Apex-PALIC Health Choice Select

The 3 key Components of the Apex-PALIC Health Choice Select 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 medical needs.

Component 2
PALIC Health Choice Select
The PALIC Health Choice Select 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 Critical Illness 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 participating 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 Select solution requires a minimum purchase of Components 1 and 2.

Component 1

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
Component 2

PALIC Health Choice Select Plan Benefits Include:

  • $5,000,000 Lifetime Coverage
  • Three Benefit Options to choose from to fit budgets
  • 1st Day (Only) Hospital Benefits Reduction (Cost Savings Option)
  • Three Annual Maximum Benefit Amounts to Choose From
  • Covers Inpatient and Outpatient Services
  • No Deductibles for 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
  • Teladoc - Free Unlimited Doctor Consultations via phone or video chat
  • Karis 360 – Health Concierge Service and Bill Negotiator
  • Guaranteed Renewable to Age 65
  • Enhanced 24 Hour Accident Benefit with Disability Income Rider
  • Critical Illness Benefit up to $50,000
Component 3

PALIC Optional Riders and Policies – Available Options Include:

  • Enhanced Outpatient Benefit Rider
  • Outpatient Emergency / Urgent Care Rider
  • Family Term Life Insurance Rider
  • Catastrophic Accident Policy
  • Critical Illness Insurance Rider/Policy
  • 24 Hour Accident Expense Insurance Policy
  • 24 Hour Indemnity Accident Policy

State Availability

State Availability: CA, IN, MD, MO, OR, WA

Riders and Policy availability can vary by State. Check with a licensed PALIC representative for State availability and specific policy and/or rider details.

Full product features and benefits are listed below.

 

Component 1:Apex Advantage Plan

The Apex Advantage Plan: for Day-to-Day Health Care Issues

Preventive Benefits – Covers all mandated Preventive benefits required by PPACA
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.
All 21 Preventive Services for Adults
100% Coverage for Mandated Preventive Care Services
All 28 Preventive Services for Women
100% Coverage for Mandated Preventive Care Services
All 31 Preventive Services for Children
100% Coverage for Mandated Preventive Care Services
Telemedicine – Health Wallet
$0 Copay, unlimited use for all family members
Primary Care Office Visit
$20 Copay
(Max 3 visits per calendar year)
Specialists Office Visit
$50 Copay
(Max 3 visits per calendar year)
Urgent Care
$50 Copay
(Max 3 visits per calendar year)
Diagnostic X-Ray, Lab
$50 Copay
(Max 3 visits per calendar year)
CT Scan or MRI
$200 Copay
(Max 1 CT Scan or MRI per calendar year)
Hospital, Surgical, Ambulance, Emergency Room
Not Covered
Prescription Drug Benefits - CitizenRx
Tier 1 – Low Cost Generics
$1 Copay
Tier 2 - Generics
10% Coinsurance
Tier 3 - Preferred Brand
20% Coinsurance
Tier 4 – Non-Preferred Brand
40% Coinsurance
Tier 5 – Specialty, Generic and Preferred
10% Coinsurance
(Plan pays 90% up to a max of $150 per Rx)
Tier 6 – Non-Preferred Specialty
20% Coinsurance
(Plan pays 80% up to a max of $250 per Rx)
Contribution Schedule (Monthly Rates)
Four Year Rate Lock: Increase in years 2 through 4 cannot exceed 3% on an accumulative basis.
EE Only
$143.00
EE Plus Child(ren)
$216.40
EE Plus Spouse
$233.50
EE Plus Family
$313.75

 

Component 2: PALIC Health Choice Select

PALIC Health Choice Select - Policy Options

Lifetime Maximum $5,000,000 Per Policy
First Day Hospital Confinement Benefit Percentage*
To help manage your healthcare costs you may choose to reduce your First Day benefit amount for Hospital Confinement and Intensive Care. (one reduction per calendar year per covered person may apply)
100%
Pays 100% of the Hospital Confinement and ICU Benefit
80%
Pays 80% of the Hospital Confinement and ICU Benefit
50%
Pays 50% of the Hospital Confinement and ICU Benefit
20%
Pays 20% of the Hospital Confinement and ICU Benefit
* Benefit reduction if selected only applies to the First Day of Hospital Confinement / ICU all other benefits are paid at the full unit benefit selected

