Pacificare of California  

 
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Pacificare of California Health Insurance Plans

PacifiCare Health Systems, a division of UnitedHealthcare, supplies coverage for more than 3 million health plan members and nearly 10 million specialty care members nationwide.  As on the nation's largest consumer health organizations and with 25 years of business, PacifiCare offers California individuals, employers, and Medicare beneficiaries a variety of consumer-driven health insurance plans including specialty behavioral health, dental, vision, and life insurance.

PacifiCare's SignatureOptions (PPO) series offers members offer a wide range of deductibles while the SignatureOptions (HDHP) is a high deductible plan that can be used in conjunction with an HSA.  Also offered is the SignatureFreedom (SDHP) that offers network-based health insurance with a Self Directed Account (SDA) and caters to individuals that lead health active lifestyles.  With variable deductibles and the option to link up health care to other financial accounts, PacifiCare offers a variety of coverage to meet your financial needs.

You can run an instant quote to see detailed information about plan details, limitations, and restrictions.  Or contact us and we will help you decide on a plan that is right for you and your family.

Rate Information:

All deductible options have a 12 month rate guarantee.  Your rates may also increase in the month of your date of birth, if you are moving in to a new age bracket.  For example, PacifiCare charges the same rate for all male applicants age 30 to 34.  You do not receive a rate increase for your age during this five year period, your rates will only go up once per year, based on PacifiCare's claims history for everyone with similar coverage.  However, when you do go to a new age bracket (age 35 in the example above), your rates will be adjusted based on your age.  It is possible to receive an age-based rate increase during your initial 12 month rate guarantee period.

Preferred rates without riders are available on our instant quote page.  Rates depend on gender, smoking status, zip code, and health status.

The premium can be paid via quarterly, semi-annual, or annual billing, or a monthly bank draft or credit card.  The bank draft will occur on the premium due date each month.  The initial premium can be paid with a check or credit card.

Network:

As a United Healthcare company, PacifiCare policy holders have access to one of the largest PPO networks in the nation.  To view the list of providers in your area, simply visit the Pacificare Provider Directory.

Underwriting:

Underwriting of your application with PacifiCare normally takes two to four weeks, though again if medical records are ordered it could take longer.  PacifiCare is fairly strict compared to many other companies, and often will decline an application that other companies would accept with an exclusionary rider.

PacifiCare performs Verification Phone Calls (VPCs) for all applicants of individual plans.  VPCs are helpful in gathering more information about medical conditions directly from you without necessarily requesting medical records.  This often reduces issue time and make it easier for you to do business with PacifiCare than many other companies.

With every individual case submitted, after the application is entered into the system, a VPC is made by the VPC team to the applicant.  If you do not respond from the first call or message, a second call is made the following business day.  If PacifiCare is unsuccessful in reaching you, they will send a letter asking you to please return their call.

To help expedite the process, please make sure to include the following information with your application:

  • Make sure to include a daytime phone number where you can be reached, as well as an email address in case they cannot reach you by phone.
  • If you are unavailable to complete the VPC, PacifiCare will leave a file number and phone number to call PacifiCare back between 6:00AM and 6:00PM MT (limited staff only from 4:30 PM to 6:00 PM - hold time might be required).
  • Please have your medical information available for the call.

60+ Year Old Applicants

If you are over 60 years old, you will need to have been seen by a licensed medical physician within the past 12 months.  If you have not, you will not be considered for coverage until the results of a complete physical exam are received, including

  • Vital signs
  • Review of bodily systems (including height and weight)
  • Notation of all medications(s) being taken
  • Chemistry panel
  • Male applicants, PSA (Prostate Specific Antigen) level
  • Female applicants, Mammogram and Pap

Full medical records will also be requested once the updated exam has been completed.

Effective dates:

The earliest your coverage can go into effect is ten days after you have signed your application.  You may request an effective date any time between 10 and 60 days after you sign your application.

