Contact  |   Testimonials   |  Glossary  Site Map

80/20 Hospital Coverage Options

Back to PacifiCare Rates

Benefit sheet reflects a general list of benefits payable to doctors / hospitals.
 

Benefits

$35 Office Copay Plans
"In-Network Providers"
Standard Deductible
"Out-Of-Network"
     
Office Visit Copay to
PRIMARY Care Provider
$35 Copay with NO NEED TO MEET DEDUCTIBLE FIRST. 60% After Deductible
Office Visit Copay to
Secondary Care Provider
$35 Copay with NO NEED TO MEET DEDUCTIBLE FIRST.  60% After Deductible 
Calendar Yr. Ded.



Deductible Options Available w/ your quotes ---->

(Up to 2 max. number of family members actually insured)

You Choose Your Deductible of
1000 or 1500


1000
  1500
 

Maximum family deductible X 2

Match up your "In-Network deductible"



 
2000
  4000

Maximum family deductible X 2  

     
Out of Pocket Max.

Single---->
 



Family---->

 

 
Single

1000 deductible plan = 3000
1500 deductible plan = 4000
 

Family
1000 deductible plan = 6000
1500 deductible plan = 8000

 
 Single
1000 deductible plan = 8000
   1500 deductible plan = 10,500


Family

1000 deductible plan = 16,000
1500 deductible plan = 21,000

     
Lifetime Max.  $5,000,000 $5,000,000
     
Pre-Existing Waiting Period
There is a 12 month waiting period for prior medical conditions at the point of effective date here IF you do not have current coverage being replaced by us
18 Month for prior medical conditions. Waived if you are replacing & or given credit if covered under 12 months 18 Month for prior medical conditions. Waived if you are replacing & or given credit if covered under 12 months
     
Prescription Coverage's   $35 Office Copay Plans
"In-Network Providers"
  Standard Deductible
"Out-Of-Network"

Up to a 30-day supply for covered medications; generic substitution required; same copay/coinsurance applies to 90-day maintenance home delivery supply.
Rx
Deductible
Rx Classes Rx
Copayment
0 Generic
Name Brand
Non-Formulary
$10
$40
$60
Rx
Deductible
Rx Classes Rx
Copayment
70% Generic
Name Brand
Non-Formulary
$10
$40
$60
     
Hospitalization    
Room & Board You pay 20% after Ded. The insurance carrier pays the difference (80%) 60% After Deductible
Inpatient Physician
Surgeon & Anesthesiologist
     
Maternity    
Outpatient Care No delivery coverage what so ever. BUT you do have coverage for the infant in the event of premature birth or other problems which is very costly.

Inquire about maternity coverage you can buy WHEN you get pregnant. To qualify you must have a insurance policy through www.Texas-Health-Insurance-online.com

No delivery coverage what so ever. BUT you do have coverage for the infant in the event of premature birth or other problems which is very costly.

Inquire about maternity coverage you can buy WHEN you get pregnant. To qualify you must have a insurance policy through www.Texas-Health-Insurance-online.com

 
Physician Delivery Fee
Hospital Room & Board 
     
Out-Patient Care    $35 Office Copay Plans
"In-Network Providers"
 Standard Deductible
"Out-Of-Network"
Immunizations Covered 100% 60% After Deductible
Preventative Care-By Primary Doctor $35 copay - No Ded. 60% After Deductible
Annual Physical 100% coverage 60% After Deductible
     
Office Visits - Primary Care $35 copay - No Ded. 60% After Deductible
Office Visits - After Hours $35 copay - No Ded. 60% After Deductible
Office Visits Specialist $35 copay - No Ded. 60% After Deductible
Minor Lab/X-ray w/ mammography 100% No Deductible No Copay to Pay! 60% After Deductible
     
Major Lab/X-ray w/ CT scan, MRI/MRA  You pay 20% after Ded. 60% After Deductible
     
Physiotherapy -  No max 60% After Deductible
Physiotherapy -  No max 60% After Deductible
Providers Office - $35 copay - No Ded. 60% After Deductible
Outpatient Facility You pay 20% after Ded. 60% After Deductible
     
Out Patient Surgery  You pay 20% after Ded. 60% After Deductible
   
Out Patient Rehab Therapy -
limit is 20 per calendar year.
You pay 20% after Ded. 60% After Deductible
     
Outpatient Hospital Services You pay 20% after Ded. 60% After Deductible
Chemotherapy, Radiation therapy
Kidney Dialysis
     
Eye Exams - Optometrist  Not available but coming soon! Not available but coming soon!
     
Emergency Care    
     
Emergency Room Visit Full Coverage 60% After Deductible
     
In-network Hospital You pay $75 after deductible. You pay $75 after deductible.
Urgent Care Facility $35 copay - No Ded. 60% After Deductible
     
KidsCare
Urgent Care Facility 
$35 copay - No Ded.  60% After Deductible 
     
Ambulance, Paramedics You pay 20% after Ded. 60% After Deductible
Air Ambulance You pay 20% after Ded. 60% After Deductible
     
Other Benefits   $35 Office Copay Plans
"In-Network Providers"
  Standard Deductible
"Out-Of-Network"
     
Medical Supplies You pay 20% after Ded. 60% After Deductible
Accident-Related Dental Services You pay 20% after Ded. 60% After Deductible
Lifetime Dental Max for injury  $1,000 60% After Deductible
     
Allergy Conditions
Testing & Treatment
$35 copay - No Ded. 60% After Deductible
Injections  You pay 20% after Ded. 60% After Deductible
     
Serum: You pay 20% after Ded. 60% After Deductible
     
Infertility
Does not apply to maximum out of pocket.
No coverage No coverage
     
Chiropractic Care -   $35 copay - No Ded. 60% After Deductible
     
Mental Health & Substance Abuse
Not applied to your maximum out of pocket.
You pay 20% after Ded. 60% after deductible (additional $500 deductible per admission applies)