CALIFORNIA - Pacificare Health Systems

PART B
the agreed-upon budget. If the actual cost
of services is less than the agreed upon
budget, the Contracting Medical Group/IPA
shares in the savings. The Network Hospital
and Contracting Medical Group/IPA typically
participate in programs for Hospital services
similar to that described above.
Stop-loss insurance protects Contracting
Medical Groups/IPAs and Network Hospitals
from large financial losses and helps the
Providers with resources to cover necessary
treatment. PacifiCare provides stop-loss
protection to the Contracting Medical
Groups/IPAs and Network Hospitals that
receive capitation payments. If any capitated
Providers do not obtain stop-loss protection
from PacifiCare, they must obtain stop-loss
insurance from an insurance carrier acceptable
to PacifiCare. You may obtain additional
information on compensation arrangements
by contacting Customer Service or your
Contracting Medical Group/IPA.
In addition, the Centers for Medicare and
Medicaid Services (CMS) requires PacifiCare
to conduct a Member Satisfaction Survey,
providing beneficiary requestors with
a summary of survey results including
information pertaining to Physician incentives.
If you would like a copy of the results of this
survey, please contact Customer Service.
Public Policy Participation
PacifiCare/Secure Horizons MA Plan affords
its Members the opportunity to participate
in establishing the public policy of Secure
Horizons. One-third of PacifiCare of California’s
Board of Directors is comprised of PacifiCare/
Secure Horizons MA Plan Members. If you are
interested in participating in the establishment
of the PacifiCare/Secure Horizons MA Plan
public policy, please call or write: PacifiCare;
Attn: Customer Service; P.O. Box 489; Cypress,
CA 90630.
210
Section 12 – General Provisions
Important Information About Organ and
Tissue Donations
Transplantation has helped thousands of
people suffering from organ failure, or in need
of corneas, skin, bone or other tissue. The
need for donated organs and tissues continues
to outpace the supply. At any given time, nearly
50,000 Americans may be waiting for organ
transplants while hundreds of thousands more
need tissue transplants. Organ and tissue
donation provides each of us with a special
opportunity to help others.
Almost Anyone Can Be a Donor
Almost everyone can be a donor. There is no
age limit and the number of donors age 50
or older has increased. If you have questions
or concerns about organ donation, speak
with your family, doctor or clergy member.
There are many resources that can provide the
information you need to make a responsible
decision.
Be Sure to Share Your Decision
Sharing your decision to be an organ and
tissue donor with your family is as important
as making the decision itself. Your organs
and tissue will not be donated unless a family
member gives consent at the time of your
death – even if you’ve signed your driver’s
license or a donor card. A simple family
conversation may help to prevent confusion or
uncertainty about your wishes.
It is also helpful to document your decision
by completing a donor card in the presence of
your family and having them sign as witnesses.
The donor card serves as a reminder to your
family and medical staff of your personal
decision to be a donor. Carry it in your wallet
or purse at all times.
How to Learn More
n To obtain your donor card and information
on organ and tissue donation, call
1-800-355-SHARE or 1-800-633-6562.
n
Request Donor Information from your local
Department of Motor Vehicles (DMV).