Philadelphia American Life

Philadelphia American Life

Philadelphia American Life offers Fixed Benefit health plans in 33 states. The availability of each plan(s) vary by state. Below you will find more information about these plans and the states where they are available.

As discussed on our NAHP Alternative Health Plan Solutions page, Fixed Benefit plans work differently than traditional major medical plans (like what are available under the ACA/Obamacare). With a Fixed Benefit plan, you receive a “fixed” payment from the insurance company for every covered health care service. The amount of each payment depends on the coverage level you choose and the type of health care service you receive.

Unlike major medical plans that have (often high) annual deductibles and coinsurance that you have to pay before the insurance begins paying, