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Summary Plan Description (SPD)
PacifiCare HMO Medical Plan
In This Section:
- Summary of Benefits
- Basic Information About the Plan
- Definition of Dependents
- In Case of An Emergency Situation
- Chiropractic Benefit
- Allergy Serum Benefit
- Women’s Health & Cancer Rights Act
- Online Internet Website – PacifiCare
- Exclusions and Limitations
- Converting To An Individual Plan – Contact PacifiCare Directly
- Coordination of Benefits
- Extension of Benefits
- Third Party Liability
This section modified by: Amendment 35. View Previous Language
- This benefit chart is a summary only. It does not fully describe your benefit coverage. For details on your benefit coverage, please refer to PacifiCare Health Systems, Inc., Evidence of Coverage. The Evidence of Coverage is the binding document between Health Plan and its members.
- PacifiCare participants are covered for mental health and substance abuse benefits under a separate “carve out” plan. Refer to the separate Summary Plan Description listed in the Table of Contents under the heading “Integrated Member Assistance Program (MAP) and Managed Mental Health & Chemical Dependency Benefits Program.”
- For details on the benefit and claims review and adjudication procedures, please refer to PacifiCare Health Plan’s Evidence of Coverage or contact PacifiCare Customer Service Department at 1(800) 624-8822.