield, Burnett, Chippewa, Douglas, Dunn, Eau Claire, Pierce, Polk, Sawyer, St. Croix and Washburn.
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