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Schedules of Benefits

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2. The pdf files provided are in English only
 
  SMALL GROUP PLANS INDIVIDUAL PLANS
HMO
10-30/100 SOB
10/500d SOB
15-30/250a SOB
20-40/500d SOB
30-40/70 SOB
10-35/250
20-35/80
35/70
 
 
PPO
10/90-70/250 SOB
15/90-50/250 SOB
20/80-60/250 SOB
30/70-50/250 SOB
35/50-50/1000 SOB
35/70-50/1000 SOB
35/80-60/500 SOB
70-50/2000 SOB
70-50/3500 SOB
70-50/500
70-50/1000
70-50/1000(m)
70-50/1500(m)
70-50/2000
70-50/3000
70-50/5000
 
 
INDEMNITY
80/1000 SOB
 
SDHP
70-50/2000 SOB
80-50/2000 SOB
70-50/2000 (D) SOB
80-50/2000 (D) SOB
70-50/3000
70-50/5000
 
 
POS
15/80-60 SOB
 
HDHP
70-50/3500 SOB
80-50/2700 SOB
100-50/5000 SOB
 
 
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Health plan products and services are offered by PacifiCare of California and PacifiCare Behavioral Health of California, Inc.
Indemnity insurance products (including PPO products) offered in California are underwritten by PacifiCare Life and Health Insurance Company.
Other products and services are offered by PacifiCare Health Plan Administrators, Inc., RxSolutions, Inc., and PacifiCare Behavioral Health, Inc.
PacifiCare® is a federally registered trademark of PacifiCare Life and Health Insurance Company.
 		  
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