The self directed account is like a “health care checking account.” You receive a credit of $250.00 quarterly for a single person or $500.00 quarterly for a couple or family. PacifiCare provides you with this quarterly allowance to use on preventive services including (but not limited to):

�* Physician visits
�* Covered diagnostic X-ray and lab services
�* Preventive care for children with immunizations (through age 18)
�* Mammography
�* Breast and pelvic exams
�* Prostate cancer screening
�* Periodic health evaluations

You can access any physician for services covered by the SDA. If you choose to use a physician from PacifiCare’s extensive provider network, you will have access to lower, PacifiCare-negotiated rates. This will help make the most of your SDA funds.

You can save your unused portion of your SDA and roll it over quarter to quarter, year after year. This feature allows you to “save” for health care expenses and helps you make more informed decisions about your health care costs. You will only lose the SDA funds if you terminate your policy. In addition to the SDA, you will also have access to a dedicated Web site where you can utilize a variety of support tools that help you manage your SDA funds.

You will have access to your plan information, including personalized pages for you to:

�* Track your SDA balance
�* Track your health care services and pharmacy claims
�* Research physicians as well as health- and pharmacyrelated costs

The SDA can be used to pay for specified eligible medical plan expenses. The SDA is available to satisfy part of the annual PPO deductible. The amount of the SDA is disclosed in the SDA Rider.

The SDA’s rollover feature allows the covered person to “save” the unused balance of the SDA by rolling it over to the next quarter. They can continue to roll over the remaining balance of the SDA quarter to quarter, year after year. The unused balance of the SDA is only forfeited if the policy is terminated.

Services not covered by the SDA include (but are not limited to) expenses such as hospitalization, outpatient surgery, emergency room services and nontraditional medical expenses, such as acupuncture services.

PacifiCare PPO benefits work just like those of any other PPO plan. The covered person can see any physician or specialist, but he or she may enjoy greater benefits when seeing participating providers who have contracted with PacifiCare to provide services at prenegotiated rates.

What will the covered person have to pay for?

Here are a few scenarios where a covered person will pay for services:

1. The covered person has used all the funds available in the SDA (the balance of the SDA is zero) and the covered person hasn’t met the plan year deductible. In this scenario, the covered person would be responsible for paying the difference between the amount of the annual deductible and the amount already satisfied by the SDA. The annual deductible must be met before the covered person can use PPO benefits.
    
2. The SDA balance is zero and the covered person has met the plan year deductible. In this scenario, the covered person would be responsible for paying his/her share of the coinsurance as specified in the PacifiCare PPO Schedule of Benefits.
    
3. The SDA has not been used and the covered person hasn’t met the plan year deductible, and the covered person is hospitalized for surgery. In this scenario, the covered person would pay up to the annual deductible amount because hospitalization is not covered by the SDA. The plan then begins paying a percentage of the covered expense under the PacifiCare PPO benefits. The funds in the SDA are still available to the insured for eligible expenses. 
    
4. The SDA has not been used and the covered person hasn’t met the plan year deductible, and the covered person is visiting his/her physician for a routine checkup. In this scenario, the covered person would not be responsible for paying as long as the cost of the office visit does not exceed the amount of the SDA balance. The cost of the visit will be deducted from the SDA.