Medica health insurance plans will now provide in-network access to Mayo Clinic for enrollees in 22 southern Minnesota counties. This expands Medica members' access to high-quality healthcare from Mayo Clinic and Mayo Clinic Health System. Medica and Mayo Clinic have also entered into a financial agreement where Mayo Clinic will be reimbursed based on how well it manages the health of the covered population. This new agreement aims to improve healthcare quality and outcomes while controlling costs for Medica members in the region.

1. Medica Individual Product Portfolio with Access to Mayo
Frequently Asked Questions
What’s new about this relationship?
Medica’s popular portfolio of health plans sold directly to consumers will now offer in-
network access to Mayo Clinic, in addition to the in-network access already available
through Mayo Clinic Health System, for enrollees living in 22 counties in southern
Minnesota.
Also, Medica and Mayo Clinic have entered into a financial agreement where Medica
will reimburse Mayo Clinic based on how well it manages the population’s health in the
22 county region.
How does this benefit the community?
Medica’s individual and family plans (Medica Solo, Medica Encore and Medica
Symphony) are the fastest growing in the state, with over half of all enrollment (in this
segment) coming to Medica since 2009. Providing in-network access to Mayo Clinic and
Mayo Clinic Health System, at competitive rates, provides greater choice and access to
high quality health care in the communities that Mayo serves.
What are the 22 counties?
Blue Earth, Brown, Cottonwood, Dodge, Faribault, Fillmore, Freeborn, Goodhue,
Houston, Jackson, Le Sueur, Martin, Mower, Nicollet, Olmsted, Redwood, Rice, Steele,
Wabasha, Waseca, Watonwan, Winona
Will this area be expanded?
Mayo and Medica are committed to discussions of expansion into other parts of
Minnesota, as well as into western Wisconsin. The initial roll-out is focused on the
Minnesota counties where Mayo Clinic Health System is a primary care provider.
What are the details of the financial relationship?
The details are proprietary. Medica and Mayo have made a commitment to ensuring
access to quality care and health improvement, while simultaneously managing costs.
How is this product portfolio different from others available in the market on a
direct to consumer basis?
Medica’s individual and family products offer the most value – competitive rates paired
with leading benefit designs that have been copied by competitors – and now have the
added bonus of offering direct access to Mayo Clinic at an in-network benefit level (the
highest level of coverage).
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2. Why is access to Mayo Clinic and Mayo Clinic Health System so important?
It brings to southern Minnesota healthy competition based on quality and outcomes, as
well as total cost. Access to Mayo Clinic and Mayo Clinic Health System offers members
the choice of the entire spectrum of care from an acknowledged high quality medical
provider.
Is Medica and Mayo Clinic and Mayo Clinic Health System creating a “narrow
network” or single provider network?
No. This agreement adds the Mayo Clinic as an in-network provider to Medica members
in 22 southern Minnesota counties. Those members can access the Mayo Clinic and
Mayo Clinic Health System as well as many other in-network providers in Medica’s
southern Minnesota service area.
If a Medica member sees a specialist at the Mayo Clinic but receives primary care
from a provider not part of the Mayo Clinic Health System, how will that care be
coordinated?
Mayo Clinic specialists routinely see patients who receive their primary care from
providers throughout the state (and world). There is a system in place that ensures all care
is coordinated regardless of the referring physician.
This agreement between Medica and Mayo Clinic provides in-network access to Mayo
Clinic for Medica members in the 22 southern Minnesota counties. This step represents
an evolution in the relationship between the two organizations, which will be looking for
opportunities to expand the agreement beyond the 22 original counties.
Won’t patients who are not part of Mayo Health Care System and receive specialty
care from Mayo Clinic have an impact on the organizations’ ability to ensure
quality care, improve health and manage costs?
That scenario is accounted for in our financial agreement. The details of those
arrangements are proprietary.
Will members be paying more for access to Mayo Clinic services through this
insurance plan?
Mayo Clinic and Mayo Clinic Health System are included in the network for Medica’s
members in southern members. There are no additional costs involved in accessing either
Mayo Clinic or Mayo Clinic Health System. The premium rate for these Medica
members is generally is less than rates charged by competing plans that do not include
Mayo Clinic and Mayo Clinic Health System in their network, or have Mayo Clinic at a
higher “tier,” which means more out-of-pocket costs for the consumer.
Isn’t it difficult to change health insurance coverage and providers?
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3. Not when working with Medica and Mayo. Medica’s direct-to-consumer products are
health history underwritten, and a percentage of individuals are charged more or declined
coverage. However, the vast majority of applicants are approved at the standard rate and
the approval decision generally takes less than a week.
If someone doesn’t get sick very often and doesn’t see a doctor on a regular basis,
why should they switch from their current health insurance coverage?
We all need medical attention at some point in our lives, and when that time comes, it’s
important to have convenient, high quality options available. Mayo Clinic and Mayo
Clinic Health System provide right care, in the right place, at the right time leads to high
quality, better outcomes and overall lower costs over the long term. Also, shopping
around for different insurance can often mean finding a lower price for comparable or
even increased coverage.
Will medical records transfer with the new insurance plan?
Current patients of Mayo do not need to transfer their records. Mayo is committed to
providing a quality experience for all of its patients and has a thorough new patient
onboarding process that takes into account medical histories and records.
Do consumers have to wait for a certain time of the year in order to switch health
insurance coverage?
No. Prior to health care reform becoming fully implemented effective January 2014,
consumers can change plans at any time.
How does a consumer go about switching to a new Medica health insurance plan
with access to Mayo Clinic and Mayo Clinic Health System?
Contact their Medica broker, call Medica at 1-800-670-5935, or go online to medica.com
and click on “Individual and Family Plans.”
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