The 3 key Components of the Apex-PALIC Health Saver Plus Gold Edition solution pairs the Apex Advantage Plan with Indemnity Benefit Plans from Philadelphia American Life Insurance Company – (PALIC).
Component 1
Apex Advantage Plan
The Apex Advantage Plan Component satisfies the Minimum Essential Coverage requirement of the PPACA, and is designed to be utilized for preventative and day-to-day healthcare needs.
Component 2
PALIC Health Saver Plus Gold Edition
The PALIC Health Saver Plus Gold Edition component is for more serious and unforeseen healthcare needs.
Component 3 (Optional)
PALIC Optional Riders and Policies
PALIC Supplemental Benefits provide added protection for life’s unexpected expenses. Options include the highly recommended Specified Disease Policy and more.
By pairing Apex and PALIC products, employers and employees can benefit from significant health care cost reductions and savings. The PALIC Component of this health care solution provides generous defined benefit payments for treatment for various sickness, injury, and professional services provided. All 3 Component choices are efficiently enrolled and administered on one convenient platform.
At the employer level these plans are available to employer groups starting at low as 4 (four) employees with Full Underwriting. Guaranteed Issue plans start with employer groups as small as 10-15 employees with a minimum of 8 eligible employees participating in the plan. PALIC can supply the Employer Sponsored Enrollment Guide for further information regarding enrollment and underwriting guidelines.
At the employee level, the Apex and PALIC Health Saver Plus Gold Edition requires a minimum purchase of Components 1 and 2.
Apex Advantage Plan Benefits Include:
- ACA Compliance for employers of 50 or more
- Four (4) Year "Rate Lock"
- No waiting periods
- Small Co-pays
- Coverage for Primary Care, Specialist, Urgent Care, Lab, Imaging, and Prescription Drugs
PALIC Health Saver Plus Gold Edition Benefits include:
- $5,000,000 Lifetime Coverage
- Three Annual Benefit Options to Select from
- Seven Deductible Options to Choose from (Deductible only Applies to Inpatient)
- Hospital Admission Benefit for First Inpatient Day (Reduces Out of Pocket Cost)
- First Dollar Coverage for Outpatient Benefits up to Benefit Selected
- Covers Inpatient and Outpatient Services
- 20 Doctors Office Visits/year – 6 can be for Chiropractic
- Covers Brand Name and Generic Prescriptions
- Freedom of Choice – Any Doctor, Any Hospital, Nationwide
- National PPO Network Available for Additional Cost Savings
- Teledoc - Free Unlimited Doctor Consultations via phone or video chat
- Karis 360 – Health Concierge Service and Bill Negotiator
- Guaranteed Renewable to Age 65
PALIC Optional Riders and Policies
- Specified Disease Insurance Policy (Highly Recommended)
- Catastrophic Accident Policy
- Critical Illness Rider
- 24 Hour Accident Expense Insurance Policy
- 24 Hour Indemnity Accident Policy (CA Only)
- Family Term Insurance Rider
NCBA Apex-PALIC Health Health Saver Plus Gold Edition is only available to NCBA members.
State Availability
State Availability: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MO, MS, NC, NE, NM, NV, OH, OK, PA*, SC, SD, TN*, TX, UT, VA, WI, WY.
* Please note there is a separate brochure posted for PA and TN.
Riders and Policy availability can vary by State. Check with a licensed PALIC representative for State availability and specific policy and/or rider details.
The PALIC Specified Disease Insurance Policy (Component 3) is available in the above States except for KY, PA, WA
Full product features and benefits are listed below.
The Apex Advantage Plan: for Day-to-Day Health Care Issues
Note: This list will be updated from time to time and a current list of covered preventive services is available at healthcare.gov
Medical Benefits – Must utilize a PHCS Network provider or facility. PHCS is part of MultiPlan, Inc. Call to confirm.
