Please read before using these policies.

Medical Policies

These policies provide general information concerning Medica's administrative processes. They apply to all fully-insured Medica Health Plans, Medica Insurance Company, and Medica Health Plans of Wisconsin products, unless a specific limitation or exception exists. For self-insured plans, consult individual plan sponsor benefit documents. If there is a discrepancy between a policy and a self-insured benefit plan, the provisions of the benefit plan will govern. With respect to Medicare and Medicaid members, this policy will apply unless Medicare or Medicaid policies require different coverage.

Clinical Guidelines

Clinical guidelines are intended to be used to support quality patient care, but cannot guarantee specific patient outcomes, and should be used only as a reference guide. The guidelines are not intended to replace a clinician’s own judgment with regard to the care needed by individual members or to establish protocols for the care of all members. Coverage of specific services may vary based on the terms of specific member/enrollee contracts (including state and federal government program contracts), administrative policies, and state/federal mandates.

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