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
Small Group Submission Checklist 1.19
01/01/2019 Download
Large Group Submission Checklist 1.19
01/01/2019 Download
Employer Application - Small Group 5.19
05/01/2019 Download
Employer Application - Large Group 1.19
01/01/2019 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-Bilingual 1.19
01/01/2019 Download
Employee Waiver Form-Bilingual 1.19
01/01/2019 Download
Affidavit for Enrollment of Domestic Partners 1.19
01/01/2019 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
2019 Medical HMO Small Group
Ultra Platinum Plan (Plan P5)
01/01/2019 Summary SBC
Platinum Plus Plan (Plan P20)
01/01/2019 Summary SBC
Platinum Mirror Plan (Plan PM)
01/01/2019 Summary SBC
Gold Mirror Plan (Plan GM)
01/01/2019 Summary SBC
2019 Dental
Dental Plan 100
01/01/2019 Summary
Dental Plan 200
01/01/2019 Summary
2019 Vision
Vision Plan V100
01/01/2019 Summary
2018 Medical HMO Small Group
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
2018 Dental
Dental Plan 100
04/01/2018 Summary
Dental Plan 200
04/01/2018 Summary
2018 Vision
Vision Plan V100
10/01/2018 Summary
Form Name Effective Date Download Form
MediExcel Benefits Guide 2018
01/01/2018 Download
MediExcel Underwriting Guidelines 1.19
01/01/2019 Download
MediExcel Underwriting Guidelines 7.19
07/01/2019 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
Ancillary
MediExcel Dental Sell Sheet
04/01/2018 Download
MediExcel Vision Sell Sheet
10/01/2018 Download
Video Name Watch Video
Introduction to MediExcel Watch Video
Form Name Effective Date Download Form
Contact Sheet
Download