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:
Dental and Vision Discount
PacifiCare does offer a very basic dental and vision discount plan that can be added on to any plan. You can see more about it here...
http://www.signaturesavings.net/
This will perform the same as other stand alone discount dental and vision plans, or plans that come along with an accident supplements.
Rates
You can compare the rates of PacifiCare plans to other plans in Colorado using our instant quotes or see the rate sheet of PacifiCare plans only.
Application Options
Applications can be done by downloading a Paper Application and faxing or mailing it to us at the fax number or address in the instructions, by Phone Application, or with an easy to use Online Application that expedites the underwriting process (make sure you have all pop up blockers turned off or it won't work). If you have any health conditions at all make sure you let us know, underwriting at PacifiCare is very different from other health insurance companies in Colorado. There is no difference in cost between applying directly through the company and going through a broker. PacifiCare has an A.M. Best rating of "A-" (Excellent).
**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.
