PacifiCare Health Systems, founded in 1978, is among the largest providers in the United States. Headquartered in Cypress, California, it provides a nationwide network for individuals and group members. Its health plan base is approximately 4 million members strong, and more than 9 million customers participate in specialty plan coverage.
As a United HealthCare company, its core business lies in Arizona, California, Colorado, Nevada, Oklahoma, Oregon, Texas, and Washington. Within these regions, the following companies are part of the PacifiCare organization: PacifiCare Behavioral Health, PacifiCare Dental and Vision, Prescription Solutions, and Secure Horizons Senior Solutions. In 2004, American Medical Security Group (AMS) became part of the group.
PacifiCare Products
PacifiCare utilizes an extended range of Primary Care Physicians (PCP), either individually or in physician groups, to manage treatment plan options. Under standard Health Maintenance Organization (HMO) operations, the PCP selection is flexible and physicians must maintain quality ratings. While coverage and options will vary from state to state, PacifiCare's core plans are:
- PacifiCare SignatureValue HMO
- PacifiCare Signature Point of Service (POS)
- PacifiCare SignatureOptions
- PacifiCare Signature Independence Indemnity
- PacifiCare SignatureFreedom Self-Directed Health Plan (SDHP).
The Signature Value Plan is a cost-saving, HMO-based program. Members select a primary care physician who manages all medical consultations and makes referrals as required. For individuals who want to eliminate making specialized decisions, this may be the preferred plan.
The PacifiCare SignatureOptions PPO plan, with no restriction to selecting a general physician or specialist, allows individuals to take advantage of greater options. Members can also elect to visit out-of-network doctors at a higher cost.
The SignatureFreedom plan is specifically geared toward individuals who want complete control of their health care choices. It is based on a Self Directed Sccount (SDA) system in which a specific sum is set aside for standard visits and exams. It is up to the member's discretion how these funds are directed during the course of a year. They also apply toward major medical expenses. If not used, the funds roll over, and are added to an account quarterly. Different plan levels with escalating price points are available within this specialized offering.
Prescription Solutions, PacifiCare's pharmaceutical subsidiary, provides an extensive list of generic and brand names in three pricing plans:
- Saver - This plan offers a value-based premium and may best be suited for those who do not require specific or numerous medications
- Select - This plan allows for an extended menu of generic and brand name drugs
- Comprehensive - This plan is geared toward eliminating Medicare drug restrictions if generics are ordered.
All three selections feature no annual deductible.
Group members have the added advantage of participation in PacifiCare Health Credits, a credit-based incentive program. Customized fitness program and meal plans are recommended by virtual practicing physicians, wellness experts, and nutritionists. Credits are awarded for redemption on special goods and services. Members can participate in and complete the steps in program topics that include: smoking, diabetes, asthma, menopause, cancer management, and heart health.
Credits can also be received by utilizing the mail order pharmacy. Other options are available at no additional fees. The PacifiCare Perks program is a discount opportunity for health-related services and products. The Personal Assistant Network is an easy and instant referral service to all of PacifiCare's providers, including financial and legal resources.