Choose Your Calendar Year Maximum Benefit Level
Maximum Covered Benefits per Covered Person Per Calendar Year $100,000 $250,000 $1,000,000

Hospital Indemnity Benefits - Facility Fees

  1 UNIT 2 UNIT 3 UNIT
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 sickneess or injury
1 UNITSickness: $1,500
Injury: $3,000
2 UNITSickness: $3,000
Injury: $6,000
3 UNITSickness: $4,500
Injury: $6,000
Hospital ICU
The plan will pay the daily Indemnity benefit selected (up to 20 days per calendar year) if any Covered Person incurs charges for and is confined in a Hospital’s Intensive Care Unit (ICU) as a result of a covered sickneess or injury
1 UNITSickness: $2,250
Injury: $3,000
2 UNITSickness: $4,500
Injury: $6,000
3 UNITSickness: $6,750
Injury: $6,750
Mental Illness, Alcohol and/or Substance Abuse
The plan will pay the daily Indemnity benefit during confinement in a Hospital for Mental Illness, Alcohol and/or Substance Abuse Dependency.
1 UNIT $200 2 UNIT $400 3 UNIT $600
Rehabilitation Facility / Skilled Nursing Facility
The plan will pay the daily Indemnity benefit during Confinement in a Rehabilitation Facility or Skilled Nursing Facility as a result of a covered Injury or Sickness. (does not include Mental Illness, Alcohol and/or Substance Abuse Dependency).
1 UNIT $750 2 UNIT $1,500 3 UNIT $2,250
Outpatient Radiation or Chemotherapy
The plan will pay the daily Indemnity benefit selected if any Covered Person incurs charges for Outpatient Radiation or Chemotherapy.
1 UNIT $750 2 UNIT $1,500 3 UNIT $2,250
Outpatient Hospital or Ambulatory Surgical Center
The plan will pay the daily Indemnity benefit selected for Outpatient Hospital or Ambulatory Surgical Center services when surgery is performed as a result of a covered Injury or Sickness:
1 UNITSurgery performed under
general anesthesia: $1,500
2 UNITSurgery performed under
general anesthesia: $3,000
3 UNITSurgery performed under
general anesthesia: $4,500
Outpatient Hospital or Ambulatory Surgical Center
The plan will pay the daily Indemnity benefit selected for Outpatient Hospital or Ambulatory Surgical Center services when surgery is performed as a result of a covered Injury or Sickness:
1 UNITSurgery performed not
requiring general anesthesia: $750
2 UNITSurgery performed not
requiring general anesthesia: $1,500
3 UNITSurgery performed not
requiring general anesthesia: $2,250

Professional Services

  1 UNIT 2 UNIT 3 UNIT
Surgical Procedure
The plan will pay this benefit if any Covered Person undergoes a surgical procedure when performed in a Hospital or in an Ambulatory Surgical Center due to an eligible Injury or Sickness. The reimbursement schedule is the Medicare RBRVS (Resource-Based Relative Value Scale) per procedure based on your providers location.
1 UNIT1 X the Current RBRVS Schedule 2 UNIT2 X the Current RBRVS Schedule 3 UNIT3 X the Current RBRVS Schedule
Inpatient Pathologist / Radiologist
The plan will pay the daily indemnity benefit if any Covered Person undergoes an Inpatient Pathologist / Radiologist procedure as a result of a Covered Injury or Sickness. The reimbursement schedule is the Medicare RBRVS (Resource-Based Relative Value Scale) per procedure based on your providers location.
1 UNIT1 X the Current RBRVS Schedule 2 UNIT2 X the Current RBRVS Schedule 3 UNIT3 X the Current RBRVS Schedule
Physicians Care Indemnity Benefit Non-Surgical
We will pay the daily benefit amount selected for each visit a Covered Person receives from a Physician while confined.
1 UNIT $50 2 UNIT $100 3 UNIT $150
Daily Assistant Surgeon Surgical Services Indemnity Benefit
For covered services when performed in a hospital or ambulatory surgical center.
1 UNITWe will pay 20% of the eligible surgical benefit payable 2 UNITWe will pay 20% of the eligible surgical benefit payable 3 UNITWe will pay 20% of the eligible surgical benefit payable
Daily Anesthesia Indemnity Benefit
For covered services when performed in a hospital or ambulatory surgical center.
1 UNITWe will pay 25% of the eligible surgical benefit payable 2 UNITWe will pay 25% of the eligible surgical benefit payable 3 UNITWe will pay 25% of the eligible surgical benefit payable

