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Pacificare

PacifiCare Health Systems, Inc. provides managed care and other health insurance products to employer groups, individuals, and Medicare beneficiaries in the United States and Guam. The company was formerly known as Pacificare Health Sys Cl B and changed its name to Pacificare Health Systems Inc. in 1999.

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About Pacificare

Pacificare’s products include health insurance; health benefits administration; and indemnity insurance products, such as Medicare Supplement products offered through health maintenance organizations (HMO) and preferred provider organizations. The company also offers various specialty managed care products and services as a supplement to its basic commercial and senior medical plans or as stand-alone products.

Its specialty managed care products include pharmacy benefit management (PBM) services, behavioral health services, group life and health insurance, and dental and vision benefit plans. The company had approximately 3.3 million HMO and other commercial and senior product members; and approximately 10.4 million members in its PBM, dental, and behavioral plans, as of December 31, 2004.

Pacificare, Inc.

Corporate Headquarters:
5995 Plaza Dr
Cypress, California 90630
(714) 952-1121
CEO:
Howard G. Phanstiel
Employee Number:
3,000
2008 Revenue:
$1.2 Billion

Product Types Offered

Individuals

Pacificare offers Health Products for individuals, families and sole proprietors under the age of 65 and not eligible for Medicare. Pacificare Advantage Plans for individuals, families and the self-employed are designed to make it easy for you to find and choose the coverage that's right for you and your family.

PacifiCare Health Systems, through its subsidiaries, offers a wide range of products and services for employer groups, families and individual members.:

Pacificare SignatureValue®
A Health Maintenance Organization (HMO) focuses on the quality of care provided to its members - with prevention and wellness as the key components of that care. Health services are accessed through contracted primary care physicians (PCPs) who know the member's medical history and individual needs; thus a partnership is formed between the member, the provider and the health plan. HMOs offer minimal paperwork and low, predictable out-of-pocket costs. Members pay a small, predetermined copayment each time they receive health care services.

PacifiCare SignaturePOS® (POS)
A Point of Service (POS) plan offers members greater flexibility and options. POS plans combine the savings of an HMO with the flexibility of a typical indemnity arrangement. If you are looking for affordability, use the in-network option of your benefit plan. If you prefer to see a doctor who is not participating in our network, choose the out-of-network option.

PacifiCare SignatureEliteSM (PPO)
A Preferred Provider Option is a plan which offers an even wider selection of physicians to our members. These participating providers may be primary care doctors or specialists and PPO members are free to see any of them. PPO members may also visit non-contracted providers, but at a higher out-of-pocket cost. PacifiCare SignatureEliteSM is available to employer groups of 51 or more employees.

PacifiCare SignatureIndependence® (Indemnity)
The PacifiCare SignatureIndependence® Plan is a traditional indemnity plan. It gives you the independence to go to any doctor -- including a specialist -- without a referral.

PacifiCare SignatureFreedom® (SDHP)
The PacifiCare SignatureFreedom® plan is a Self Directed Health Plan, or SDHP. It is PPO-based, so you'll have access to a broad network of physicians and hospitals. PacifiCare SignatureFreedom rewards you with an annual Self Directed Account (SDA), which you can use toward certain types of preventative health care services like doctor's office visits, mammography screening, breast and pelvic exams, and more.

Employers

PacifiCare Health Systems, through its subsidiaries, offers a wide range of products and services for employer, groups, families and individual members. The following is a list of products and services available through our health care plans for Arizona, California, Colorado, Oklahoma, Oregon, and Nevada.
Products

  • PacifiCare SignatureValue®
  • PacifiCare SignatureOptions
  • PacifiCare SignaturePOS® (POS)
  • PacifiCare SignatureElite (PPO)
  • PacifiCare SignatureElite (PPO)/Life Insurance
  • Independent Plan
  • PacifiCare SignatureIndependence® (Indemnity)
  • Medicare Advantage
  • Individual
  • PacifiCare SignatureFreedom® (SDHP)

Plan availability and terms vary from state.

Medicare Plans

Medicare is the nation’s largest health insurance program, covering 40 million Americans. It was designed to provide high-quality health care to people 65 and over, as well as to others with disabilities.

Medicare Advantage
In addition to Pacificare’s regular HMO product, the company offers Medicare beneficiaries Secure Horizons an alternative to Medicare. Secure Horizons, their Medicare HMO plan, essentially works the same as our regular HMO. When a member chooses a PCP, he or she is also choosing the group of specialists available and the hospital they will go to when necessary. This plan covers all services and supplies offered by Medicare, plus additional benefits, often at little or no premium to the member.

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Provider Network

Pacificare has one of the country’s biggest provider networks. You can use Pacificare’s online provider directory to learn more about doctors, hospitals, other medical services, dentists, vision care providers and pharmacies that work with your Pacificare plan.

Click here to access Pacificare’s online Provider Directory search

Network Facts

Membership:

  1. 3.3 million HMO and other commercial and senior product members
  2. 10.4 million members in its PBM, dental, and behavioral plans

Health Care Networks:

  1. Over 68,000 physicians and specialits in California, 10,000 in Oregon, 15,000 in Washington, among other states.
  2. A vast nationwide network, and a comprehensive local network.

Recent News

Here are some of the most recent news regarding Pacificare:

UnitedHealth: e-payments could save billions, help pay for health reform
San Francisco Business Times - by Chris Newmarker

San Francisco CA., July 01, 2009 — UnitedHealth Group Inc. has more advice for health care reformers in Washington.

A report released Tuesday by the health insurance giant claims the system could save $332 billion over the next 10 years if health providers update their technology.

The Minnetonka, Minn.-based parent of PacifiCare Health Systems estimated 50 percent of the savings would go to hospitals and doctors, 20 percent to the federal government’s Medicare and Medicaid programs, and 30 percent to commercial payers. But UnitedHealth believes the government could institute policies to take a larger share to help pay for reform programs. (Continue Reading)

Rating

Pacificare’s rating, as rated by A.M. Best Company. A.M. Best Company is a full-service credit rating organization dedicated to serving the financial services industries, including the banking and insurance sectors.

Financial Strength Rating
Rating: A- (Excellent)
Affiliation Code: g (Group)
Financial Size Category: X ($500 Million to $750 Million)
Outlook: Stable
Action: Affirmed
Effective Date: June 15, 2009

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