Option One provides the most extensive coverage, with the lowest out-of pocket expense. Benefits provided under Option One include unlimited hospital coverage, including room and board, intensive care, general nursing, physician and surgeon services, laboratory tests, and medicines and supplies. Outpatient services covered include physician services, prescription drug benefits, chiropractic care, physician health assessments, preventive care, health education, home health care, hospice care physical therapy, outpatient surgery and durable medical equipment. Emergency medical services are covered worldwide. Special services covered include mental health services and acute alcohol or substance abuse services.
All conditions are covered provided it is a covered benefit.
Option Two allows the member to receive care from any provider listed in PacifiCare's HMO and PPO Directory of Physicians. Visits can be made to these providers without a referral from a Primary Care Physician. The coverage under Option Three provides the opportunity to see any licensed provider not listed in either PacifiCare Directory. In general, services and supplies provided under Option Two and Option Three must be approved by a physician, may require pre-authorization by PacifiCare and must be medically necessary for the care and treatment of a covered sickness, accidental injury, pregnancy or other covered health care condition. This plan is available to all eligible University employees residing out of the state of California.