Welcome Texas Federal Employees and Annuitants
Health care coverage designed
to help you stay healthy.
Finally, a Health Plan to Provide You
With Resources for a Healthy Life.
Thank you for taking the time to ﬁnd out more about what makes
PacifiCare the health care plan of choice for so many federal
employees. Your health is important, and we are committed to
providing you with all the resources you need to manage it at 2005 Plan Highlights
every stage of your life.
■ Lower Copayments for Prescription
The information in this booklet is provided as a resource to
help you review and determine which health care options will
best ﬁt your needs. PaciﬁCare has made changes to the 2005 ■ New: Chiropractic and Acupuncture Visits
medical beneﬁts, so please review this booklet and your other
materials carefully – this will help you understand the key beneﬁt ■ Lower Annual Out-of-Pocket Maximum
changes as you make your health care decisions.
■ Now Included with your Medical Plan –
Federal employees who enroll in the PaciﬁCare medical plan
automatically receive the PaciﬁCare SignatureSavingsSM (Dental New PacifiCare SignatureSavingsSM Dental
and Vision) plan, at no additional premium cost. and Vision Plan
PacifiCare also encourages you to take advantage of the new
OPM Flexible Spending Account (FSA) to maximize the efﬁciency
of your health care spending and to help you plan ahead.
Detailed health plan information is available in the back pocket of this brochure.
As you review the information enclosed, we know you’ll see why this plan is such
a good choice.
Also in this back pocket, you’ll find a Primary Care Physician Selection card.
In choosing PacifiCare, it is important to fill out and return this card to ensure
you have access to the doctor you choose.
Take Advantage of Programs Designed to Help
You Maintain Physical and Emotional Health.
Every day, you make decisions that affect your overall health PaciﬁCare PerksSM: Access to Savings
and well-being. And we believe that one of the most
important ways to stay healthy is to make good lifestyle
on Alternative Care Beneﬁts and More
choices. Sometimes conventional medicine isn’t the answer for your
health care needs. PaciﬁCare expands your and your family’s
This is why we provide PaciﬁCare members with a wide health choices by providing members special savings. Just
variety of programs and services designed to help you and some of these PaciﬁCare Perks1 programs include:
your family get the most out of a healthful life – at no
additional premium cost. ■ Complementary & Alternative Care1 – savings on
participating massage therapists.
PaciﬁCare HealthCreditsSM: ■ Vision & Hearing – savings on eye exams, contact
lenses, frames and corrective laser eye surgery.
Tools to Help You Stay Healthy
Everyone knows eating right and exercise are critical to good ■ Pharmacy & Personal Care – save money on vitamins,
health, but it’s not always easy. No matter where you are in supplements, nutrition products and much more.
your personal journey toward good health, PaciﬁCare offers a ■ Healthy Home – savings on products such as air
way to help through our PaciﬁCare HealthCredits program, puriﬁers, water ﬁlters, dehumidiﬁers, etc., as well as
where you can: information on how to make your home healthy
■ Browse for general health information and healthy recipes. and safe.
■ Build a customized ﬁtness or diet plan. ■ Personal Safety – savings and information on safety
equipment, emergency equipment, ﬁre ladders, ﬁrst-aid
■ E-mail coaches and get personalized responses to your kits, water storage equipment, disaster preparation kits
speciﬁc questions and issues. and more.
■ Find out ways to improve your emotional well-being.
■ Create a plan to help motivate your children. Programs to Help Manage Ongoing
And along the way toward good health, be rewarded for your
healthful lifestyle choices. By participating in PaciﬁCare As a PaciﬁCare member, you’re entitled to extended services
HealthCredits, you can earn credits that can be used to get over and above your traditional health care coverage at no
discounts on ﬁtness products and become eligible for extra premium cost. PaciﬁCare’s Health Management
quarterly drawings. programs2 are designed to put you and your family on the
path to better health – through education, self-care guidance
and lifestyle suggestions that meet your speciﬁc medical
For more detailed information on needs. PaciﬁCare’s Health Management programs focus
on the areas of depression, asthma, heart health, diabetes
any of these programs, please visit
Access to Health Care Resources
When You Need Them.
If you’re looking for general health information on topics Also included is our easy-to-navigate online Provider
from acupuncture to headaches, poison prevention, yoga and Directory to help you locate a participating provider. You
more, this plan provides you with convenient, online services can search by name, specialty or Zip Code so you can ﬁnd
and customer service to ﬁt your busy schedule. the health care provider who best meets your needs.
1. Access the Federal Employee site, as described above.
Convenient Access, Day or Night 4. Click on the Doctor Directory tab.
With PaciﬁCare’s 24-Hour Health Information program you 3
5. Select Doctor Search.
don’t need to make an appointment, rearrange your schedule
or wait for Monday morning to get answers to your general 6. Select Medical Plan and follow the directions on
health questions, from rashes to headaches, allergies to the screen.
stomach pain, or nutrition to vaccines. Once you ﬁnd a doctor, be sure to ﬁll out and return the
Simply: Primary Care Physician Selection card, located in the back
pocket of this brochure. It is very important to ﬁll out and
■ Call the 24-Hour Nurse Line toll-free, return this card to ensure you have access to the doctor you
1-866-PHS-HEALTH (1-866-747-4325). choose.
