Copay Plans
PacifiCare offers a wide variety of plans. This grid will help explain the differences between the more comprehensive copay plans...
| Deductible | $500 | $1000 | ||
|---|---|---|---|---|
| Coinsurance | 20%
|
20%
|
||
| Coinsurance Limit | $1,500 |
$2,000 |
||
In-Network
|
Out-of-Network | In Network
|
Out-of-Network |
|
| Provider/Facilities | PPO
|
PPO
|
||
| Lifetime Benefit Maximum | $2 Million
|
$2 Million
|
||
| Physician Visits | 100% after $25 Copayment; 80% after Deductible for associated lab and X-ray services |
60% of Usual and Customary after Deductible | 100% after $35 Copayment; 80% after Deductible for associated lab and X-ray services |
50% of Usual and Customary after Deductible |
| Prescription Drug | Copayment of $10 generic/ $40 brand/$60 non- Formulary |
50% after Copayments of $10 generic/$40 brand/ $60 non-Formulary |
100% after Copayment of $15 generic/$40 brand/$60 non-Formulary and a $100 Deductible |
50% after Copayments of $15 generic/$40 brand/$60 non-Formulary and a $100 Deductible |
| Adult Preventive Care (In-network) | 100% after $25 Copayment 80% after Deductible for associated lab and X-ray services |
60% of Usual and Customary Deductible waived for office visit 60% after Deductible for associated lab and X-ray services |
100% after $35 Copayment 80% after Deductible for associated lab and X-ray services $300 maximum benefit per Calendar Year |
50% of Usual and Customary 50% after Deductible for associated lab and X-ray services $300 maximum benefit per Calendar Year |
| Child Preventive Care | 100% after $25 Copayment 80% Deductible for associated lab and X-ray services |
60% Usual and Customary 60% after Deductible for associated lab and X-ray services |
50% Usual and Customary o 50% after Deductible for associated lab and X-ray services |
50% Usual and Customary o 50% after Deductible for associated lab and X-ray services |
| Inpatient Hospital Care | 80% after deductible | 60% of Usual and Customary after Deductible; Up to $1,000 maximum benefit per day (Covered Expenses for these services do not apply to the Coinsurance Maximum) |
80% after deductible | 50% of Usual and Customary after Deductible; Up to $500 maximum benefit per day (Covered Expenses for these services do not apply to the Coinsurance Maximum) |
| Emergency Room | 80% after Deductible and $75 Copayment per visit | 80% after Deductible and $75 Copayment per visit | ||
More detailed PacifiCare of Colorado plan information for each deductible can be seen by downloading a PacifiCare of Colorado Plan Description Form for that plan:
**Any descriptions of coverage on this page may not be current and should not be taken as a description of coverage. Any persons seeking to get a full description of coverage should view Colorado plan description forms and/or brochures for the plan they are interested in.