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
01/01/2020 Download
Large Group Submission Checklist 1.19
01/01/2020 Download
Employer Application - Small Group 5.20
05/01/2020 Download
Employer Application - Large Group 5.20
05/01/2020 Download
Dependent Only Coverage Kit (includes Employer instructions and FAQs)
01/01/2020 Download
Employer Attestation for Out of Area Employee Mailing Address
01/01/2020 Download
In Force Group Forms
ACH Payment Information - for ongoing monthly premium payments
01/01/2020 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment Form-Bilingual
06/01/2020 Download
Employee Waiver Form-Bilingual 1.19
01/01/2020 Download
Affidavit for Enrollment of Domestic Partners 1.19
01/01/2020 Download
Continuity of Care Brochure and Form
01/01/2020 Download
Dependent Only Coverage Kit (includes Dependent Only Enrollment Application)
01/01/2020 Download
Claim Forms
Health Care Services Reimbursement Form
01/01/2020 Download
SENTRI Pass Reimbursement Form
01/01/2020 Download
Form Name Effective Date Download Form
2021 Medical HMO Small Group
P5 Platinum HMO Plan (P5)
01/01/2021 Summary SBC
P10 Platinum HMO Plan (P10)
01/01/2021 Summary SBC
Platinum 90 HMO 0/20 INF Plan (PM90)
01/01/2021 Summary SBC
Gold 80 HMO 250/35 INF Plan (GM80)
01/01/2021 Summary SBC
2021 Medical HMO Large Group
VP5 HMO
01/01/2021 Summary SBC
VP10 HMO
01/01/2021 Summary SBC
VP20 HMO
01/01/2021 Summary SBC
MEP HMO
01/01/2021 Summary SBC
QEP HMO
01/01/2021 Summary SBC
2020 Medical HMO Small Group
Ultra Platinum Plan (Plan P5)
01/01/2020 Summary SBC
Platinum Plus Plan (Plan P20)
01/01/2020 Summary SBC
Platinum Mirror Plan (Plan PM)
01/01/2020 Summary SBC
Gold Mirror Plan (Plan GM)
01/01/2020 Summary SBC
2020 Medical HMO Large Group
VP5
01/01/2020 Summary SBC
VP10
01/01/2020 Summary SBC
VP20
01/01/2020 Summary SBC
MEP
01/01/2020 Summary SBC
QEP
01/01/2020 Summary SBC
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
Form Name Effective Date Download Form
General Information
Benefits Guide
01/01/2020 Download
Underwriting Guidelines
01/01/2020 Download
Binational Healthcare Flyer
01/01/2020 Download
Broker Bonus Small Group Sales July 2020 - Sept 2020
07/01/2020 Download
Commission Schedule
01/01/2020 Download
COVID-19 and Antibody Testing Flyer
10/01/2020 Download
COVID-19 Temporary Billing Options Flyer
10/01/2020 Download
Dependent Only Coverage Flyer
01/01/2020 Download
Dependent Only Coverage Kit (includes FAQ, Employer Instructions and Employee Dependent Only Coverage Application)
01/01/2020 Download
DMHC Infographic
08/01/2020 Download
DMHC Infographic & 2019 Annual Report
06/01/2020 Download
Imperial County Flyer
01/01/2020 Download
Independent Medical Review
01/01/2020 Download
Large Group Cost Solutions Flyer
08/01/2020 Download
Large Group Value Flyer
01/01/2020 Download
Large Group 2020 MEP QEP Plans [effective 10/1/2020]
10/01/2020 Download
Large Group 2020 MEP Rates [effective 10/1/2020]
10/01/2020 Download
Large Group 2020 QEP Rates [effective 10/1/2020]
10/01/2020 Download
Mail Order Pharmacy Program
10/01/2020 Download
Medical Authorization Process Brochure
01/01/2020 Download
MediExcel Health Plan Accepted at AFC Urgent Care Flyer
06/01/2020 Download
Minute Clinic Flyer
01/01/2020 Download
Prescription Drug Formulary - In Mexico
02/01/2020 Download
Prescription Drug Formulary - Urgent Care in the US
02/01/2020 Download
Provider Directory
01/01/2020 Download
Q2/Q3 No Employer Contribution Promotion
05/01/2020 Download
Q4 2020 Carrier Update
10/01/2020 Download
SENTRI Pass Flyer
01/01/2020 Download
Urgent Care Network Flyer
10/01/2020 Download
Virtual Care Services Flyer
07/01/2020 Download
Ancillary
Dental Sell Sheet
01/01/2020 Download
Vision Sell Sheet
01/01/2020 Download
Video Name Watch Video
Introduction to MediExcel Watch Video
Form Name Effective Date Download Form
Contact Sheet
Download