(Max 3 visits per calendar year)
(Max 3 visits per calendar year)
(Max 3 visits per calendar year)
(Max 3 visits per calendar year)
(Max 1 CT Scan or MRI per calendar year)
(Plan pays 90% up to a max of $150 per Rx)
(Plan pays 80% up to a max of $250 per Rx)
Four Year Rate Lock: Increase in years 2 through 4 cannot exceed 3% on an accumulative basis.
PALIC Health Saver Plus Gold Edition - Policy Options
| Lifetime Maximum Per Policy is $5,000,000 | |||
| Calendar Year Maximum Benefit per Insured Person | $250,000 | $500,000 | $1,000,000 |
| Benefit Level | Gold Value (One Unit) | Gold Plus (Two Unit) | Gold Preferred (Three Unit) |
| Calendar Year Confinement Deductible Per insured person with a maximum of three (3) deductibles per Policy | $10,000 - $7,500 - $5,000 - $2,500 - $1,000 - $500 - $100 | ||
Hospital Indemnity Benefits - Facility Fees
| FIRST DAY INPATIENT Choose a Calendar Year Inpatient Deductible per Insured person. Higher deductible plans will pay a First Day Hospital Admission Benefit. | |||||||
| Hospital Admission Benefit for the First Inpatient Day One benefit per Insured person per Calendar Year. |
$10,000 Deductible Per Year $3,000 |
$7,500 Deductible Per Year $3,000 |
$5,000 Deductible Per Year $2,000 |
$2,500 Deductible Per Year $1,000 |
$1,000 Deductible Per Year $0 |
$500 Deductible Per Year $0 |
$100 Deductible Per Year $0 |
| Hospital Confinement The plan will pay the daily Indemnity benefit selected if any Covered Person incurs charges for and is confined in a Hospital as a result of a covered Sickness or Injury. |
Deductible Applies:YES | VALUE (One Unit) Per Day Sickness: $1,500 Injury: $2,250 |
PLUS (Two Unit) Per Day Sickness: $3,000 Injury: $4,500 |
PREFERRED (Three Unit) Per Day Sickness: $4,500 Injury: $6,750 |
| Confinement in a Hospital's Intensive Care Unit (ICU) Indemnity Benefit Up to twenty (20) days per Calendar Year as a result of a covered Sickness or Injury. |
Deductible Applies:YES | VALUE (One Unit) Per Day Sickness: $2,250 Injury: $2,500 |
PLUS (Two Unit) Per Day Sickness: $4,500 Injury: $5,000 |
PREFERRED (Three Unit) Per Day Sickness: $6,750 Injury: $7,500 |
| Confinement in a Hospital for Mental Illness, Alcohol and/or Substance Abuse Dependency Indemnity Benefit | VALUE (One Unit) Per Day $200 |
PLUS (Two Unit) Per Day $400 |
PREFERRED (Three Unit) Per Day $600 |
|
Confinement in a Rehabilitation Facility or a Skilled Nursing Facility Indemnity Benefit |
VALUE (One Unit) Per Day $750 |
PLUS (Two Unit) Per Day $1,500 |
PREFERRED (Three Unit) Per Day $2,250 |
|
Outpatient Hospital or Ambulatory Surgical Center Services When Surgery is Performed |
VALUE (One Unit) Per Day $2,000 Per Day $750 |
PLUS (Two Unit) Per Day $3,500 Per Day $1,500 |
PREFERRED (Three Unit) Per Day $5,000 Per Day $2,250 |
|
| Outpatient Radiation Therapy, Chemotherapy and Immunotherapy Indemnity Benefit | VALUE (One Unit) Per Day $750 |
PLUS (Two Unit) Per Day $1,500 |
PREFERRED (Three Unit) Per Day $2,250 |
Professional Services
| Inpatient Physicians Care Indemnity Benefit When medical care is from a physician other than an operating surgeon. |
VALUE (One Unit) Per Day $50 |
PLUS (Two Unit) Per Day $100 |
PREFERRED (Three Unit) Per Day $150 |
| Surgery Indemnity Benefit for Covered Services When Performed in a Hospital or in an Ambulatory Surgical Center Per procedure for your provider location. |
