|
|
|
|
|
|
|

PacifiCare,
a division of UnitedHealthcare, offers three high-deductible
health plans for individuals and families that qualify
to be used with a Health Savings Account. Coinsurance
levels range from 100% to 50%, which can offer much
lower rates.
To
be considered for reimbursement, expenses must qualify
as covered expenses. Expenses are also subject
to reasonable and customary limits, unless you use a
network.
|
|
|
|
|
|
Plans
at a Glance:
This
information is presented only as a very brief overview
of some of the benefits of this plan, and is intended
only for general education. The amount of benefits
provided depends on the plan selected. Premium will
vary with the type of benefits selected. These plans
contain exclusions from and limitations of coverage.
Please see the product brochure for more complete information,
as well as information about terms of renew ability, preexisting
conditions, out-of-network penalties, and notification
requirements. Plans are subject to health underwriting.
To be considered for reimbursement, expenses must qualify
as covered expenses. Expenses are also subject to
reasonable and customary limits, unless you use a network,
and all other policy provisions, including determinations
of medical necessity.
For
complete details on each plan, please view the PacifiCare
plans description
brochure.

Coverage
Synopsis:
PacifiCare
Plan 100-50/1500 - 100-50/2700
- 100-50/5000
Once
the deductible has been met, covered expenses are at
100% and the maximum out of pocket is equal to the deductible
amount. Covered expenses include routine doctor
visits, immunizations, x-ray and lab tests, mammograms,
pap smear and prostate screenings. Policy maximum
benefit is $5 million per person.
Pacificare
Plan 100-50/3000
- 100-50/5400
- 100-50/10,000
With
this plan your deductible only needs to be met once
per family per year. Everyone listed on the policy
will then be covered the rest of the year at 100% of
covered expenses, even for such things as routine doctor
visits and prescriptions, until you have spent a total
equal to the deductible out of pocket. From there,
everyone is covered at 100% up to $5 million per person.
PacifiCare
members are also offered a special enrollee-only program
that offers savings (through vendor agreements) on selected
health-related products and services - at no additional
health plan premium. Here is just a sampling of
what's available to enrollees at a savings of 5 to 25
percent:
- Child
Safety products; products for a Healthy Home
-
Pharmacy & Personal Care items; products for Healthy
Moms & Kids
-
Fitness & Weight Management items
-
Complementary & Alternative Care services
-
Vision & Hearing products

Rates:
All
deductible options have a 12 month rate guarantee.
Your rates may also increase in the month of your date
of birth, if you are moving in to a new age bracket.
For example, PacifiCare charges the same rate for all
male applicants age 30 to 34. You do not receive
a rate increase for your age during this five year period,
your rates will only go up once per year, based on PacifiCare's
claims history for everyone with similar coverage.
However, when you do go to a new age bracket (age 35 in
the example above), your rates will be adjusted based
on your age. It is possible to receive an age-based
rate increase during your initial 12 month rate guarantee
period.
Preferred
rates without riders are available on our instant
quote page. Rates depend on gender, smoking
status, zip code, and health status.
The
premium can be paid via quarterly, semi-annual, or annual
billing, or a monthly bank draft or credit card.
The bank draft will occur on the premium due date each
month. The initial premium can be paid with a check
or credit card.

PPO
Network:
As
a United Healthcare company, PacifiCare policy holders
have access to one of the largest PPO networks in the
nation. To view the list of providers in your area,
simply visit the Pacificare
Provider Directory.

Underwriting:
Underwriting
of your application with PacifiCare normally takes two
to four weeks, though again if medical records are ordered
it could take longer. PacifiCare is fairly strict
compared to many other companies, and often will decline
an application that other companies would accept with
an exclusionary rider.
PacifiCare
performs Verification Phone
Calls (VPCs) for all applicants of individual
plans. VPCs are helpful in gathering more information
about medical conditions directly from you without necessarily
requesting medical records. This often reduces issue
time and make it easier for you to do business with PacifiCare
than many other companies.
With
every individual case submitted, after the application
is entered into the system, a VPC is made by the VPC team
to the applicant. If you do not respond from the
first call or message, a second call is made the following
business day. If PacifiCare is unsuccessful in reaching
you, they will send a letter asking you to please return
their call.
To
help expedite the process, please make sure to include
the following information with your application:
-
Make sure to include a daytime phone number where you
can be reached, as well as an email address in case
they cannot reach you by phone.
- If
you are unavailable to complete the VPC, PacifiCare
will leave a file number and phone number to call PacifiCare
back between 6:00AM and 6:00PM MT (limited staff only
from 4:30 PM to 6:00 PM - hold time might be required).
- Please
have your medical information available for the call.
60+
Year Old Applicants
If
you are over 60 years old, you will need to have been
seen by a licensed medical physician within the past 12
months. If you have not, you will not be considered
for coverage until the results of a complete physical
exam are received, including
- Vital
signs
- Review
of bodily systems (including height and weight)
- Notation
of all medications(s) being taken
- Chemistry
panel
- Male
applicants, PSA (Prostate Specific Antigen) level
- Female
applicants, Mammogram and Pap
Full
medical records will also be requested once the updated
exam has been completed.

Effective
dates:
The
earliest your coverage can go into effect is ten days
after you have signed your application. You may
request an effective date any time between 10 and 60 days
after you sign your application.
Please
note, if you are requesting an effective date of less
than 21 days from the time you complete the application,
you may not receive notification of your approval until
after your effective date. If you have claims during
this period, they will be eligible for coverage if submitted
after you have been approved. Also note that you
will be billed starting on your requested effective date,
even if you have not yet been notified that you have been
approved. This is very good for someone who does
not have any present coverage and would like for their
benefits to begin right away. For those who are
already covered, it is suggested that you maintain your
current coverage in force until you have received notice
from either HSA for America
or directly from PacifiCare that your coverage
has been approved and is in force.

About
PacifiCare:
PacifiCare
Health Systems is a division of UnitedHealthcare.
They serve more than 3 million health plan members and
approximately 10 million specialty plan members nationwide
with annual revenues of more than $12 billion.
PacifiCare
recently celebrated its 25th anniversary as one of the
nation's largest consumer health organizations, offering
individuals, employers and Medicare beneficiaries a variety
of consumer-driven health care and insurance products.
PacifiCare
has been given a rating of "A-" (Excellent)
from the A.M.
Best Company, an independent insurance rating
organization.
HSA
for America is an independent authorized
PacifiCare agent. CA License #: 0E39302

|
|
|
 |
 |
 |
 |
 |
"We
feel that an HSA-plan is more geared toward
preventative medicine and leading a healthy lifestyle."
We
lead healthy lifestyles and don't need to go to doctors
much, so we didn't want to spend a lot of money on a policy
that we don't really use. But we still wanted the
protection of major medical coverage in case of an emergency.
We also feel that an HSA-plan is more geared toward preventative
medicine and leading a healthy lifestyle. You can use the
HSA to pay for naturopathic care, for example. And
our particular insurance covers an annual physical exam.
Angie
Spinelli
Piano Teacher
Oakland, CA
Read
More...
|
|
|