• Critical Illness• Dental• Accident
CRISIS RECOVERYCRISIS RECOVERYCritical Illness Critical Illness PolicyPolicy
Critical Illness Critical Illness PolicyPolicy
Provides immediate cash for your customers when they are diagnosed with a covered medical crisis.They can use the money for:
• Treatment not covered by or limited by their existing ….medical insurance.• Non-medical expenses resulting from their condition: …. travel, childcare, and spouse’s time off from work.• Extended convalescence services or for rehabilitation.• Mortgage, auto loans and credit card payments• Or, any way you choose. There are NO restriction on how …..they spend their money.
Crisis RecoveryCrisis Recovery
Five benefit level to choose from: .
$10,000 $20,000 $30,000 $40,000 $50,000
Dependent Chldren's Benefit: $10,000 per child
Provides up to $50,000 to help cover out-of-pocket medical expenses and the other costs associated with a covered critical illness.
Crisis Recovery is designed to ease the financial pressure by providing a lump sum cash benefit paid directly to you upon diagnosis of a covered illness to help you cope with the high cost of recovering from a Medical Crisis.
Two Category of BenefitsTwo Category of Benefits
If you collect a benefit for the first diagnosed illness or procedure under this policy in one category of benefits and then have a second diagnosis of a condition or procedure in another category under this policy we will pay the maximum benefit to you again. If a partial benefit is paid (25%) the remainder of the benefit will be payable upon the diagnosis of another covered condition.
Two Category of BenefitsTwo Category of BenefitsCATEGORY ONE BENEFITS
Conditions Percent Paid
Cancer (Internal Cancer) 100%
Non-Invasive Carcinoma In-Situ 25%CATEGORY TWO BENEFITSHeart Attack 100%
Stroke 100%
Coronary Artery Bypass 25%
Angioplasty 10%
Pacemaker Implant- Single chambered
30%
Pacemaker Implant- Double chambered
40%
End Stage Renal Failure 100%
Organ Transplant (kidney) 50%
Organ Transplant (heart, lung, liver and pancreas)
100%
Policy ProvisionsPolicy Provisions
Waiting PeriodThe benefits of this Policy are payable for loss that begins more than 90 days after the Effective Date of coverage for each Insured person. If the Diagnosis is made within the first 90 days, we will pay 25% of the benefit payable as listed in Category One and Two of the policy.
During the first 90 days after the Effective Date of coverage, Reinstatement date or for a second date of occurrence resulting in a Diagnosis or procedure in a Multiple Condition instance, We will pay 25% of the Percentage Benefit Payable listed in the Policy Schedule.
Reduced Benefits
Reduction of Benefits Due To AgeAny benefits remaining at age 65 or older will reduce 50%.
Guaranteed RenewableThis Policy is guaranteed renewable to age 75 by the timely payment of premiums. It must be paid on or before its due date, or within the 31 days that follow. When an Insured’s coverage terminates at age 75, coverage for other Insured persons, if any, shall continue under this Policy.
Policy ProvisionsPolicy Provisions
Attained Age PricingIn order to make this plan as affordable as possible, we used a pricing method that is called Attained Age Pricing. By using this method the cost of the plan is lower at the beginning and takes small incremental increases each year there after.
This is in contrasts to a method called Issue Age Pricing where the premium starts out much higher but remains at the same level for several years or the life of the policy.
Which method is better?
We believe that Attained Age Pricing is better for the consumer since it’s more affordable up front and allows you to purchase the amount you need by paying less when your income is lower and as your income continues to grow you will be able to pay a little higher premium.
In comparing this method to other insurance carriers that prices their product using Issue Age Pricing, we find that our method can save you as much as 20% to 30% (see graph) in the first 10 Years depending on your age.
Policy ProvisionsPolicy Provisions
Policy ProvisionsPolicy Provisions
Pre-Existing Sickness or Injury Provision
The benefits of the policy will not be payable during the first 12 months that coverage is in force with respect to an insured person for a loss caused by a Pre-Existing Sickness or Injury disclosed or not disclosed in the application. This 12 month period is measured from the effective date of coverage for each insured person. A Pre-Existing Sickness or Injury means a Sickness or Injury which is Diagnosed by a legally qualified physician or for which medical advice or treatment was recommended or received from a legally qualified physician within 12 months prior to the effective date of coverage for each insured person.
CRISIS RECOVERYCRISIS RECOVERY
If you knew that you would be diagnosed with cancer in six months, would you buy this insurance?
How do you know that you won’t be?
