CHOOSE
THE PLAN
THAT FITS
YOUR NEEDS |
MAXIMUM COVERED BENEFITS PER COVERED PERSON – PER CALENDAR YEAR |
$100,000 |
$250,000 |
$1,000,000 |
| Daily Indemnity Benefits as described below are Limited to the Maximum number of Days Per Calendar Year indicated (for all benefits combined). |
30 |
60 |
180 |
CHOOSE YOUR
CALENDAR YEAR
DEDUCTIBLE
(per Covered Person with a Maximum of three Deductibles per policy)
$1,000.00 
$2,500.00
$5,000.00
|
Hospital Indemnity Benefits – Facility Fees |
Select the number of benefit units
to fit your needs. |
1 Unit |
2 Units |
3 Units |
HOSPITAL
CONFINEMENT |
The plan will pay the Benefit Amount selected if any Covered Person incurs charges for and is confined in a Hospital as a resultof a covered Accident or Sickness. |
$1,000 |
$2,000 |
$3,000 |
| HOSPITAL ICU |
The plan will pay the Benefit Amount Selected if any Covered Person incurs charges for and is Confined in A Hospital ICU due to A covered Accident or Sickness. |
$1,500 |
$3,000 |
$4,500 |
MENTAL ILLNESS
ALCOHOL AND/ OR SUBSTANCE ABUSE |
The plan will pay the daily Indemnity if any Covered Person incurs charges for Hospital Confinement for Mental Illness, Alcohol and/ or Substance Abuse Dependency. |
$500 |
$1,000 |
$1,500 |
REHABILITATION
FACILITY/ SKILLED
NURSING FACILITY |
The plan will pay the Benefit Amount selected if any Covered Person incurs charges for and is Confined in a Rehabilitation Facility or Skilled Nursing Facility as a result of a covered Accident or Sickness. |
$500 |
$1,000 |
$1,500 |
OUTPATIENT
RADIATION OR
CHEMOTHERAPY |
The plan will pay the Benefit Amount selected if any Covered Person incurs charges for Outpatient Radiation or Chemotherapy (each day will apply to maximum days covered). |
$500 |
$1,000 |
$1,500 |
INPATIENT
PHYSICIAN
HOSPITAL VISIT |
We will pay the Benefit Amount selected for each visit a Covered Person receives from a Physician while confined. |
$50 |
$100 |
$150 |
OUTPATIENT
HOSPITAL OR
AMBULATORY
SURGICAL CENTER |
The plan will pay the Benefit Amount selected for Outpatient Hospital or Ambulatory Surgical Center services when surgery is performed as a result of a covered Accident or Sickness. |
$1,000 |
$2,000 |
$3,000 |
EMERGENCY
AMBULANCE |
This benefit is paid for each Emergency Ambulance trip due to a covered Accident or Sickness. The ambulance service must be to or from a Hospital and result in a hospital confinement. |
$250 per trip |
$250 per trip |
$250 per trip |
HEALTH
SAVER
NOTICE TO APPLICANTS
Your Effective Date will be assigned by the Home Office. Insurance coverage is not effective until the Coverage Applied For has been Accepted, and Approved and Issued in writing by Philadelphia American Life Insurance company.
Completing the Application does not mean that coverage is in force. Please allow two to three weeks following approval for the delivery of your policy.
GUARANTEED RENEWABLE TO AGE 65. THE COMPANY RESERVES THE RIGHT TO CHANGE PREMIUM RATES ON A CLASS BASIS.
You have the right to renew this policy until the first premium due date on or after your 65th birthday.
We reserve the right, subject to 45 prior written notice to You at your last known address, to establish a new schedule of premium rates; such schedule of rates will be effective on the following premium due date for all or any class of Insured’s covered by the policy. Premiums may also change due to attained age. Please read the premium Rate Change provision carefully that is contained in the policy.
Pre-Existing Condition means a condition for which medical treatment was rendered or recommended by a Physician or for which drugs or medicine was prescribed within 12 months prior to a Covered Person’s Effective Date. A condition shall no longer be considered a Pre-Existing Condition after the date a person has been covered under this policy for 12 consecutive months.
THIRTY DAY FREE LOOK
You have thirty (30) days after receiving the policy, and if you are not satisfied for any reason, you may return it to the company for a full refund of all premiums paid. Mail the policy with your written request to cancellation to us at our Home Office. We will promptly refund the premium paid and the insurance will be void. |
Professional Services |
Select the number of benefit units
to fit your needs. |
1 Unit |
2 Units |
3 Units |
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 Accident or Sickness. The reimbursement schedule for 1 unit is similar to what is payable under Medicare’s Physician fee schedule for surgeries. You may acquire up to three units based on plan selected. |
1 x The
Policy Fee
Schedule |
2 x The
Policy Fee
Schedule |
3 x The
Policy Fee
Schedule |
INPATIENT
PATHOLOGIST/
RADIOLOGIST |
The plan will pay this benefit if any Covered Person incurs charges for the services of Pathologist/ Radiologist while hospital confined as a result of a Covered Accident or Sickness. The reimbursement schedule for 1 unit is similar to what is payable under Medicare’s Physician fee schedule for such services. You may acquire up to three units |
1 x The
Policy Fee
Schedule |
2 x The
Policy Fee
Schedule |
3 x The
Policy Fee
Schedule |
| SURGICAL INDEMNITY BENEFIT FOR COVERED ASSISTANT SURGICAL SERVICES |
We will pay 20% of the
eligible surgical benefit |
ANESTHESIA INDEMNITY BENEFIT
FOR COVERED SERVICES |
We will pay 25% of the
eligible surgical benefit |
| Outpatient Benefits |
| CALENDAR YEAR MAXIMUM |
$2,000 PER COVERED PERSON |
| CALENDAR YEAR DEDUCTIBLE |
$500 PER COVERED PERSON |
| |
1 Unit |
2 Units |
3 Units |
OUTPATIENT
OFFICE VISITS |
The plan will pay the Benefit Amount Selected for physician visits, surgery, or treatment of any kind in the office, outpatient clinic, or emergency room. |
$25 |
$50 |
$75 |
OTHER
OUTPATIENT
SERVICES
(PER TEST) |
MRI, CAT Scan or Nuclear Testing |
$175 |
$350 |
$525 |
| Other Diagnostic Testing or X-rays |
$40 |
$80 |
$120 |
| Laboratory Testing |
$10 |
$20 |
$30 |
| Injections |
$5 |
$10 |
$15 |
GENERIC PRESCRIPTION
(PER PRESCRIPTION FILLED) |
$5 |
$10 |
$15 |
BRAND NAME PRESCRIPTION
(PER PRESCRIPTION FILLED) |
$10 |
$20 |
$30 |
| WELL CARE |
The plan will pay the Benefit amount shown in the Schedule of Benefits for WellCare. |
$50 per visit up to $150
per calendar year |
|
|
"To speak to an Agent call 214-821-6677 or
toll-free 1-800-462-2322"
maximize consumer savings