Chiropractic Benefit

Note: PacifiCare changed its name to UHC of California and will do business as (dba) UnitedHealthcare of California, effective May 2011. (See the March 25, 2011 announcement.)

PacifiCare makes available to you and your eligible dependents, ChiroCare, a supplemental chiropractic benefit program. This program is provided through an arrangement with the 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 ChiroCare benefits covers the services described in this section when performed by a Participating ChiroCare Chiropractor and authorized when necessary by ACN, up to the Annual maximum Benefit listed.

• Copayment for Each Visit: $5.00 (See article from News and Announcements of 12/29/09)
• Annual Maximum Benefit - 30 Visits
• Annual Maximum Benefit for Chiropractic Appliances - $50.00