Crisis Recovery Approved States
Critical Illness Availability
AK
OR
NV
AZ
TX LA
AR
MOKS
NEIA
MSAL GA
FL
IL INOH
KY
WVVA
PA
HI
WI
CA
ID
MT
WY
WA
UTCO
NMOK
SD
ND
MN
TNSC
NC
MI
ME
NY
4.13All states listed except North Carolina has the Standalone 24HR Enhanced Accident Plan approved
Approval Pending Release
Dental ChoicePlus
Introducing a new type of “hybrid” dental insurance policy that combines traditional fully insured benefits with PPO discount pricing.
Choice PlusDental
Freedom of Choice
• Unlike many PPO plans that will not pay anything if you go outside their network, Dental Choice Plus will pay the non-network provider at the same rate as if they were in network.
• Your client will only be responsible for the
non-network charges that are in excess of the pre-negotiated network fee schedule.
Choice PlusDental
Individual Dental Plan • No waiting periods on Diagnostic
and Preventive care benefits.• Diagnostic & Preventive paid at
100% when using a network provider.
• Two plan options to choose from
with Calendar Year Maximums benefits of either $1,500 or $2,000.
• Over 169,000 access points
across the United States.
• eApplication enrollment
Employer Sponsored PlanIn addition to the key benefits list for
individual plans, employer sponsored plans are available.
• Available for groups of 3 or more
• $25 application fee is waived
• List Bill eApplication enrollment
• Rates for ages 65+
Choice PlusDental
Dental Choice Plus Benefits
Reimbursement Method In/Out Standard Plan Pays**Yr. 1 / Yr. 2 / Yr. 3+
Enhanced Plan Pays**Yr. 1 / Yr. 2 / Yr. 3+
Diagnostic & Preventative No Wait 100% / 100% / 100% 100% / 100% / 100%
Basic (Filings & Simple Extraction) Basic 6 months 50% / 65% / 80% 50% / 65% / 80%
Endodontic Major No Wait 0%* / 25% / 50% 0%* / 25% / 50%
Periodontics Major No Wait 0%* / 25% / 50% 0%* / 25% / 50%
Oral Surgery Major No Wait 0%* / 25% / 50% 0%* / 25% / 50%
Restorations Major No Wait 0%* / 25% / 50% 0%* / 25% / 50%
Orthodontics Major No Wait 0%* / 25% / 50% 0%* / 25% / 50%
Prosthodontics Major No Wait 0%* / 25% / 50% 0%* / 25% / 50%
Co-Pay (Per Person, Per Visit) No more than 3 per person per calendar year
$25 Thru age 64 $40 over age 65
$25 Thru age 64 $40 over age 65
Insurance Calendar Year Maximum per person per calendar year $1,500 $2,000
Orthodontic and Prosthodontics Lifetime Maximum ($1,000 Lifetime Max, Limited to $350 per Calendar Yr.) $1,000 $1,000
* Insured pays only the discounted pre-negotiated network provider rate.
$25 Application Fee For Individual Applications. Application Fees are waived for employer sponsored plans
**Annual coinsurance amounts are based on policy years.
Choice PlusDental
Good oral hygiene and regular dental care is important throughout your life
• Given the suspected link between periodontitis and systemic health problems, prevention is the first step to maintain good long-term health.
• Dental Choice Plus is economical because it focuses on benefits you need…not benefits you may never use.
• Diagnostic & Preventive Services are paid at 100% with only a $25 co-pay when using a network provider. No waiting periods or deductibles.
Choice PlusDental
Examples of Diagnostic & Preventive Services when receiving benefits through PPO Waiting Periods Amount Paid
Routine oral exams - 1 exam per 6 month period No Waiting Period 100%
Bitewing X-rays (up to a set of 4) - 1 set per Calendar Year No Waiting Period 100%
Full Mouth X-rays (Panoramic Film or Full Series) - no less than 36 months apart No Waiting Period 100%
Prophylaxis (cleaning and scaling of teeth) - 1 per Calendar Year No Waiting Period 100%
Topical application of Fluoride for dependent children under 19 - 1 per Calendar Year No Waiting Period 100%
Consultation - other than treating doctor No Waiting Period 100%
Comprehensive Oral Exam No Waiting Period 100%
Sealant - dependents under 14, one treatment per tooth no less than 36 months apart No Waiting Period 100%
Space Maintainers - the initial appliance for dependent children under 13, including
adjustments within the 6 month period immediately following installationNo Waiting Period 100%
Diagnostic & Preventative Services paid at 100% No Waiting Periods
Dental Choice Plus focuses on providing the benefits you need to maintain good oral health at affordable prices
Choice PlusDental
The schedule applies to services provide by a participating General Dentist and is an extensive list of most common procedures. The purpose of this schedule is to establish the maximum fee that a General Dentist will charge for each listed procedure . Fee schedules are determined by the zip code of the participating provider. Participating Specialists do not charge according to this fee schedule but will give a 20% discount.