This is a limited-benefit fixed-indemnity plan and not a major medical insurance plan. Fixed-indemnity benefits are provided for hospital confinement, specified medical, surgical and outpatient events. These benefits are paid in specific amounts and do not provide expense reimbursement for charges based on your health care provider’s bill. Fixed-indemnity insurance plans do not meet the Minimum Essential Coverage requirements under the Affordable Care Act and you may need to pay a tax penalty depending upon your income level and the cost of plans available.

Outpatient Benefits

  1 UNIT 2 UNIT 3 UNIT
Aggregate Calendar Year Maximum (per covered person) 1 UNIT$2,000 2 UNIT$4,000 3 UNIT$6,000
Daily Outpatient Physicians Indemnity Benefit for each day a covered person sees a physician in office or outpatient clinic
Limit of 20 benefit days (6 chiropractor visits) per covered person per calendar year.
1 UNIT$60 2 UNIT$80 3 UNIT$100
Other Outpatient Daily Indemnity Benefits (per day)

MRI, CAT Scan or Nuclear Testing

1 UNIT$175 2 UNIT$350 3 UNIT$525

Other Diagnostic Testing or X-rays

1 UNIT$40 2 UNIT$80 3 UNIT$120

Laboratory Testing

1 UNIT$20 2 UNIT$40 3 UNIT$60

Injections

1 UNIT$10 2 UNIT$20 3 UNIT$30
Daily Generic Prescription Indemnity Benefit 1 UNIT$5 2 UNIT$10 3 UNIT$15
Daily Brand Name Prescription Indemnity Benefit 1 UNIT$10 2 UNIT$20 3 UNIT$30
Emergency Room Benefit (limit 1 of each benefit per covered person per Calendar Year)
Facility Fee - Charges / Professional Services
1 UNIT$100/$100 2 UNIT$150/$150 3 UNIT$250/$250
Urgent Care Center Benefit (limit 1 benefit per covered person per Calendar Year) 1 UNIT$100 2 UNIT$125 3 UNIT$150
Daily Emergency Ambulance Indemnity Benefit
(limit 2 benefit payments (ground) and 1 benefit payment (air) per covered person per Calendar Year)
1 UNIT$500 ground / $1,500 air 2 UNIT$500 ground / $1,500 air 3 UNIT$500 ground / $1,500 air
Preventive Care Indemnity Benefits start 60 days after the policy effective date
You are eligible to receive 1 of each of the benefits listed below per covered person per calendar year unless noted otherwise. Preventive Care Indemnity benefits are not subject to Pre-existing Conditions Exclusions.

Preventive Care Benefit for Mammograms

1 UNIT$125 per calendar year 2 UNIT$125 per calendar year 3 UNIT$125 per calendar year

Preventive Care Benefit for Colonoscopy

1 UNIT$300 every three years 2 UNIT$300 every three years 3 UNIT$300 every three years

• Preventive Care Benefit for Colonoscopy - Beginning the 4th policy year

1 UNIT$600 every three years 2 UNIT$600 every three years 3 UNIT$600 every three years

All Other Preventive Care Services

1 UNIT$125 per calendar year 2 UNIT$125 per calendar year 3 UNIT$125 per calendar year

 

Component 3: PALIC Optional Riders & Policies

PALIC Optional Riders & Policies


OUTPATIENT EMERGENCY/URGENT CARE RIDER:
Pays an additional benefit for treatment in an emergency room or urgent care facility. Also pays an accidental death benefit if death occurs due to accidental bodily injury.

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 Select 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.

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

SAVE BY TAKING AVANTAGE OF THE PPO NETWORK DISCOUNTS
While you are free to use any Doctor or Hospital you choose without Penalty. You have the option of accessing the MultiPlan / PHCS Limited Benefit Network to take advantage of great savings at no additional costs. You will have access to Doctors, Hospitals, Labs, Imaging Centers and Home Healthcare Centers. To find providers in your area go to www.neweralife.com and select Provider Search.

 

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.

 

Request Pricing and Contracting Information