PacifiCare offers four different HMO plans to California individual and families and call this portfolio series the SignatureValue HMO Plans. Each PacifiCare HMO plan offers comprehensive coverage and low copayments with reduced out-of-pocket expenses. You must select a primary care physician from the list of participating PacifiCare HMO providers. This primary care doctor may be an independent physician or part of a medical group or independent practice association. With PacifiCare's extensive provider network, finding a primary care physician within a 30 mile radius of your home or office should not be a problem. PacifiCare HMO plans are not available in all counties in California. With a PacifiCare HMO plan, you expected medical expenses are predictable and there are no claim forms to bother with, since all of your health care is coordinated and managed through your primary care physician.
There are no calendar year deductibles on any of the PacifiCare HMO plans, and lifetime maximum benefits are unlimited. Office visit co-payments range from $10 to $35, depending on which plan you select and all four plans provide maternity benefits. Regardless of which HMO plan you select, emergency health care services require a $100 copayment, which is waived if your emergency room visit results in admittance to the hospital. Well-Baby care is provided free of charge, as are health education services and laboratory costs associated with an office visit conducted by your primary care physician or a referred specialist. Family planning services are also available through the PacifiCare HMO plans and include tubal ligation, vasectomy, insertion and removal of intra-uterine devices, Norplant removal, Depo-Provera injections, and voluntary interruption of pregnancy. Infertility services are not covered by PacifiCare.
This PacifiCare HMO plan has the lowest office visit copayment available at $10 with your primary care physician and $35 with a specialist. Office visits include physician visits, allergy testing, attention deficit disorder treatment, hearing screenings, immunizations, maternity care, periodic health evaluations, vision refractions and screening, well-baby care and well-woman care. For in-patient hospital services, there is a $250 per day co-payment for the first 4 days of hospitalization, after which you are covered in full. Skilled nursing care has a $50 copayment per visit and is limited to 100 consecutive days from the first treatment. Alcohol and drug detoxification is limited to 5 days per year and 30 days lifetime. Prescription drugs are $10 generic and $35 brand for a 30 day supply. 90 day supplies are twice the copayment amount, but provide a 90-day supply. Out-patient mental health care for severe mental illnesses is $35. Maternity care is covered like any other in-patient visits, with a $250 per-day copayment up to a 4 day maximum.
This is PacifiCare's second most complete HMO plan with a $20 office visit copayment and the same $35 copayment required for visits to a specialist. For most other covered medical expenses, there is no deductible but you will pay 20% of the discounted rate, up to a $2,500 copayment maximum. Some services have set copayment amounts, such as tubal ligation for $100 and vasectomies for $50. Oral surgery services are covered in full after a $100 copayment if they are related to a covered medical condition. Out-patient surgery an in-patient hospital services require you to pay 20% of the contracted rate that PacifiCare has with that health care professional or medical group. For prescription drugs, there is a $100 per year deductible on brand name only. Ambulance services have a $100 copayment, as do emergency medical treatments.
This PacifiCare HMO plan requires a 30% coinsurance for out-patient surgical procedures and in-patient hospitalization, including maternity related medical expenses. For most other covered benefits, there are set copayment, such as $35 for office visits and preventive health care. The 30% coinsurance liability is limited to $5,000 per family member with no per family or two-member limitation. Hospice care and rehabilitation also require you to pay 30% of the contracted rate. There is no deductible for prescription drugs. Home health care visits are $10 per visit and hospice care is covered in full. This is the second least expensive PacifiCare HMO plan, but still provides first dollar benefits and low co-payments for the most commonly required medical services.
This is the least expensive of all four PacifiCare HMO plan, primarily because it requires a 50% coinsurance for out-patient surgery and in-patient hospitalization. The coinsurance is capped at $5,000 per calendar year with no family maximum. Prescription drug coverage is the same as the HMO 35/70 plan, with no deductible, $20 generic and $35 brand copays.
*The information provided on this page is subject to change and my not be current. Check with the insurance company or your insurance agent for verification of details. The information provided is for comparison purposes only and is not legally binding. Always review the plan brochure or your policy details for complete and accurate details about this policy.