Care PPO Schedule
CI-5
If the annual calendar year maximum benefit is exhausted, you can still take advantage of the pre-negotiated network provider’s fee schedule as long as you use a participating network provider.
With over 169,000 access points across the United States Care PPOpre-negotiated fee schedule will apply to give continued savings even after the insured benefits are exhausted.
If you go to a participating network provider who resides in a higher cost area we will pay based on the point of service provider at no additional cost.
Choice PlusDental
www.careington.com/co/PAL
PHILADELPHIA AMERICANLIFE INSURANCE COMPANYSM
Provider Search
PHILADELPHIA AMERICANLIFE INSURANCE COMPANYSM
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PHILADELPHIA AMERICANLIFE INSURANCE COMPANYSM
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PHILADELPHIA AMERICANLIFE INSURANCE COMPANYSM
Provider Search Results For 75070Step 4
PHILADELPHIA AMERICANLIFE INSURANCE COMPANYSM
www.careington.com/co/PAL
Administered by:Careington International Corporation7400 Gaylord ParkwayFrisco, TX 75034
Toll Free Service Line 855-332-1271
PHILADELPHIA AMERICANLIFE INSURANCE COMPANYSM
October 1, 2013
Dental ChoicePlus
Zip Codes By StateState State State State
Zip Area Zip Area Zip Area Zip Area
Alabama Florida Indiana Mississippi
All 3 320-322 4 460-466 6 386-391 2
Arizona 323 3 467-479 5 392 3
All 4 324-328 4 Iowa 393 2
Arkansas 329 5 All 6 394-395 4
All 6 330-331 6 Kansas 396-397 3
California 332 7 660 4 Missouri
900 9 333-334 6 661-662 5 630-633 4
901-928 8 335-337 4 664-679 4 634-651 3
930-937 7 338-344 5 Kentucky 652 4
938 8 346-349 4 All 3 653-658 3
939 9 Georgia Louisiana Nebraska
940 8 300-310 4 700-701 5 All 3
941 9 311 5 703-708 3 Nevada
942-948 8 312 4 710-711 4 889-890 5
961 9 313-319 5 712-714 3 891 5
949-956 7 399 4 Michigan 893 7
957 8 Illinois 480-483 5 894-896 9
958 7 600 6 484-485 4 897 9
959 7 601-604 5 485 4 898 7
960 7 605 4 486-491 8 New Mexico
961 9 606-608 5 492-496 10 All 6
Colorado 609-628 3 497-498 8 North Carolina
All 6 629 3 499 8 All 10
State State State State
Zip Area Zip Area Zip Area Zip Area
Ohio Pennsylvania Texas Texas
430-434 3 182 3 763 6 797 10
435 4 183-185 4 764 4 798-799 3
436-439 3 186 3 765 3 885 3
440-441 4 187-189 4 766 5 Utah
442 3 190-192 6 767 3 840-843 7
443-444 2 193 4 768 5 844-847 8
445-453 3 194-196 5 769 4 Virginia
454 4 South Carolina 770 6 201 6
455-459 3 290 5 772 6 220-222 5
Oklahoma 291-292 6 773-774 5 223 6
All 3 293 5 775 7 224-236 3
Pennsylvania 294 6 776-778 4 237-238 4
150-151 4 295-299 7 779-784 3 239-246 3
152-154 3 Tennessee 785-787 4 West Virginia
155-156 2 370 2 788 5 All 6
157 3 371-380 3 789 4 Wisconsin
158 2 381-385 2 790 5 530-535 8
159-166 3 Texas 791 4 537 9
167 2 733 4 792 5 538 8
168-177 3 750-753 5 793 3 539 8
178 4 754-758 3 794 4 540-549 8
179 3 759 5 795 6 Wyoming
180-181 4 760-762 4 796 5 All 8
October 1, 2013
Dental ChoicePlus
Rates By Area
Standard ($1,500 Annual Benefit)
Area 2 3 4 5 6 7 8 9 10
Individual 17.30 18.40 19.50 20.70 22.00 23.40 24.90 26.40 28.00
Individual +Spouse 31.40 33.40 35.50 37.70 40.10 42.60 45.30 48.20 51.20
Individual + Child(ren) 32.30 34.30 36.50 38.70 41.20 43.80 46.50 49.50 52.60
Family 47.50 50.60 53.80 57.10 60.80 64.60 68.70 73.00 77.70
Enhanced ($2,000 Annual Benefit)
Area 2 3 4 5 6 7 8 9 10
Individual 19.40 20.60 21.90 23.20 24.70 26.20 27.90 29.60 31.50
Individual +Spouse 35.40 37.70 40.00 42.50 45.20 48.10 51.10 54.30 57.80
Individual + Child(ren) 36.30 38.60 41.10 43.60 46.40 49.30 52.40 55.70 59.30
Family 53.60 57.00 60.60 64.40 68.50 72.90 77.50 82.40 87.60
ChoicePlusDental
Finally, a dental policy that covers the services you want at a price you can afford.
