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Options PPO
Quotes and Plan Description
Pacificare has two series of affordable health insurance plans, Options PPO which is similar to many other PPO plans, and Freedom PPO which has a unique "self-directed account" feature.
The Colorado Health Plan Description Form is a standard format of explanation mandated by the State of Colorado to help consumers compare plans from different health insurance companies.
Is it the Lowest Quote? There is no lower quote than here for these individual/family affordable health insurance Colorado plans. It is not cheaper to apply with an employee of the health insurer or with any other licensed representative, agent, broker, or producer.
The premium rate is set by each health insurance company who must file it with the Colorado Division of Insurance before those rates can be charged. No one else can adjust those rates. We are paid by the health insurer for approved affordable health insurance Colorado applications. We do not charge you anything.
Click here for the Adobe Acrobat Reader to view the Description Form, Brochure and Quote Table.
The comments on this page are in brief summary form, refer to in-network unless specified otherwise, and were not prepared by Pacificare. See Disclaimer below.
FAQs Supplement to Description Form and Brochure
| Application Fee | None | |
| Payment options | Monthly bank draft or monthly billing | |
| Copays for office visits, i.e., the doctor's time only | For $500 and $1,000 deductible only. Deductible does not apply when copay applies. Like most PPO plans, lab tests and x-rays are not covered by the copay and are subject to the deductible. | |
| Deductible | (i) Per calendar year per person - 3 deductibles maximum per family (ii) Carryover (deductible paid in last 3 months is credited towards next year's deductible) - None (iii) Common Accident (only one deductible applies for covered expenses for two or more covered family members on same policy) - None | |
| In-network vs. out-of-network for deductible and coinsurance | Deductible is shared, the same for in-network and out-of-network. In-network satisfies out-of-network and vice versa. Coinsurance is not shared and must be satisfied separately. | |
| Additions to deductible, e.g, service deductible, facility charge, or double deductible from separate inpatient and outpatient deductibles | $75 for emergency room | |
| Preventive - wellness | Under 13 years of age - $25 copay for office visit, 80% of balance paid by Pacificare, no deductible 13 years and above - some coverage - better than average | |
| Copays for prescriptions | With all deductible choices. $3,000 deductible has a separate $250 prescription deductible before copay is available. | |
| Extras included at no additional premium | Self-administered injectibles are covered after deductible | |
| Optional Riders at extra premium | None | |
| Alternative Medicine | None | |
| Maternity | Not covered except for complications. Difficulties also not covered. | |
| 24 hour coverage | Always | |
| Effective dates | 1st and 15th. | |
| Coverage issue | No exclusion riders. Some medical conditions have an increased premium of 25% to 50% (a rateup). No occupational rateup. There is no standard list of procedures or conditions for which there is a special waiting period. | |
| Anticipating application result for pre-existing conditions | Best done with the help of an assisting producer. Let us know what the medical conditions are and we will advise what the result will likely be. | |
| (i) Medical records if needed (ii) Paramedic exam | (i) Obtained by Pacificare at its expense (ii) None, but applicant may be required to have had a medical exam within last 2 years. |
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| Statutory 12 month pre-existing condition limitation | Any condition not specifically excluded will not be covered for 12 months unless there was prior coverage in the 90 day period prior to the policy's effective date - the 12 months is reduced by one month for every month of prior coverage. | |
| Relocation | Coverage can continue only for states in which Pacificare operates - currently AZ, CA, CO, NV, OK, OR, TX, WA (as of 11-04) | |
| (i) Network(s) used (ii) In-network scope |
(i) Pacificare PPO and a network other than its own in states where Pacificare does not operate. (Freedom Choice Network when last checked) (ii) Most counties in Colorado. Nationally in most states |
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| Travel | Out-of-state: in-network available in most states.
Out-of-country: emergencies only |
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| Plan history | Individual plans became available in 2003 | |
| Renewal rating | After buying coverage, premium changes are determined by the claims experience of all insureds on the plan from year to year. That helps to achieve lower premium increases after you have bought the coverage compared to health insurance companies that periodically close off the same coverage into separate blocks of business. Blocks of business isolated from new business are more likely to generate relatively higher claims and higher premiums the older the block gets. | |
| Premium changes | At annual policy anniversary | |
| Initial premium guarantee | 12 months | |
| Type of company | Publicly owned for profit. Listed on the New York Stock Exchange | |
| (i) Commenced operations (ii) National headquarters (iii) Operation in Colorado |
(i) In business since 1974 (ii) Cypress, California (iii) Since 1997 |
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Financial strength (8-04) |
A M Best rated "A-". Financial information is available from the National Association of Insurance commissioners | |
| Claims payment | Colorado state law mandates that clean claims must be paid within 30 days (electronic) or 45 days (otherwise) of receipt or the health insurance company owes a 10% penalty (CRS 10-16-106.5) | |
| Complaint Ratio at Division of Insurance | DOI has not published any statistics for a few years. May be available later in 2004 | |
| Notice Disclaimer |
Premium rates are set by Pacificare and coverage is determined by the Pacificare policy form, not by our comments here. Our commentaries are a good faith attempt to explain but are not guaranteed to be accurate. We will mail, email, or fax written materials from Pacificare to you upon request. Prior to application, rates and coverage may change without notice. Any opinions expressed are ours and not those of Pacificare. | |