PacifiCare Health Systems

Useful Information About PacifiCare Health Systems

PacifiCare Health Systems is one of the largest healthcare companies in the United States, currently serving over 3 million customers. It also provides more than 10 million specialty plans to clients. With annual operating revenues of $12 billion, PacifiCare Health Systems is an industry leader in terms of membership and financial stability.

PacifiCare offers a wide range of policies to individuals and families, as well as employers and Medicare recipients.

A wholly owned subsidiary, Prescription Solutions, provides comprehensive prescription drug and medical care coverage, as well as specialty options such as behavioral health, life insurance, dental, and vision care.

The goal of PacifiCare Health Systems has always been simple and straightforward- to help its members lead healthy, productive lives. Policyholders can be assured of having secure and adequate healthcare coverage at a price which is fair and reasonable.


An Overview of PacifiCare Health Systems Plans

PacifiCare Health Systems offers the PacifiCare Signature Value HMO (Health Maintenance Organization) plan to consumers. This plan places a strong emphasis on wellness and preventive care programs and options.

The Signature Value HMO plan utilizes primary care physicians (PCP) from within a large network of qualified physicians, specialists, and hospitals. This allows members to predict and plan for the cost of routine care and treatment. There is very little paperwork involved with this HMO plan.

When a policyholder uses an in-network treatment facility, all which is required is a small copayment amount at the time of service. This amount varies, depending on the specific contract.

Through the Signature Value HMO plan, members have convenient access to an extensive network of healthcare professionals. It includes over 47,000 physicians and 222 hospitals from which to choose medical services.

For consumers who are looking for flexibility and a wide range of options when choosing a health insurance policy, PacifiCare offers its PacifiCare Signature POS (Point Of Service) plan. This plan combines the features of an HMO plan with the advantages of a typical indemnity plan. Policyholders can choose from either in-network or out-of-network providers. This allows customers more flexibility when choosing their healthcare providers. If members opt to see an in-network physician or facility, they have access to the same large network that is available under the HMO plan.

Another plan consumers can choose from PacifiCare Health is the Signature Elite PPO (Preferred Provider Organization) plan. It offers a large number of primary care physicians and specialists to its policyholders. This plan is only available to employers with 51 or more employees. This PPO plan has a network of more than 68,000 physicians and 330 affiliated hospitals.

The PacifiCare Signature Freedom plan is designed as a Self-Directed Health Plan (SDHP). It is formulated like the PPO plan, but with the difference of having a Self-Directed Account (SDA) from which funds are used to pay for qualified medical services and treatment.

These include routine office visits, breast and pelvic examinations, and mammograms. Members can choose from any in-network physician and pay only a low copayment or coinsurance percentage at the time the service is rendered. These amounts vary according to the actual policy. Any money not used at the end of the year is automatically rolled over to the following year.


Competing Carriers

PacificSource Health Plans
Rocky Mountain Health Plans