Oleg Skurskiy Authorized Agent for PacifiCare  

If you have any questions, please call (818) 654-4548

Contact Us

Get A Quote Apply Now Download Application PacifiCare of California Plans Benefit Details Pacificare Dental plan Click Here
 
Apply Now & Applications
Outside of California >>

Plan Name
Premium (monthly)
Deductible
Physician Office Visits
Inpatient Hospital Benefits
Emergency & Urgently Needed Services
Outpatient Prescription Drugs (generic / brand)
Maternity Care
Annual Copay Max
 
PacifiCare SignatureValue
HMO 35/50

pacificare application
Application

 

Instant Quote
None
$35 Copay
50% of cost Copayment
$100 Copayment
$20 Copayment generic/$35 Copayment brand
$35 Copayment per visit
$5,000/Individual
 
PacifiCare SignatureValue
HMO 35/70


pacificare hmo application
Application
Instant Quote
None
$35 Copay
30% of Cost Copay
$100 Copay
$20 Copay/$35 Copay
30% of Cost Copay
$5,000 No per family Limit
 

PacifiCare Signature Value
HMO 20-35/80


pacificare hmo application
Application

Instant Quote
None
$20 Copay
20% of Cost Copay
$100 Copay
$20 Copay/$35 Copay
20% of Cost Copay
$2,500 2 per family
 

PacifiCare Signature Value
HMO 10-35/250


pacificare hmo application
Application

Instant Quote
None
$10 Copay
$250/admit
$100 Copay
$10 Copay/$30 Copay
$250 Copay
$2,500 2 per family
 
PacifiCare Signature Options
PPO 70-50/5000



pacificare hmo application
Application
Instant Quote
*I= $5,000 individual/$10,000 family
II= N/A
*I= 30% after deductible
II= N/A
*I= 30% after deductible
II= N/A
*I= Additional $200 deductible per occurrence (waived if admitted)
II= N/A
*I= Not Covered/Not Covered
II= N/A/N/A
*I= Not Covered
II= N/A
*I= $4,000 individual/$8,000 family
II= N/A
 
PacifiCare Signature Options
PPO 70-50/3000


pacificare hmo application
Application
Instant Quote
*I= $3,000 Individual, $6,000 Family (2 x Individual Deductible)
II= $3,000 Individual, $6,000 Family (2 x Individual Deductible)
*I= 70% Deductible
II= 50% of Limited Fee Schedule after Deductible
*I= 70% after Deductible
II= 50% after Deductible(s) up to $500 maximum benefit per day. Covered Expenses for these services do not apply to Coinsurance Maximum
*I= Subject to Inpatient Hospital deductible plus $200 per occurrence (waived if admitted)
II= Subject to Inpatient Hospital deductible plus $200 per occurrence (waived if admitted)
*I= Not Covered/Not Covered
II= Not Covered/Not Covered
*I= Not Covered
II= Not Covered
*I= $4,000 per person, $8,000 family plus Deductible(s), Copayments and penalties
II= $8,000 per person, $16,000 family plus Deductible(s), Copayments, penalties and all amounts above the Limited Fee Schedule
 
PacifiCare Signature Options
HDHP 100-50/5000


pacificare hmo application
Application
Instant Quote
*I= $5,000 Individual, $10,000 Family
II= $10,000 Individual, $20,000 Family
*I= Not Specified
II= Not Specified
*I= 100% of Covered Expenses after satisfying the Deductible
II= 50% of Covered Expenses after satisfying the Deductible up to $1,000 maximum benefit per day
*I= Not Applicable
II= Not Applicable
*I= 100% of Covered Expense after satisfying the deductible (per Prescription Unit or up to 30-day supply)/100% of Covered Expense after satisfying the deductible (per Prescription Unit or up to 30-day supply)
II= 50% of Covered Expense after satisfying the deductible (per Prescription Unit or up to 30-day supply)/50% of Covered Expense after satisfying the deductible (per Prescription Unit or up to 30-day supply)
*I= Not Covered
II= Not Covered
*I= $5,000 Individual, $10,000 Family (plus Deductible(s), Copayments and penalties)
II= $20,000 Individual, $40,000 Family (plus Deductible(s), Copayments and penalties)
 
PacifiCare Signature Freedom
SDHP 70-50/5000
Benefit Details


pacificare hmo application
Application
Instant Quote
*I= $5,000 individual/$10,000 family (2 members)
II= N/A
*I= First $250 per quarter is covered under the Self Directed Account (SDA). The SDA also applies to certain other covered services. Any unused SDA balance is rolled over to the next quarter. After the SDA account is depleted, services are covered at the coin
II= N/A
*I= 30% of Covered Expenses after Deductible
II= N/A
*I= $200 per occurrence (waived if admitted)
II= N/A
*I= $20 co payment generic/$35 co payment brand ($750 Deductible on brand only)
II= 50% after Copayment/50% after Copayment ($750 Deductible on brand only)
*I= Not covered
II= Not covered
*I= $4,000 Individual/$8,000 Family plus Deductible(s), Copayments and penalties
II= $8,000 Individual/$16,000 Family (Plan Year) Family plus Deductible(s), Copayments and penalties and all amounts above the Limited Fee Schedule
 
PacifiCare Signature Options
PPO 60-50/2500
Benefit Details


pacificare hmo application
Application
Instant Quote
*I= $2,500 Individual, $5,000 Family
II= $2,500 Individual, $5,000 Family
*I= 60% of Covered Expense after satisfying the Deductible
II= N/A
*I= 60% of Covered Expenses after satisfying the Deductible
II= 50% of Covered Expenses after satisfying the Deductible up to $1,000 maximum benefit per day
*I= $100 per occurrence
II= N/A
*I= $20/Not Covered
II= Not Covered/Not Covered
*I= Not Covered
II= Not Covered
*I= $8,000/Individual (plus Deductible(s), Copayments and penalties)
II= N/A
 
PacifiCare Signature Options
HDHP 35/80-50/2700
Benefit Details



pacificare hmo application
Application
Instant Quote
*I= $2,700 Individual, $5,400 Family
II= $5,000 Individual, $10,000 Family
*I= $35 Copayment
II= N/A
*I= 80% of Covered Expenses after satisfying the Deductible
II= 50% of Covered Expenses after satisfying the Deductible up to $1,000 maximum benefit per day
*I= $100 per occurrence
II= N/A
*I= 80% of Covered Expense after satisfying the deductible (per Prescription Unit or up to 30-day supply)/80% of Covered Expense after satisfying the deductible (per Prescription Unit or up to 30-day supply)