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PacifiCare Insurance

For those looking for an HMO plan, PacifiCare Health Plans provide several options. Whether you are looking for such a plan, or have a family or small business, PacifiCare Insurance has a plan to fit your needs.

PacifiCare Signature Value HMO: This plan is for those who focus on wellness and prevention. You choose a primary care physician (PCP) to provide your care and referrals to specialists. Each time you visit your primary care physician, you pay a predetermined co-payment. With this plan, you have over 47,000 doctors and 222 hospitals to choose from in California.

PacifiCare Signature POS Plan: If you need a health care plan that provides flexibility, the PacifiCare Signature POS plan has several options and is very flexible. Basically, you have a typical indemnity arrangement and an HMO combined, which allows you to choose a doctor in the network or out of the network.

PacifiCare SignatureElite: For employers who prefer a PPO Plan — a preferred provider option, PacifiCare Signature elite PPO gives employers the ability to provide health insurance for their employees at a reasonable cost. The SignatureElite plan is open to employers with at least 51 employees, and it allows the employees to choose from 68,000 doctors and 330 hospitals in California.

PacifiCare Signature Freedom: The PacifiCare Signature Freedom plan is a self directed health plan that is PPO-based. You have access to over 68,000 doctors and 330 hospitals in California. Each year, you get a self directed account. The account can be used for preventative health care — doctors office visits, pelvic exams, breast exams and other preventative care. If you use a physician within the plan, the co-payment is lower. If, at the end of the year, you still have money in your account, that money is carried over to the next year.

What is a Self Directed Health Plan? A self directed health plan allows you to have more freedom while making health care decisions — and it’s cheaper than an HMO or PPO. When you choose a health care plan — HMO or PPO — your premiums are affected by the one person who is constantly going to the doctor or the person who has an unfortunate and expensive illness.

With a self directed health plan, the managed care part of the HMO or PPO is nonexistent. This saves you on administrative costs that go with HMO and PPO plans. The plan provides for basic routine services, such as office visits, routine checkups for babies, basic x-rays, blood tests, lab work and more. Then, the plan allows for acute and chronic care. This is the type of care you may have if you need ongoing prescriptions, such as for diabetes or another illness. If a person has five different chronic care situations, but you have none, your health premiums are affected. With a self directed health plan, your premiums are based on what you need.

Those with chronic illnesses see the doctor more often than a person who does not have a chronic illness. The person without does not have to pay higher premiums to help cover the insurance benefits used by the person with the chronic illness, thus his or her premium is lower.

The plan also covers catastrophic care services. You are encouraged to use a plan doctor for transplants, childbirth or traumatic incidents. The plan allows a certain amount for the initial and ongoing care related to the problem. To keep your out-of-pocket costs lower, you would use the recommended facility or physician. If you chose to use a facility or physician not in the network, you would have to pay more out-of-pocket costs.

Summary: Choosing a health insurance plan is a highly personal choice and each person must determine which plan best fits his or her requirements. A person may be single or have a family with a couple of children. Because children see the doctor more often than an adult — in most cases — you want to choose a plan that includes your children. If you are single, you may want to choose a plan with lower premiums, especially if you do not need extensive care throughout the year.

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