Sep 27, 2017

What will the Medica transition mean to me?

By Robert McGriff, @m039153


On August 17th, Mayo Clinic announced a new business arrangement with Medica, a Minnesota-based health services company.  The arrangement is part of an overall strategy to help improve access to Mayo Clinic for patients with serious and complex medical conditions.  As part of this arrangement, Medica will acquire MMSI, which does business as Mayo Clinic Health Solutions.

To answer the question of how this change will impact participants in Mayo Clinic employee benefit plans, you first need to understand the services that Mayo Clinic Health Solutions provides.  Mayo Clinic Health Solutions is a benefit plan administrator.  That means that they perform the day-to-day work of a benefit plan.  They manage the provider networks, process claims, and make payments directly to health care providers on behalf of the plan.  However, the benefit plans are designed and funded by the employer who sponsors them.  A change in the plan design (deductible, coinsurance, covered items, etc.) can only come from the employer (Mayo Clinic for our plans).  We do not expect any changes to the Mayo Clinic benefit plans as a result of the change in plan administrator

In the initial phases of the transition, plan participants will see no change at all.  The sale of Mayo Clinic Health Solutions is expected to be completed by the end of 2017.  Current staff of Mayo Clinic Health Solutions will continue using the same technology to manage plan operations for the time being.  This means no immediate change in phone number, website, or forms (like the Explanation of Benefits that you receive when a claim is paid) for plan participants.

Starting in mid-2018, Medica will begin transitioning clients (including Mayo Clinic) to it's technology platform.  Following a communication campaign, you may see changes in the Online Service Center and the Explanation of Benefits may look different than what you are used to.  You may also begin to use a different method of submitting claims to the Mayo Reimbursement Account and the Flexible Spending Accounts.  Each time a change comes, you will receive plenty of information about how and when it will occur.  By the end of 2019, all clients of Mayo Clinic Health Solutions are expected to be moved to the Medica plan administration technology.

And for those of you who are wondering about our colleagues who work for Mayo Clinic Health Solutions, Mayo Clinic leadership has said that they are "committed to helping MMSI staff affected by these changes through this transition over the next two years, and intend to provide these staff with multiple employment options for their consideration."

So, while there is no immediate impact to plan participants, stay tuned for more information over the next 12-18 months.  Be sure to follow this page for updates and feel free to comment below.



Posts: 2
Joined: Sep 29, 2017
Posted by @crw03, Sep 29, 2017

Medica grades online are very poor. The service level from online reviews is totally unacceptable. What will be our recourse if indeed the service we receive is as bad as reviewed?

Liked by Dale

Tony Lehrman

Posts: 17
Joined: Oct 26, 2012
Posted by @lehrman, Sep 29, 2017

Hi Catherine – the Total Rewards Team will be working closely with Medica to ensure a smooth transition, and will communicate any changes in the way that services (EOBs, claim submissions, etc.) are delivered, well in advance. Keep in mind we don’t expect any changes to the benefits plans as a result of this transition. Mayo Clinic will remain self-insured, with Medica as the plan administrator. Thanks!


Posts: 2
Joined: Sep 29, 2017
Posted by @crw03, Sep 30, 2017

Thank u for your reply. Please google Medica. The concern is the administrative abilities, the wait time on a phone call, loss of medical records, lack of consistency between phone calls, wait fo4 an email response and the list goes on. My main concern is who at Mayo will support our wasted time, energy and money trying to get our insurance to be administered correctly in a timely and respectful manner

Robert McGriff

Posts: 99
Joined: Oct 29, 2012
Posted by @m039153, Sep 30, 2017

Catherine, I understand and share your concern but I don’t want to place too much focus on online reviews. Nowadays, there are negative reviews online for every company, even Mayo Clinic. Mayo Clinic leaders want our plan participants to continue receiveing the high level of customer service that they are used to. Contract negotiations are currently underway and the final contract will include performance guarantees for measurable customer service issues like time to answer the phone, claims processing speed and claims accuracy. If Medica is not able to meet their performance metrics, they will forfeit a portion of the fees that they charge for providing services to the plan. We don’t anticipate there being an issue but we will be monitoring to make sure that they deliver on their commitment of quality customer service for our plan participants.

Liked by Bobbie Jo

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