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PacifiCare Individual Health Care Plans

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PacifiCare Individual Health Care Plans Powered By Docstoc
					      PacifiCare Individual
       Health Care Plans
  A powerful safety net when you need health care.
Plus programs and services that help you stay healthy.
 Welcome


     What could be more important than choosing the right doctor? That’s why you’ve
     made a wise choice by finding out more about PacifiCare. We have a large
     number of health plans, access to an extensive network of doctors and hospitals,
     and rates that may fit your budget.

     PacifiCare says, “Caring is good. Doing something is better.”SM That’s why we also offer you a multitude of money-saving
     ways to help you maintain a healthy lifestyle – including fitness and prevention programs, 24-hour medical information
     and a number of other services.

     Just as important, PacifiCare makes finding out about health care options easy. We promise that everything in this brochure
     will be in plain English and easy to understand. Of course, if you have questions, we’ll be more than happy to answer them.
     Just call 1-800-577-0001 or visit www.pacificare.com.


          A QUICK COMPARISON OF OUR HEALTH PLAN OPTIONS
       Type of Plan                      PacifiCare                              PacifiCare                           PacifiCare
                                    SignatureFreedomSM                      SignatureOptionsSM               SignatureFreedomSM Elect
                             You have an annual $1,000 ($250       As a rule, you may save money         You have an annual $1,000 ($250
                             per quarter) Self Directed Account    when you use a participating          per quarter) Self Directed Account
Covered services             (SDA) to spend on health care         primary care provider. However, you   (SDA) to spend on health care
                             provider(s) and many health           can choose any certified provider      provider(s) and many health
                             care services.                        in the United States.                 care services.
                                                                                                         You do not need a referral to see
                             You do not need a referral to see a   You do not need a referral to see a
Going to a specialist                                                                                    a specialist within the PacifiCare
                             specialist.                           specialist.
                                                                                                         Participating Network.
                             You pay no out-of-pocket cost for     This will be subject to deductible    You pay no out-of-pocket cost for
How much an office
                             office visits covered under the        and coinsurance, depending on the     office visits covered under the
visit costs
                             spending account.                     plan you choose.                      spending account.
                             $1,500 or $3,000 depending upon                                             $3,000 depending upon the plan
                             the plan you choose, however                                                you choose, however usage of
Your annual deductible                                             $5,000
                             usage of your SDA account reduces                                           your SDA account reduces your
                             your total out-of-pocket.                                                   total out-of-pocket.
Your lifetime maximum
                             $2,000,000                            $2,000,000                            $2,000,000
benefit
Wellness programs            Included                              Included                              Included
                             You get an annual $1,000 Self                                               You get an annual $1,000 Self
Checkups and                 Directed Account (SDA) account to                                           Directed Account (SDA) account to
                                                                   Included
preventive care              use toward preventive care and                                              use toward preventive care and
                             doctor visits.                                                              doctor visits.
Women’s health programs      Included                              Included                              Included
Family-oriented programs     Included                              Included                              Included
Health management
                             Included                              Included                              Included
programs
Latino/Hispanic (Spanish-
                             Included                              Included                              Included
language) health solutions
Mental health coverage       Included                              Included                              Included
Prescription drug coverage
                             Included                              Excluded                              Included
Here’s an overview of your options:

PacifiCare offers you and your family innovative plans designed to meet your changing needs.

      • PacifiCare SignatureFreedomSM — Self Directed Health Plan (SDHP)
      • PacifiCare SignatureOptionsSM — Preferred Provider Organizations (PPO)
      • PacifiCare SignatureFreedomSM Elect — Self Directed Health Plan (EPO)

Which type of plan is right for you and your family?
All of our plans provide you with choice and flexibility in health care and allow you to seek services or see a specialist without a
referral. Please refer to the benefit overview for a comparison between the three types of plans and benefit levels. And please read
on for an overview of each plan.


   PacifiCare SignatureFreedomSM
   PacifiCare SignatureFreedom is a Self Directed Health Plan (SDHP). It is lower-cost PPO-based, so you’ll have access to
   a broad network of physicians and hospitals; however, the main difference between PacifiCare SignatureFreedom and a
   traditional PPO is that PacifiCare SignatureFreedom rewards you with an annual Self Directed Account (SDA) of $1,000
   which can go toward routine health care services like doctors’ office visits, mammography screening, breast and pelvic exams,
   and more.
   • First-dollar coverage for routine and preventive care.
   • Any money from your SDA that you don’t spend is carried over to the next year, allowing you to “save” for future health
     care expenses.
   • Services not covered by the SDA, such as inpatient surgery or emergency room visits, are paid for like a traditional PPO,
     with a yearly deductible and a charge for coinsurance.
   • You have access to a complete suite of online support tools that allow you to keep track of your SDA account, claim
     activity, status, etc.
   • You can see any doctor without a referral.