VALUE (One Unit) Per Day 1X RBRVS |
PLUS (Two Unit) Per Day 2X RBRVS |
PREFERRED (Three Unit) Per Day 3X RBRVS |
| Inpatient Pathology/Radiology Indemnity Benefit for Covered Services Per procedure for your provider location. |
VALUE (One Unit) Per Day 1X RBRVS |
PLUS (Two Unit) Per Day 2X RBRVS |
PREFERRED (Three Unit) Per Day 3X RBRVS |
| Assistant Surgeon Surgical Services Indemnity Benefit for Covered Services | VALUE (One Unit) Per Day 20% of Surgical Benefits Payable |
PLUS (Two Unit) Per Day 20% of Surgical Benefits Payable |
PREFERRED (Three Unit) Per Day 20% of Surgical Benefits Payable |
| Anesthesia Indemnity Benefit for Covered Services | VALUE (One Unit) Per Day 20% of Surgical Benefits Payable |
PLUS (Two Unit) Per Day 20% of Surgical Benefits Payable |
PREFERRED (Three Unit) Per Day 20% of Surgical Benefits Payable |
Additional Outpatient Benefits
| Aggregate Calendar Year Maximum for Outpatient Benefits Per Insured person. |
VALUE (One Unit) Per Year $4,000 |
PLUS (Two Unit) Per Year $6,000 |
PREFERRED (Three Unit) Per Year $8,000 |
| Physician Indemnity Benefit For each day an Insured person sees a Physician in office or at an outpatient clinic. Maximum of twenty (20) benefit days including six (6) chiropractor and two (2) Specialist Physician visits per Insured person per Calendar Year. |
VALUE (One Unit) Per Day $80 |
PLUS (Two Unit) Per Day $120 |
PREFERRED (Three Unit) Per Day $160 |
| Specialist Physician Indemnity Benefit Maximum of two (2) benefit days paid at the Specialist Physician rate per Insured person per Calendar Year. After the first two Specialist Physician Benefits are paid at this rate, you will be paid the Physician Indemnity Benefit amount, assuming that you have not met your maximum of twenty (20) benefit days per Insured person per Calendar Year. |
VALUE (One Unit) Per Day $100 |
PLUS (Two Unit) Per Day $150 |
PREFERRED (Three Unit) Per Day $200 |
| Surgery Benefit in a Physicians/Specialists Office or Outpatient Clinic Maximum of two (2) benefits per Insured person per Calendar Year. |
VALUE (One Unit) Per Day $100 |
PLUS (Two Unit) Per Day $200 |
PREFERRED (Three Unit) Per Day $300 |
| MRI, PET, CAT Scan or Nuclear Testing Indemnity Benefit | VALUE (One Unit) Per Day $300 |
PLUS (Two Unit) Per Day $500 |
PREFERRED (Three Unit) Per Day $700 |
| X-rays or Other Diagnostic Testing Indemnity Benefit | VALUE (One Unit) Per Day $80 |
PLUS (Two Unit) Per Day $160 |
PREFERRED (Three Unit) Per Day $240 |
| Laboratory Indemnity Benefit | VALUE (One Unit) Per Day $40 |
PLUS (Two Unit) Per Day $80 |
PREFERRED (Three Unit) Per Day $120 |
| Injection Indemnity Benefit | VALUE (One Unit) Per Day $30 |
PLUS (Two Unit) Per Day $60 |
PREFERRED (Three Unit) Per Day $90 |
| Emergency Department Indemnity Benefit Maximum of one (1) benefit per Insured person per Calendar Year. Maximum of two (2) benefits combined Emergency Department Benefit/Urgent Care Center Benefit per Insured person per Calendar Year. |
VALUE (One Unit) |
PLUS (Two Unit) |
PREFERRED (Three Unit) |
| → Facility Fee / Charges | Per Day $200 | Per Day $300 | Per Day $400 |
| → Professional Services | Per Day $200 | Per Day $300 | Per Day $400 |
Urgent Care Center Indemnity Benefit |
VALUE (One Unit) Per Day $200 |
PLUS (Two Unit) Per Day $300 |
PREFERRED (Three Unit) Per Day $400 |
