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PacifiCare Health Systems

Established in 1978 and headquartered in Cypress, California, PacifiCare Health Systems today is one of the largest providers in the United States having a nationwide network for individuals and group members. PacifiCare’s health plans have nearly 4 million members and more than 9 million customers take part in specialty plan coverage. This United HealthCare company’s core business is concentrated in Arizona, California, Colorado, Nevada, Oklahoma, Oregon, Texas, and Washington. The companies that are part of the PacifiCare organization within these regions are PacifiCare Behavioral Health, PacifiCare Dental and Vision, Prescription Solutions, and Secure Horizons Senior Solutions. American Medical Security Group (AMS) also became part of the group in 2004.
Many of PacifiCare's commercial health plans have received Excellent Accreditation by the National Committee for Quality Assurance (NCQA). The company specializes among others in behavioral health, dental and vision, and complete pharmacy and medical management through its wholly owned subsidiary, Prescription Solutions. The company has about 7,500 employees spread over the nation. PacifiCare Foundation is a nonprofit organization operated by PacifiCare Health Systems that is devoted to charitable and educational causes that enhance the health, wellness and welfare of individuals, families and the public at large.

The company offers several attractive health plans for customers keeping an eye on their various needs. Although plan specifics differ from state to state, these are some of the main health products that the company offers:

PacifiCare SignatureValueSM HMO: Laying more emphasis on the quality of care provided to members, it focuses on prevention and general wellness. Customers can directly contact primary care physicians (PCPs), and establish a strong link with their doctors under this option.

PacifiCare SignaturePOSSM POS: It is a Point-of-Service option providing maximum flexibility to PacifiCare's customers. This plan provides HMO savings coupled with the freedom to choose either an in-network or out-of-network approach to healthcare.

PacifiCare SignatureOptionsSM PPO: These PPO plans provide maximum freedom in choosing a physician, as customers are allowed to see any participating physician or specialist without any extra cost. Members are also free to see out-of-network doctors, but at a higher out-of-pocket expense.

PacifiCare SignatureIndependenceSM Indemnity: This standard Indemnity plan gives members the freedom to consult any doctor or specialist without needing a referral. Indemnity plan members must meet an annual deductible for coverage.

PacifiCare SignatureFreedomSM SDHP: The company’s Self-Directed Health Plans are PPO based to allow access to the widest physician network possible, and also the freedom of a Self-Directed Account (SDA). This SDA functions as an 'allowance' that can be used at the member's discretion, for preventative health services such as doctor's visits and covered exams.

PacifiCare Health Credits. Group members can participate in this credit-based incentive program that can begin with application to the VirtualHealthClub. A customized fitness program and meal plan are recommended by virtual practicing physicians, wellness experts, and nutritionists. Credits are sanctioned for redemption on special goods and services. Members can take part in and complete the steps in program topics that include: smoking, diabetes, asthma, menopause, cancer management, and heart health. One can also receive credits by utilizing the mail order pharmacy. Other appealing options are available at no additional fees.


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