    PacifiCare SignatureOptionsSM
    PacifiCare SignatureOptions are Preferred Provider Organization, or PPO, plans. They give you the freedom to go to any
    doctor – including a specialist – without a referral.
    • You can choose any certified health care provider in the United States.
    • As a rule, you save money when you choose a participating provider.
    • You must meet an annual deductible.
    • No referrals needed.
    • Low-cost catastrophic plan.



               Call 1-800-577-0001 or visit www.pacificare.com
PacifiCare SignatureFreedomSM Elect EPO plans
PacifiCare SignatureFreedom Elect is a Self Directed Health Plan (SDHP EPO). It is low-cost, EPO-based, so you’ll have
access to a broad network of physicians and hospitals. PacifiCare SignatureFreedom Elect plans are a new set of plans
which allow members the freedom to self direct within the PacifiCare provider network. PacifiCare SignatureFreedom Elect
rewards you with an annual Self Directed Account (SDA) of $1,000 which can go toward routine health care services like
doctors’ office visits, mammography screening, breast and pelvic exams, and more. These plans differ from regular PacifiCare
SignatureFreedom or PacifiCare SignatureOptions PPO plans in that members will have a special provider network to access,
and there are no out-of-network benefits.
• First-dollar coverage for routine and preventive care.
• Any money from your SDA that you don’t spend is carried over to the next year, allowing you to “save” for future health
  care expenses.
• Services not covered by the SDA, such as inpatient surgery or emergency room visits, are paid for like a normal PPO, with
  a yearly deductible and a charge for coinsurance.
• You have access to a complete suite of online support tools that allow you to keep track of your SDA account, claim
  activity, status, etc.
• You can choose any certified health care provider within the specified participating network.
• No referrals needed.




Prescription Drug Discount Program
You can take advantage of Prescription Solutions® Discount Rx Pricing, if you fall into one of the following categories:
• Prescription Solutions customers who have no prescription benefit through their health plan
• Prescription Solutions customers who have exceeded their health plan’s prescription benefit maximum
• Prescription Solutions customers purchasing medications that are not covered through their health plan’s
  prescription benefit

Discount Rx Pricing is available for most medications – including certain injectable drugs. And the Prescription Solutions
Mail Service Pharmacy can help you save time and money by providing you with access to the same quality medications you
receive from a local pharmacy mailed right to your home – usually at a lower cost. You can also order prescription refills and
nonprescription products over the Internet through its Online Drugstore.

To learn more about Prescription Solutions services, you can visit its Web site at www.rxsolutions.com.




           Call 1-800-577-0001 or visit www.pacificare.com
PacifiCare doesn’t just care for you when you are sick.
                                We help you stay healthy.

  We believe that one of the most important ways to avoid illness and injury is to practice a healthy lifestyle. That’s why PacifiCare is
  a leader in this area. At no additional cost, we provide our members with dozens of healthy lifestyle and prevention programs,
  resources and savings opportunities. They’re all designed to help you and your family get the most out of life.



                                   Living fit and healthy
                                   Take advantage of various programs to help you lose weight, get fit and quit smoking. Save
                                   with discounts on vitamins, supplements and nutrition products, as well as at health clubs
                                   and spas. And get 24/7 online and audio health information.




                                   Rewards for taking charge of your health
                                   PacifiCare HealthCreditsSM rewards you for completing select health programs that earn you
                                   credits. Your credits will save you money on selected consumer goods and services. And they
                                   make you eligible to win quarterly drawings for valuable prizes.




                                   Help for new moms
                                   We offer you a variety of pregnancy programs, and potential savings on fertility monitors,
                                   breast-feeding accessories and infant-safety products. Plus, our Pregnancy section on our
                                   Web site has the information you need before baby arrives.




                                   Help for people with children
                                   Our Mom & Baby section on our Web site offers advice to caregivers of children up to 18
                                   months. Our Preschool section guides parents of children from 19 months to three years
                                   of age. And we offer special values on virtually everything that makes your home safer for
                                   youngsters – cabinet, drawer and appliance latches, fire escape ladders, safety gates, window
                                   guards and more.




