Certificate of Coverage or Summary Plan Description: Your Certificate of Coverage (COC) or Summary Plan Description (SPD) is the most complete description of what's covered and not covered under your health plan.  Your COC or SPD carefully explains your level of benefits, your share of the costs, the member bill of rights, and other important enrollment information.

Benefits: The health services or supplies approved by Medica as eligible for coverage, as described in your Certificate of Coverage or Summary Plan Description.

Provider: A doctor, hospital, clinic, home health agency, skilled-nursing facility or pharmacy that provides health care or prescriptions.

Network/Preferred: A term used to describe a provider (such as a hospital, physician, home health agency, skilled nursing facility or pharmacy) which has entered into a written agreement with Medica or has made other arrangements with Medica to provide benefits to you. The network status of providers will change from time to time.

Non-Network/Non-Preferred: A term used to describe a provider who does not have a written agreement with Medica.

Emergency: A condition that requires immediate treatment, generally provided within four (4) hours of onset of the condition, to:
1. preserve your life; or
2. prevent serious impairment to your bodily functions, organs, or parts; or
3. prevent placing your physical or mental health in serious jeopardy.