The Western States Health & Welfare Trust Fund of the OPEIU makes PacifiCare HMO available to you as an option for medical benefits.  

The following chart is a summary of the benefits provided in the PacifiCare plan.  If you select this plan option, your medical benefits are fully described in a separate benefit booklet prepared by PacifiCare.

To be eligible for benefits, you must select and properly use the services of a participating Primary Care Provider (PCP). Your PCP will coordinate all your health care needs, including referral and authorization for specialty care, preauthorization for hospitalization, and case management for severe health problems. Each family member may choose a different participating PCP. Please refer to the provider directory for the list of Primary Care Providers.

For Out-of-Area Student and Out-of-Area Member benefits, General Features, Principle Exclusions and Limitations of Benefits, General and Specific Exclusions and Limitations, please refer to the Combined Evidence of Coverage and Disclosure Form available through the Trust Administrator or PacifiCare.

This schedule summarizes your PacifiCare coverage.  For exact coverage terms and conditions, refer to your Combined Evidence of Coverage and Disclosure Form or the Employer Group Agreement which is available through the Trust Administrator or PacifiCare.  The coverage described above is only for care provided by, or arranged and authorized by, your Primary Care Provider or Contracting Medical Group (except in emergencies or for Out-Of-Area Child/Student dependents).

For further information, call PacifiCare Customer Service at: 

800-932-3004
P.O.Box 6090
Cypress, CA  90630
www.pacificare.com