Pacificare Retiree Programs
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Early Retirees who elect the Pacificare Plan have the same hospital and medical benefits as active participants. See the Active Health BenefitTab for Pacificare.
Participants on Medicare Parts A & B who elect the PacifiCare Secure Horizons Group Medicare Advantage Plan for Retirees have benefits as described below.
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Physician Services/Basic Health Services
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Benefits and Coverage |
You Pay |
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Consultation, diagnosis and treatment |
Primary Care Physician |
$5 copayment per office visit |
Specialist |
$5 copayment per office visit |
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Annual Physical Examination
Includes pap smears
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$5 copayment per office visit
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Immunizations
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| Flu shots, pneumococcal vaccine & Hepatitis B injections |
$5 copayment per office visit |
| All other Medicare approved immunizations |
$5 copayment per office visit |
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Hospitalization
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Covered in full for unlimited days*
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*Inpatient Hospital copayments are charged on a per admission basis. Original Medicare hospital benefit periods do not apply. For inpatient hospital, you are covered for an unlimited number of days as long as the hospital stay is medically necessary and authorized by PacifiCare or contracting providers. When you are admitted to an inpatient hospital and then subsequently transferred to another inpatient hospital, you pay the copayment charged for the first hospital admission. You do not pay a copayment for the second hospital admission, the copayment is waived.
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Non-network/Out of Area Urgent Care
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Ambulance Service
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Outpatient Surgical Services
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Certified Ambulatory surgical Center
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Covered in full
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Outpatient Hospital Facility
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Covered in full
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Inpatient Psychiatric Care/
Inpatient Substance Abuse Treatment
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Emergency Services
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You may go to any emergency room if you reasonably
believe you need emergency care.
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Prescription Drugs
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$5 Generic/$15 Brand per prescription
for 30 day supply of drugs prescribed by
a contracting medical provider and when
purchased at any contracting pharmacy;
$10 Generic/$30 Brand per 90-day supply
for prescriptions through our contracting
mail service pharmacy.
Unlimited prescription drug benefit and
formulary apply to the above.
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Selected Medications
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Covered in full |
Covered Outpatient Self-Injectables
Insulin |
$15/retail/$30 mail Brand copayment for
2 packages every 30 days. |
| Medicare-covered Immunosuppressive Drugs |
Covered in full |
| Medicare-covered Oral Chemotherapy Drugs |
Covered in full |
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Renal Dialysis
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Radiation Therapy
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Radiology Services
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| Standard X-ray Films |
Covered in full |
Specialized Scanning Imaging Procedures
(CT, SPECT, PET, MRI –with or with out contrast media) |
Covered in full |
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Skilled Nursing Facility Care
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Covered 100 days per benefit period**
in a Medicare-certified skilled
nursing facility.
** A benefit period begins the day you go to a hospital. The benefit period ends when you haven't received hospital or skilled care (in a SNF) for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the skilled nursing facility care copayment, if applicable, for each benefit period. There is no limit to the number of benefit periods you can have.
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Vision Care
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| Examination for eyeglasses (Refraction) |
$5 copayment per office visit |
| Eyeglasses (Every 24 months) |
$75 materials allowance |
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Hearing Services
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| Routine Hearing Examination |
$5 copayment per office visit |
| Hearing Aids |
$500 allowance per member,
every 3 years. |
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Chiropractic Services
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$5 copayment per office visit.
Limited to 30 visits per year.
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