MediExcel

MediExcel Health Plan is a California licensed, ACA compliant HMO, specializing in cross-border healthcare. We offer health benefit coverage for companies in San Diego and Imperial County, with care delivery in Mexico.

Provider Finder

Form Name Effective Date Download Form
New Group Submission
New Group Checklist
01/01/2018 Download
Employer Application - Small Group
01/01/2018 Download
Employer Application - Large Group
01/01/2018 Download
Dependent Only Coverage Kit (includes Employer instructions and FAQs)
01/01/2018 Download
Employer Attestation for Out of Area Employee Mailing Address
01/01/2018 Download
In Force Group Forms
ACH Payment Information - for ongoing monthly premium payments
01/01/2018 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment Form
01/01/2018 Download
Coverage Declination Form
01/01/2018 Download
Affidavit for Enrollment of Domestic Partners
01/01/2018 Download
Continuity of Care Brochure and Form
01/01/2018 Download
Dependent Only Coverage Kit (includes Dependent Only Enrollment Application)
01/01/2018 Download
Claim Forms
Health Care Services Reimbursement Form
01/01/2018 Download
SENTRI Pass Reimbursement Form
01/01/2018 Download
Form Name Effective Date Download Form
2018 Medical HMO
Ultra Platinum Plan (Plan P5) - Bilingual
01/01/2018 Summary SBC
Platinum Plus Plan (Plan P20) - Bilingual
01/01/2018 Summary SBC
Platinum Mirror Plan (Plan PM) - Bilingual
01/01/2018 Summary SBC
Gold Mirror Plan (Plan GM) - Bilingual
01/01/2018 Summary SBC
2017 Medical HMO
Platinum Plan P5
01/01/2017 Summary SBC
Platinum Plan P5 - Spanish
01/01/2017 Summary SBC
Platinum Plan P20
01/01/2017 Summary SBC
Platinum Plan P20 - Spanish
01/01/2017 Summary SBC
Platinum Mirror Plan (PM)
01/01/2017 Summary SBC
Platinum Mirror Plan - Spanish
01/01/2017 Summary SBC
Gold Mirror Plan (GM)
01/01/2017 Summary SBC
Gold Mirror Plan - Spanish
01/01/2017 Summary SBC
Dental
Dental Plan 100
04/01/2017 Summary
Dental Plan 200
01/01/2017 Summary
Form Name Effective Date Download Form
Benefits Guide 2018
01/01/2018 Download
Commission Schedule
01/01/2018 Download
Dependent Only Coverage Flyer
01/01/2018 Download
Dependent Only Coverage Kit (includes FAQ, Employer Instructions and Employee Dependent Only Coverage Application)
01/01/2018 Download
Imperial County Flyer
01/01/2018 Download
Independent Medical Review
01/01/2018 Download
Medical Authorization Process Brochure
01/01/2018 Download
MediExcel Binational Healthcare Flyer
01/01/2018 Download
MediExcel Large Group Value Flyer
01/01/2018 Download
MediExcel Rx Formulary
01/01/2018 Download
Minute Clinic Flyer
01/01/2018 Download
Provider Directory
01/01/2018 Download
SENTRI Pass Flyer
01/01/2018 Download
Underwriting Guidelines
01/01/2018 Download
Video Name Watch Video
Introduction to MediExcel Watch Video
Form Name Effective Date Download Form
Contact Sheet
Download