■ Go to www.paciﬁcare.com and click on Live AssistTM and
you will be connected with a Health Information Specialist. PaciﬁCare SignatureSavingsSM
■ Dental Care – Your new PaciﬁCare SignatureSavings
Dedicated Federal Employee Web Site dental program offers greater savings on dental services
such as ﬁllings and crowns. You will also enjoy savings
Find your plan-speciﬁc 2005 beneﬁt materials on the
from our large network on services not usually included,
dedicated Federal Employee Web site. Find information on
such as teeth whitening and orthodontics.
the 2005 beneﬁt highlights, decision support tools, helpful
links for Federal Employees and information on how to use ■ Vision – At PaciﬁCare, we know that your vision health
your plan. is just as important as your dental health, so we’ve added
a PaciﬁCare SignatureSavings vision beneﬁts program.
1. Go to www.paciﬁcare.com.
You will now be able to save up to 50% on your vision
2. Click on the “Federal Employee” link in upper-righthand needs, with no limit on how often you use the program.
corner of the page.
3. Select your state and you are there.
Meeting the Needs of Our Members.
A Special Focus on Women’s Help With Every Stage of Life
Health SolutionsSM PaciﬁCare understands that through life, there are changes
PaciﬁCare provides access to programs and services designed that can be confusing, and even scary. In order to help you
to help women and those they make decisions for prevent ﬁlter through all the myths and stories, PaciﬁCare has
illness, save time, access important health information and designed several programs to help you.
potentially save money. Let PaciﬁCare’s Women’s Health ■ Cosmetic Services – get access to resources to help you
Solutions help empower you to achieve better health, wellness learn about new products, procedures and technologies
and balance. to maintain or restore a youthful appearance.
One of our goals is to help every woman become aware of her ■ Menopause: Understanding Your Options – helps
risk of heart disease and learn how to prevent it and reverse you make informed decisions about your health.
its effects. That’s why our Foundation has made a grant to
support the American Heart Association in a multiyear ■ Caregiver Resources – through an association with
national awareness campaign called Go Red For Women. Caregivers Marketplace, you have access to discounted
products and rebates that are commonly used when
caring for an aging loved one.
Resources to Help With Parenting
PaciﬁCare has programs and services to help at every stage
of parenting – from pregnancy to adolescents. PaciﬁCare
Latino Health Solutions
offers these programs to help you navigate through the very PaciﬁCare understands that Hispanics/Latinos have unique
difﬁcult, but rewarding, job of being a parent: health care and cultural preferences, and many prefer
Spanish-language communication, especially when dealing
■ Pregnancy to Preschool – an Internet-based program with complicated or personal subjects such as their health
that provides you with valuable information, interactive and health care coverage. Therefore, we offer a broad range
tools and personalized e-mail reminders on topics from of Spanish services to serve our unique Hispanic/Latino
conception to the classroom – all from a single resource. members, including a dedicated toll-free Spanish-language
■ Parenting Adolescents – provides information and free Customer Service number, 1-800-730-7270 and a Spanish-
advice on teen health, teen eating disorders, how to better language Web site, www.paciﬁcarelatino.com.
communicate with your teens, recognizing a teen in
trouble, and keeping teens away from drugs, smoking
■ Healthy Moms & Kids1 – savings on services and
products that every Mom needs, such as Gymboree®
Play and Music programs and breast-feeding accessories.
2005 Benefit Summary.
Member Copayments Red indicates an improvement over 2004
Annual Copayment Maximum $3,000 Individual/$9,000 Family $5,000/$15,000
Physician Ofﬁce Visit Copayment $20 Primary/$40 Specialist $20 Primary/$40 Specialist
Inpatient Hospital Copayment $400 per day, $2,000 maximum $400 per day, $2,000 maximum
Outpatient Surgery Copayment $200 per procedure $200
Emergency Copayment $250 per visit (not waived if admitted) $250
Mental Health & Substance Abuse $40 per visit $40
Chiropractic & Acupuncture $20 per visit, up to 20 combined Not covered
Chiropractic and Acupuncture visits
Retail Pharmacy Rx Copayment (30-day supply) $10 Generic/$40 Brand/$50 Non-Formulary $20/$40/$50
Mail Order Rx Copayment (90-day supply) $20 Generic/$80 Brand/$100 Non-Formulary $40/$80/$100
Dental Exam4 $21 Covered at 100% UCR5
Routine Teeth Cleaning4 $41 Covered at 100% UCR5
Vision Lenses Discounts on select lenses and lens options Not covered
Vision Frames Discounts on select frames Not covered
Durable Medical Equipment Coinsurance 80% up to the annual $1,500 limit 100%
per beneﬁt year, all charges thereafter
Specialized Scanning Copayment $200 per procedure $200
(MRI, CT, PET and SPECT)
