|
Learn about
PacifiCare Added Benefits
Download PacifiCare Application
About PacifiCare of California
PacifiCare of California, established
in 1978, was the first HMO in California to receive a full three-year
accreditation from the National Committee for Quality Assurance. The
PacifiCare provider network includes more than 300 hospitals, 28,000
primary care and specialty physicians and 4,400 pharmacies. PacifiCare of
California offers 3 HMO plan options and 3 PPO plans.
PacifiCare PPO Plans
About the PacifiCare PPO 70-50/3000
This is PacifiCare's most cost efficient PPO plan and is
designed to protect you against unforseen major medical expenses. The PPO
3000 plan has a $3,000 annual deductible that applies to all covered
expenses, including office visits. After the deductible is met, you have a
30% coinsurance up to a $4,000 annual out-of-pocket maximum that does not
include the deductible. This plan does not provide out-patient
prescription drug benefits.
About the PacifiCare PPO 30/80-50/1500
.This is PacifiCare's mid range PPO plan. Under this plan,
you are provided $30 office visit co-payments without having to meet your
annual deductible (limit of 4 per year). For most other covered services,
there is an annual deductible of $1,500. Once your deductible has been
met, you will continue to pay a 20% coinsurance up to tha annual
out-of-pocket maximum of $4,000 (not including the deductible).
Prescription drug benefit is limited to $1,000 per year for out-patient.
About the PacifiCare PPO 30/70-50/1000
This is PacifiCare's most comprehensive PPO plan. Under
this plan, you are provided $30 office visit co-payments without having to
meet your annual deductible. For most other covered services, there is an
annual deductible of $1,000. Once your deductible has been met, you will
continue to pay a 30% coinsurance up to the annual out-of-pocket maximum
of $3,000 (not including the deductible). Out-patient prescription drugs
are covered benefit with no annual maximum limit.
PacifiCare HMO Plans
(Health Maintenance Organization)
About the PacifiCare HMO 10-30/250a
This is the most complete and comprehensive HMO plan
offered by PacifiCare. Office visits are provided at a $10 co-payment when
using the services of your primary care physician. You pay $30 when using
the services of a specialist within the medical group of your primary care
physician. There is a $250 per admission co-payment for inpatient hospital
services and out-patient surgery. Most other covered services are provided
at 100%, with no deductible or co-payment.
About the PacifiCare HMO 15-30/80
The HMO 15 plan provides office visits and preventative
health care for a $15 co-payment when using the services of a primary care
physician. You pay $30 when visiting a specialist within the medical group
of your primary care physician.. Most other professional services are
covered in full. For out-patient surgery and in-patient hospital services
you pay a 20% co-insurance up to an annual maximum of $2,500.
About the PacifiCare HMO 35/70
The HMO 35/70 plan provides office visits and preventative
health care for a $35 co-payment. Most other professional services are
covered in full. For out-patient surgery and in-patient hospital services,
there is a 30% co-insurance up to an annual maximum of $5,000.
Added Benefits
PacifiCare Perks
is a members-only program that includes discounts through vendor
arrangements for safety products, health clubs, alternative care,
vitamins, body care products and much more.
Health Pregnancy and Taking Charge of
Diabetes provide educational resources to help members maintain and
improve health.
Ready Reply - PacifiCare has
contracted with select medical groups throughout California to help you
get fast answers to your health care questions.
Out-of-State Benefits
As is typical with any HMO plan, benefits
provided by any physician outside of the network of your primary care
physician are only available in an emergency situation where you do not
have access to your primary medical group. This includes emergencies
outside the State of California.
Waiting Periods
The PacifiCare Plan 10 HMO has no waiting
periods for pre-existing conditions.
Enrollment Process
Enrollment requires the completion of a
somewhat lengthy and detailed health questionnaire. You may apply online,
download an application, or request a detailed plan brochure and
application. A refundable deposit in the amount of the first month's
premium must be included along with the completed application.
For additional help... Call us toll-free at
1-949-394-7676.
|
