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PacifiCare of California Offers New PPO Plan!

Reduce your monthly group health insurance rates
Up To 20% to 50%

This plan is for Business owners, Employees, and dependents.

NO DEDUCTIBLE & NO COPAY
For Routine Office Visits, Female Exams, Covered diagnostic X-rays and lab services, Prostate Cancer screening and Well Child Care for THE FIRST $1,000 (combine totals) YES! FIRST $1,000 is FREE!

Is Rx / Prescriptions Covered?
Absolutely! $10.00 CoPay ( generic drugs )

Unused portions of the SDA can be rolled over, year after year.

Click here to view and print the Pacificare Brochure

 

( Los Angeles County Rates Below. Please call for other counties. )
RAF 1.0

Employee Age
Employee
Family
Under 30
$85.46
$288.34
30 to 39
$104.67
327.76
40 to 49
$137.78
$358.08
50 to 54
$187.07
$426.16
55 to 59
$229.13
$513.92
60 to 64
$299.05
$654.05


Scenario #1
Jane Smith - Employee Only Coverage
* Self Directed Account $1,000
* PPO Deductible $2,000

On September 15, Jane visits her doctor for her annual physical exam. Total Cost of this visit is $275.00.

On February 22, 2004, Jane visits the doctor for flu symptoms. The Doctor prescribes an antibiotic. Total cost of office visit $100.00. Prescription cost $18.50.

What is Jane’s total out-of-pocket expense?
How much money is left in her SDA account to roll over?

SDA Balance $1,000
Annual Exam ($ 275.00)
SDA Balance $ 725.00
Office Visit (flu) ($ 100.00)
SDA Account rollover
(as of Sept. 1, 2004 ) $625.00		 Total out-of-pocket for Jane
$10.00

Click here to view and print the Pacificare Brochure


Scenario #2
Mary Jones- Family Coverage
* Self Directed Account $1,833.32
* PPO Deductible $4,000

On September 01, 2003, Plan renews.

On October 01, Mary Jones plus 1 dependent (Melissa) enrolls in PacifiCare’s SignatureFreedom Plan (SDHP). (SDA account is prorated for 11 mos. due to off anniversary enrollment)

On October 31, 2003 , Melissa gets visits doctor for strep throat symptoms. Total cost of visit $185.00.

On November 15, Mary visits for annual physical. Total cost of visit $395.00.

On March 18, both Mary and Melissa have flu symptoms and visit the doctor. Cost for visit $370.000 (185 x 2).

What is the Sept. 01, 2004 SDA Balance?
What is the total out of pocket expense for Mary and Melissa Jones?

SDA Balance
$1,833.32
Strep Throat Visit
$185.00
SDA Balance
$ 1,648.32
Annual Physical
$395.00
SDA Balance
$1,253.32
Flu Symptoms Visit
$37000
SDA Balance
$883.00
September 01, 2004 SDA Balance
$2,883.32
Total out-of-pocket for Mary
$00.00

Click here to view and print the Pacificare Brochure


Scenario #3
Jack Splat - Employee Only Coverage
* Self Directed Account $1,000
* PPO Deductible $2,000

On September 01, 2003, Jack enrolls in PacifiCare’s SignatureFreedom Plan (SDHP).

On December 13, 2003, Jack breaks his leg skiing. He has not used any of his SDA account to date. The In-Network Hospital bill for breaking his leg totals $3,675.

What is Jack Splat’s total out of pocket expense?
How much money is left in his SDA account?
Total Amount due for Hospital $3,675.00
Amount covered in Self Directed Account $00.00
Amount of out-of -pocket for Jack $2,000.00
PPO Coverage at 70%
( $1,675 x .70 = $1,172.50 )		 PPO Deductible Amount
$502.50
Total out-of-pocket for Jack $2,502.50
Total SDA Account $1,000.00

Click here to view and print the Pacificare Brochure
Click here to print enrollment Applications

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