              Call 1-800-577-0001 or visit www.pacificare.com
We’re there for you at every stage of life




                  Help for parents of teens
                  We provide information on teen health, teen eating disorders, surviving youth sports, how to
                  better communicate with your teens, recognizing a teen in trouble, and keeping teens away
                  from drugs, smoking and alcohol – it’s all free advice for our members.




                  Keeping your home healthy
                  Take advantage of special opportunities on products that help provide a safe and healthy
                  home for your family, including air purifiers, water filters, dehumidifiers and more.




                  Keeping your home safe
                  Members receive timely information on personal safety, as well as potential savings on
                  emergency equipment, including fire ladders, first-aid kits, water storage equipment,
                  disaster preparation kits and more.




                  Help throughout life
                  Learn about cosmetic treatment procedures and how to choose a provider. Find out about
                  menopause options and elder care. Plus, enjoy discounts on pharmacy and personal care
                  products, as well as on vision and hearing products and services.




                  Help with serious conditions
                  PacifiCare has health management programs that can help you or a loved one manage critical
                  health problems, including heart disease and cancer, as well as help take charge of diabetes,
                  depression and heart health.




        Call 1-800-577-0001 or visit www.pacificare.com
Enroll with PacifiCare and take the next step
toward protecting yourself and the ones you love.
If you think you know enough to apply, everything you need is inside this pocket. The process is simple.

1. Review the plans and rates within this brochure to find the plan and price that is right for you and your family.

2. Complete the enclosed application. Please be sure to answer all questions on the application, print in black ink, sign
   and date where indicated to avoid a delay in processing. Also, remember to include a check or credit card option
   for your first month’s payment.

3. Use the enclosed Easy Pay form to activate automatic premium payment withdrawals from your checking account,
   so you’ll never have to remember to write a check.

4. Return your completed application and Easy Pay form directly to PacifiCare in the enclosed postage-paid envelope.
   You may also choose to use an insurance agent to help you select a plan. If so, please submit your applications to
   your agent.

5. Once received, we will review and process your application. We will notify you by mail if your application has been
   accepted. If denied, we will inform you or your family members of the reasons and other options available to you.

6. Once accepted, we will mail your contract so that you may review the details of your plan, and ID card to present
   for medical services.

7. Your coverage will be effective on the first of the month following processing. We will notify you of your plan
   effective date and will send you copies of the official plan documents for your records before your coverage effective
   date. Should you decide that the plan you have selected does not meet your needs, you will have 10 days to return
   the contract with your request to cancel or reapply for a different plan.

If you have questions or would like to learn more, please call us toll-free at 1-800-577-0001 (TDHI 1-866-816-2018).
Our friendly and knowledgeable customer service representatives are ready to help you. If you’d prefer, we’ll be happy to
give you the names of licensed PacifiCare agent in your area. You can also visit our Web site www.pacificare.com.

You’ve come this far toward protecting yourself and your family. Don’t stop now when they could have health coverage
– and be on the way to a healthier lifestyle – in just a few days. Find out more or apply now.
                                  Want more information? Call
                                         1-800-922-1444
                                                          or visit
                                        www.pacificare.com




PacifiCare products and services are offered by one or more of the following PacifiCare family of companies: Health plan products
and services are offered by PacifiCare of Arizona, Inc.; PacifiCare of California; PacifiCare of Colorado, Inc.; PacifiCare of Nevada,
Inc.; PacifiCare of Oklahoma, Inc.; PacifiCare of Oregon, Inc.; PacifiCare of Texas, Inc.; PacifiCare of Washington, Inc.; PacifiCare
Dental of Colorado; PacifiCare Behavioral Health of California, Inc.; and PacifiCare Dental (in California). Indemnity insurance
products (including PPO products) offered by PacifiCare in California are underwritten by PacifiCare Life and Health Insurance
Company. Indemnity insurance products (including PPO products) offered by PacifiCare in Arizona, Colorado, Nevada,
Oklahoma, Oregon, Texas and Washington are underwritten by PacifiCare Life Assurance Company. Other products and services
are offered by PacifiCare Heath Plan Administrators; RxSolutions, Inc.; PacifiCare Southwest Operations, Inc.; and PacifiCare
Behavioral Health Inc. PacifiCare® is a federally registered trademark of PacifiCare Life and Health Insurance Company.
                                                                                                                          POR085513-000

				
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