Dental Choice Plus Availability
AK
OR
NV
AZ
TX LA
AR
MOKS
NEIA
MSAL GA
FL
IL INOH
KY
WVVA
PA
HI
WI
CA
ID
MT
WY
WA
UT CO
NMOK
SD
ND
MN
TNSC
NC
MI
ME
NY
9.13
Approved States
Approved Pending Release
Filed Pending Approval
BENEFIT SUMMARY 1 Unit 2 Units
Accidental Injury Benefit $ 2,000.00 $ 4,000.00
Accidental Death Benefit $ 50,000.00 $ 100,000.00
Ground or Air Ambulance $ 5,000.00 $ 10,000.00
Hospital Income Benefit $ 150.00 $300.00
Dismemberment Benefits
Loss of Finger or Toe Single Loss Benefit Multiple Loss Benefit
$ 500.00$ 1,000.00
$ 1,000.00$ 2,000.00
Loss of Hand, Arm, Foot, Leg Single Loss Benefit Multiple Loss Benefit
$ 5000.00$ 10,000.00
$ 10,000.00$ 20,000.00
Loss of Site Single Loss Benefit (One Eye) Multiple Loss Benefit (Both Eyes)
$ 5000.00$ 10,000.00
$ 10,000.00$ 20,000.00
• This benefit pays the actual charges for ground or air ambulance transportation due to an accidental injury, up to the amount shown per unit: 1 Unit = $5,000 / 2 Units = $10,000
HOSPITAL INCOME BENEFIT•If an insured is hospitalized for an accidental injury, we will pay a fixed amount per day, beginning the first day of confinement, subject to the number of units purchased. Payment will be made up to 30 days per hospital confinement resulting from any one accidental injury: 1 Unit = $150 a day / 2 Units = $300 a day
DISMEMBERMENT BENEFITS
•This benefit pays a fixed amount per unit if the Primary Insured suffers any of the following dismemberments as a result of accidental injury.
•Benefits are for the Primary Insured only.
Loss of Finger or Toe 1 Unit 2 UnitsSingle Loss Benefit $500 $1,000Multiple Loss Benefit $1,000 $2,000
Loss of Hand, Arm, Foot, LegSingle Loss Benefit $5,000 $10,000Multiple Loss Benefit $10,000 $20,000
Loss of SightSingle Loss Benefit (One Eye) $5,000 $10,000Multiple Loss Benefit (Both Eyes) $10,000 $20,000
Optional Accident Disability Income Benefit 1 Unit 2 Units
Monthly Benefit $ 1,000.00 $ 2,000.00
12 Months 24 Months
Two Benefit Period To Choose From
Type 1 Type 2
Only Two Occupational Classes
If the Primary Insured incurs an accident disability, we will pay a monthly disability benefit, on a weekly basis, beginning the thirty first day, up to a maximum benefit period of 12 months or 24 months. This benefit applies only to the Primary Insured and pays up to 60% of the insured’s gross monthly income.
ACCIDENT PLAN 1 Unit 2 Units
Insured $23.00 $31.05
Insured & Spouse $44.28 $56.93
Insured & Children $53.48 $69.00
Family $74.75 $94.88
Child Only $16.10 $20.13
ACCIDENT DISABILTY INCOME RIDER 1 Unit 2 Units
Type 1 - 12 months $10.35 $20.70
Type 1 - 24 months $13.23 $26.45
Type 2 - 12 months $19.55 $39.10
Type 2 - 24 months $26.45 $52.90
• 1 or 2 units of accident coverage available
• Issue ages 0-75 Accident Plan
• Guaranteed renewable to age 80
• $50,000 or 100,000 of Accidental Death Benefit
• Pays in addition to any other insurance
• Individual, Individual & Spouse, Single Parent, Family, and Children Only coverage available
• Pays in addition to worker’s compensation, employer’s liability or similar laws or coverage
• Optional Accident Disability Income Benefit for the Primary Insured• Issue ages 18 – 64 Optional Accident Disability Rider
• Coverage 24 hours a day, anywhere in the world
Enhanced 24-Hour Accident Expense
AK
OR
NV
AZ
TX LA
AR
MOKS
NEIA
MSAL GA
FL
IL INOH
KY
WVVA
PA
HI
WI
CA
ID
MT
WY
WA
UT CO
NMOK
SD
ND
MN
TNSC
NC
MI
ME
NY
9.13
Approval Pending Release
Approved States