PacifiCare of California SignatureOptions PPO Plans

In California, PacifiCare offers 8 different PPO plan in their SignatureOptions category. There is a wide array of deductible options available, and two of these PPO plans provide maternity benefits. With deductible options ranging from $500 to $5,000, interested plan members can surely find a PacifiCare PPO plan that meets their budget and health care requirements. All SignatureOption PPO plans offer a $5 million dollar lifetime maximum benefit. The out-of-pocket maximums vary based on which plan you select, with a family maximum set at a maximum of two times the individual out-of-pocket maximum. Even if you have over two family members insured under the plan, once two family members reach the individual out-of-pocket maximum, all remaining family members will be covered in full for the remainder of the calendar year. Not all covered benefits apply to the out-of-pocket maximum and these maximums are increased if you seek medical care outside of the PacifiCare PPO participating provider network. There is a Network Wellness Benefit available on all SignatureOption PPO plans that include preventive health care coverage for mammograms, Pap Smears and prostate screenings, as well as the lab costs associated with these preventive treatments. On some of the SignatureOption plans, the deductible is waived for this wellness benefit but they all are limited to a maximum benefit of $300 per year.

On all of these PacifiCare PPO plans, emergency room visits have an additional $100 deductible per occurrence, and then the plan deductible must be met before the coinsurance benefits apply. For most other covered services, the plan deductible must be met, then you will pay your coinsurance amount, up to the plan's maximum out-of-pocket limit.

PacifiCare SignatureOption PPO 70-50/1000

There are t 70-50/1000 plans offered through PacifiCare of California, one offers maternity coverage while the other does not. Aside from maternity benefits, these two plans are identical. Both have an annual deductible of $1,000 with a 30% plan member coinsurance after the deductible has been met. The deductible is waived for office visits and for the wellness benefits and immunizations are provided at 100% benefit with no applicable deductible. Prescription drugs are $10 generic, $35 brand with an annual deductible of $250 that applies only to brand name drugs. The network coinsurance maximum is $2,500 on the plan with maternity, and $4,000 on the 70-50/1000 plan that does not offer maternity coverage. The premium amount for the maternity option is substantially higher than the non-maternity benefits option.

PacifiCare SignatureOption PPO 70-50/1500

This plan is only available with maternity coverage and is one of the two options available in the SignatureOption series for prospective plan members who need a medical insurance plan that covers maternity benefits. The annual deductible is $1,500; with a 30% plan member coinsurance after the deductible has been met. Members of this plan will pay a 30% coinsurance on most covered benefits until their share of cost reaches the network coinsurance maximum of $3,000 (not including the plan deductible). The deductible must be met for all covered services, including office visits and preventive health care. The $1,500 deductible does not apply to prescription coverage, but there is a separate $250 deductible on brand name drugs only, after which there is a $35 co-payment. Maternity benefits include prenatal care, postnatal care and in-patient hospital delivery expenses.

PacifiCare SignatureOption PPO 70-50/500

This SignatureOption PPO plan offers the lowest deductible amount at $500 and a low network out-of-pocket maximum of $2,500. Combined with the low deductible, a member of this plan would be covered in full for most medical expenses after they have paid a total of $3,000 out of their pockets for health care benefits offered under this plan. First dollar benefits are available on office visits and preventive health care because the $500 deductible is waived on this plan. Generic drugs are available for a $15 copay and no deductible is required. Maternity benefits are not available on this plan.

PacifiCare SignatureOption PPO 70-50/2000

With an annual deductible of $2,000, a coinsurance maximum of $4,000 and no maternity benefits, this is the mid-range SignatureOption PPO plan in regards to premium amount and plan benefits. The deductible in not waived for office visits, making it applicable to all covered benefits except prescription drugs, which are offered at $20 generic and $35 brand. Mammograms and Pap Smears are provided at the coinsurance level without having to meet a deductible. There is an annual brand deductible of $250. The coinsurance for all covered services, except ambulance, is 30% after the plan deductible.

PacifiCare SignatureOption PPO 60-50/2500

This plan has the highest coinsurance percentage of all of the available SignatureOption plans. Instead of paying 30% of the negotiated rate for in-network medical expenses, you will pay 40% under this plan. The annual deductible is $2,500, which must be met before the 40% coinsurance applies. With an out-of-pocket coinsurance maximum of $4,000, your total share of cost is not much higher than the other plan options available, limiting your annual liability to $6,500 per year. Brand name drugs or maternity benefits are not offered under the 60-50/2500 plan.

PacifiCare SignatureOption PPO 70-50/3000

The annual deductible is $3,000 on this plan, with the network coinsurance maximum set at $4,000. Treatment received outside of the PacifiCare network of participating health care providers will have a higher coinsurance with greater annual maximums and limitation on paid benefits. Emergency room visits have a separate $200 charge in addition to the deductible, and there are no benefits for maternity or prescription drugs. Of the eight SignatureOption PPO plans, this is the second least expensive because of its higher deductible and reduction in plan benefits.

PacifiCare SignatureOption PPO 70-50/5000

With a deductible of $5,000, no maternity coverage and no prescription drug benefits, this is the least expensive option in this PacifiCare PPO category. The lower monthly premium may make this the better option for persons looking for inexpensive medical insurance that provides them with benefits toward major medical expenses. With a coinsurance maximum of $4,000 added to the $5,000 deductible, the plan member would be liable for no more than $9,000 in personal health care expenses annually.

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.