Self-Injectables Copayment (excluding insulin) $50 per prescription 100%
Infertility Copayment 50% up to 3 cycles, excludes fertility medication 50%
2005 Non-FEHB Benefits.
This is only a brief summary of the many non-FEHB Medicare Advantage HMO – As a member of Secure
optional beneﬁt programs offered to plan members to Horizons, you beneﬁt from low or no plan copayments,
enhance your existing health care coverage. In Texas, for an low or no deductibles, and virtually no paperwork. Secure
added monthly premium, you can select and enroll in one of Horizons offers peace of mind for Medicare beneﬁciaries
the following programs to supplement your plan coverage. residing in parts of Arizona, California, Colorado, Nevada,
Oklahoma, Oregon, Texas and Washington by offering
more services than original Medicare for an additional
Medicare Managed Care and Medicare cost. For more information, call toll-free 1-800-637-9284,
Supplement Plans 1-800-647-6038 (TDHI) or visit www.securehorizons.com.
If you are Medicare eligible, enhance your coverage options Medicare Supplement – Secure Horizons Medicare
with Medicare Managed Care and Medicare Supplement Supplement plans pick up where Medicare leaves off, so
Plans – a Non-FEHB beneﬁt offered by Secure Horizons. you don’t have the worry about overwhelming medical
If you are Medicare eligible and are interesting in enrolling bills. Better yet, as a Medicare beneﬁciary you can choose
in a Medicare HMO or a Medicare Supplement Plan the level of coverage you feel best suits your needs. Choices
sponsored by PaciﬁCare without dropping your enrollment range from a plan that covers some basic hospitalization
in PaciﬁCare’s FEHB plan, call 1-800-637-9284 or and medical coinsurance expenses to a plan with a richer
1-800-647-6038 (TDHI). beneﬁt package that includes foreign travel emergency
and at-home recovery. For more information, call toll-free
1-800-637-9284, 1-800-647-6038 (TDHI) or visit
1. Special arrangements are only for PaciﬁCare enrollees whose plan beneﬁts do not include products/services described or whose
PaciﬁCare plan beneﬁts covering these products/services have reached the allowable maximum. Vendor participation and actual,
usual and customary charges may vary, exclude certain items or require additional charges. PaciﬁCare does not endorse or guarantee
2. Physicians must direct enrollment in Disease Management programs; other requirements may apply.
3. The 24-Hour Health Information Program’s intent is to provide general information regarding common health questions or
conditions. If you have a speciﬁc question relating to a condition or medical course of treatment for yourself or others, please
consult your physician. If you believe you need emergency services, call 911, or its local equivalent, or go to the nearest medical
facility for treatment.
4. Member’s discounted fee will vary by geographic location.
5. Usual, customary and reasonable.
PaciﬁCare HealthCreditsSM is offered by PaciﬁCare Health Plan Administrators, Inc. Programs subject to availability by state;
components may change. PaciﬁCare HealthCreditsSM is available to PaciﬁCare enrollees.
Programs vary by state; components may change. Women’s Health SolutionsSM programs and services available to enrollees only.
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, Inc.; PaciﬁCare Behavioral Health of California, Inc.; PaciﬁCare Health Insurance Company of Micronesia, Inc.;
and PaciﬁCare Dental (in California). Indemnity insurance products (including PPO products) offered in California are underwritten
by PaciﬁCare Life and Health Insurance Company. Indemnity insurance products (including PPO products) offered in Arizona,
Colorado, Nevada, Washington, Oregon, Texas and Oklahoma are underwritten by PaciﬁCare Life Assurance Company. Other
products and services are offered by PaciﬁCare Health Plan Administrators, Inc.; PaciﬁCare Southwest Operations, Inc.; RxSolutions,
Inc.; SeniorCo, Inc.; and PaciﬁCare Behavioral Health, Inc. PaciﬁCare® is a federally registered trademark of PaciﬁCare Life and
Health Insurance Company.
2005 Rate Information
Non-Postal Premium Postal Premium
Biweekly Monthly Biweekly
Type of Enrollment Code Gov’t Share Your Share Gov’t Share Your Share USPS Share Your Share
Self Only GF1 $131.08 $44.33 $284.01 $96.05 $154.74 $20.67
Self and Family GF2 $298.23 $104.59 $646.17 $226.61 $352.08 $50.74
PacifiCare updates Provider Directories periodically. PacifiCare cannot guarantee the
availability of the physicians or other providers in the contracting network. Please
verify a doctor's participation status prior to obtaining services by calling the
PacifiCare Customer Service department. The phone number is located on your
PacifiCare SignatureSavingsSM is a program/service that only provides discounts on
health care services obtained from participating providers within the plan. For more
information, please visit www.pacificare-dental.com
Secure Horizons Group Retiree Medicare + Choice Plans are offered by PacifiCare®
that contracts with the federal government. Limitations, copayments and coinsurance
will apply. Group Retiree prospects must meet the eligibility requirements to enroll
for group coverage. Health plan premiums and benefits may vary by employer group.
Pharmacy benefits are limited to a Formulary that is subject to change without notice
during the contract year. Contact PacifiCare/Secure Horizons for additional details.