Please note, if you are requesting an effective date of less than 21 days from the time you complete the application, you may not receive notification of your approval until after your effective date.  If you have claims during this period, they will be eligible for coverage if submitted after you have been approved.  Also note that you will be billed starting on your requested effective date, even if you have not yet been notified that you have been approved.  This is very good for someone who does not have any present coverage and would like for their benefits to begin right away.  For those who are already covered, it is suggested that you maintain your current coverage in force until you have received notice from either eCAHealthinsurance or directly from Blue Shield that your coverage has been approved and is in force.

How to Apply:

Simply run an instant quote and select the plan you are interested in.  Then select to apply online or download the application, fill it out and fax it in to us.  We will then stay in touch with your during the underwritting process to keep you informed of the progress.

About PacifiCare:

PacifiCare Health Systems is a division of UnitedHealthcare.  They serve more than 3 million health plan members and approximately 10 million specialty plan members nationwide with annual revenues of more than $12 billion.

PacifiCare recently celebrated its 25th anniversary as one of the nation's largest consumer health organizations, offering individuals, employers and Medicare beneficiaries a variety of consumer-driven health care and insurance products.

PacifiCare has been given a rating of "A-" (Excellent) from the A.M. Best Company, an independent insurance rating organization.

eCAHealthinsurance is an independent authorized PacifiCare agent. 


Pacificare of California in the News

PacifiCare’s Parent UnitedHealth Tops Q4 Expectations
UnitedHealth Group posted solid profits, in Healthcare

Blue Shield won't delay planned March rate hikes
Anthem Blue Cross, Aetna and PacifiCare have all agreed to delay their proposed health premium increases for 60 days, leaving Blue Shield of California as the only insurer in California to go ahead with plans to raise...

3 health insurers agree to 60-day delay on rate hikes
Aetna, Anthem Blue Cross and PacifiCare agree to put off premium increases for people with individual policies while they are reviewed by the California insurance commissioner. Three of California's largest health insurers have agreed to delay for 60 days planned rate hikes for thousands of customers after state Insurance Commissioner Dave Jones asked for time to review the increases.

Insurers agree to delay rate hikes
Mark Lacter: Aetna, Anthem Blue Cross and PacifiCare will hold off for 60 days after State Insurance Commissioner Dave Jones asked for more time.

Blue Shield of California agrees to postpone rate increase
With this announcement, Blue Shield joins other large California insurers — Anthem Blue Cross, Aetna and PacifiCare — in agreeing to the delay.

In California, Anthem Blue Cross, Aetna And PacifiCare Agree To 60-Day Rate Hike Delay
Blue Shield of California has still not agreed to the state health insurance commissioner's request to delay the planned hikes. Los Angeles Times: 3 Health Insurers Agree To 60-Day Delay On Rate Hikes Three of California's largest health insurers have agreed to delay for 60 days planned rate hikes for thousands of customers after state Insurance Commissioner Dave Jones asked for time to review ...

3 insurers agree to delay Calif rate increases
Customers of three California health insurers will get some breathing room after the companies agreed Thursday to delay rate increases for 60 days, isolating Blue Shield of California as the lone holdout.

Health insurers to hold off on rate increases
SACRAMENTO – California Insurance Commissioner Dave Jones said Thursday that Anthem Blue Cross, Aetna, and PacifiCare have agreed to comply with his request to refrain from increasing premiums for 60 days beyond their anticipated effective dates for their recent rate filings with California Department of Insurance (CDI).

California Insurers Deny 26% Of All Claims, State's 7 Largest Rejected 67.5 Million Since '02
Blue Shield, which has recently garnered attention for pushing through premium rate hikes of up to 59 percent for individuals in California denied nearly 2 million claims last year, trailing only Anthem Blue Cross, which denied nearly 6 million claims. PacifiCare had the highest percentage of denials at a shocking 44 percent. Nurses, patients, and consumer advocates will cite the data, along ...

3 insurers agree to delay California rate increases
The Anthem Blue Cross headquarters is seen on February 9, 2010 in Woodland Hills, California.

 

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