HMO / POS - English

Employer Forms
New Group Check List
Group Application
Group Acceptance/Change Application
Medical Questionaire
Group Name Change Check List
Proprietor Statement
Workers Comp Exemption Statement
Termination form
Group Life
Census

Employee Forms
Employee Enrollment form
Health Statement
Change Request form
Domestic Partner form
Student Status
Life enrollment
Life change request
Mail Order Prescription Program
Authorization to Release Medical Records
PPO Indemnity Medical Claim Form


Cal-Cobra form*
Cal-Cobra Qualifying Event Notice
COBRA form**
HIPAA***

*Cal-Cobra 2-19 employees
**Cobra 20+ employees
***HIPAA - After Cal-Cobra / Cobra has exhausted benefit period 

Medicare Supplements
Secure Horizons Application

Secure Horizons Prescription Adavange Plan - Outline of coverage.

Secure Horizons Plan Outline

Pacificare of Califonira Health Insurance is one of the nation's largest health and consumer services companies with approximately $11 billion in annual revenues. Primary operations of Pacificare of California Health Insurance includes health insurance products for employer groups and Medicare beneficiaries in eight states and Guam, serving approximately 3.3 million members. Other Pacificare of California specialty products and operations include pharmacy and medical management , behavioral health services, life and health insurance and dental and vision services. Our mission at Pacificare of California is to create long-term shareholder value as a leading health and consumer services company committed to making people's lives healthier and more secure. To find out more about PacifiCare of California, such as our leadership and our vision and values, call us today.

Los Angeles Insurance Agency handles all matters related to Pacificare of California health insurance.

Questions about Pacificare Health Insurance benefits vs. other insuance carriers? Just call us and ask. We provide No Pressure Hassle free information. We have been a broker with Pacificare of California for over 20 years. Pacificare Health insurance is among the best in California.