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Summary Plan Description (SPD)
Chiropractic Benefit
PacifiCare makes available to you and your eligible dependents a supplemental chiropractic benefit program. This program is provided through an arrangement with ACN Group, Inc. ACN monitors the quality of the care provided by Participating ChiroCare Chiropractors.
This is a summary only. For additional information regarding your chiropractic benefits under PacifiCare, you should consult the Evidence of Coverage and the Schedule of Benefits as provided by PacifiCare.
Schedule of Benefits
The Chiropractic benefits covers the services described in this section when performed by a Participating Chiropractor and authorized when necessary by ACN, up to the Annual maximum Benefit listed.
- Co-payments for Each Visit - $5.00 (changed by Amendment 12)
- Annual Maximum Benefit – 30 Visits
- Annual Maximum Benefit for Chiropractic Appliances - $50.00