| Ambulance Indemnity Benefit Maximum of two (2) ground benefit payments and one (1) air benefit payment per Insured person per Calendar Year. |
VALUE (One Unit) Per Day 1,000 (Ground) / $2,500 (Air) |
PLUS (Two Unit) Per Day 1,000 (Ground) / $2,500 (Air) |
PREFERRED (Three Unit) Per Day 1,000 (Ground) / $2,500 (Air) |
| Generic Prescription Indemnity Benefit Per Insured person per prescription filled. |
VALUE (One Unit) Per Day $10 |
PLUS (Two Unit) Per Day $20 |
PREFERRED (Three Unit) Per Day $30 |
| Brand Name Prescription Indemnity Benefit Per Insured person per prescription filled. |
VALUE (One Unit) Per Day $20 |
PLUS (Two Unit) Per Day $40 |
PREFERRED (Three Unit) Per Day $60 |
Preventive Care Indemnity Benefits |
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| Mammograms | VALUE (One Unit) Per Calendar Year $250 |
PLUS (Two Unit) Per Calendar Year $250 |
PREFERRED (Three Unit) Per Calendar Year $250 |
| Colonoscopy Without Finding Any Polyps Policy Years One (1) Through Three (3) / Beginning the Fourth (4th) Policy Year |
VALUE (One Unit) Every Three Years $500 / $750 |
PLUS (Two Unit) Every Three Years $500 / $750 |
PREFERRED (Three Unit) Every Three Years $500 / $750 |
All Other Preventive Care Services |
VALUE (One Unit) Per Calendar Year $250 |
PLUS (Two Unit) Per Calendar Year $250 |
PREFERRED (Three Unit) Per Calendar Year $250 |
| Regardless of the charge for the inpatient, professional, or outpatient medical services you receive, we pay the listed benefit amount for eligible services. | |||
Daily time periods are twenty-four (24) or more consecutive hours. |
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PALIC Optional Riders & Policies
SPECIFIED DISEASE POLICY
| Covered Diseases, Conditions & Procedure Heart Attack, Stroke, Cancer (Internal Cancer), Angioplasty, Coronary Artery Bypass Surgery, Pacemaker Implant or Insertion of Implantable Cardiac Defibrillator, Heart Valve Surgery, Amputation, Joint Replacement, End Stage Renal Failure, Amyotrophic Lateral Sclerosis (ALS), Major Organ Failure/Major Organ, Transplant (Bone marrow, heart, kidney, liver, lung, pancreas)*, Ruptured Aneurysm (Ruptured Cerebral, Carotid or Aortic Aneurysm) *The Maximum Lifetime transplant benefit for all transplant benefit for all transplants is $100,000 per insured person per policy. |
|
| Lifetime Maximum Benefit | $2,000,000 |
Calendar Year Maximum Benefit – Choice of |
$250,000 |
Deductible |
Specified Disease Deductible Levels |
|
Per Insured Person with a maximum of three (3) deductibles per Calendar Year under this policy. After the deductible, the plan will pay the Actual Charges up to the Usual, Customary and Reasonable amount for expenses incurred for a Covered Condition or Procedure. Actual Charges are defined as the actual amount paid by You or any other entity for services, treatment, or material rendered. Benefits are subject to the Covered Condition or Procedure definitions that can be found in the Specified Disease Insurance Policy Outline of Coverage or Policy Form. |
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Other Benefits |
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CATASTROPHIC ACCIDENT POLICY: Provides catastrophic accident coverage and pays 100% of the usual, customary and reasonable charges for covered expense. Plus, an accidental death benefit of $50,000 due to an accidental death.
CRITICAL ILLNESS RIDER: Select from $10,000 to $50,000 to help cover out-of-pocket medical expenses and other cost associated with a covered medical illness. Critical Illness insurance is designed to ease the financial pressure by providing a lump sum cash benefit paid directly to you upon diagnosis of a covered illness. Maximum amount of Critical Illness Insurance available is $50,000 for any one person.
24 HOUR ACCIDENT EXPENSE INSURANCE POLICY: Accident Expense insurance provides you with up to $4,000 for accidental injury; up to $100,000 for an accidental death and up to $10,000 for ground or air ambulance. The accident plan also has an optional accident disability benefit and pays in addition to other insurance you may have and is guaranteed renewable to age 80.
24 HOUR INDEMNITY ACCIDENT POLICY (CA ONLY): Indemnity Accident Insurance pays a fixed benefit amount of up to $2,000 for an accidental injury. Also covers air and ground ambulance. A daily hospital confinement benefit if an injured is hospitalized for an accidental injury and a dismemberment benefit.
FAMILY TERM LIFE INSURANCE RIDER: Protect your family with inexpensive term life insurance coverage that pays a death benefit depending on age of up to $50,000 for the principle insured, $10,000 for the spouse and $3,000 on each child.
Note: Riders and Policy availability can vary by State. Check with a licensed PALIC representative for State availability and specific policy and/or rider details.
Value Added Benefits
Taking charge of your healthcare spending has never been easier! As our policyholder, many resources and value added benefits are available for you to use with your Gold Plan at no additional charge.
TELADOC
The quality of care you need, in the convenience of your home!
Feeling a bit under the weather? If you are feeling unwell, you can receive convenient, quality care from a large network of health professionals 24 hours a day, 365 days a year, by web, phone or mobile app. www.teladoc.com
PHCS NETWORK
An additional opportunity to save healthcare dollars!
You will have access to doctors, hospitals, labs, imaging centers and home healthcare centers at discounted rates through MultiPlan’s PHCS Limited Benefit Network at no additional charge. PHCS Provider Search
KARIS 360
Patient advocacy before, during and after a healthcare event!
Members gain a resource and concierge-style service to help them navigate through the chaos and confusion often associated with the healthcare marketplace. This includes services such as finding providers and healthcare facilities, scheduling appointments, pricing for non-emergency surgeries, and a personal advocate to help lower the patient’s portion of medical bills to something more manageable. www.thekarisgroup.com
SCRIPTSAVE WELLRX
ScriptSave allows you to locate the lowest discounted price for your medication!
At no extra cost you have access to use the prescription savings card, or app, to receive instant savings on both brand name and generic prescription medication. ScriptSave WellRX is accepted at over 62,000 pharmacies! Philadelphia American’s group number is 2242. www.scriptsave.com
IMPORTANT: Product Pricing and Agent Contracting Inquiries
Unlike other Apex Management Group offerings, our agreement with PALIC requires that PALIC Plan Pricing and/or Contracting Inquiries to be addressed directly by a PALIC representative.
To get started, please fill out the website form so a representative can contact you to discuss the process for working with Apex-PALIC health care solutions. Please note that in order to reach you quickly and to schedule adequate time for discussion, we ask that you also provide three (3) days/times as options for a representative to schedule with you. You will receive a confirmation for one of the pre-scheduled times that you propose.
Following this initial meeting, arrangements for contracting and training on Apex-PALIC heath care solutions will be made.
Apex-PALIC health care offerings provide Agents numerous options and flexibility to meet client needs and budgets. It is our goal to ensure that Agents are provided thorough training to gain an understanding of how the pairing of Apex and PALIC products can provide outstanding health care coverage at very affordable prices. Use the link below to get started.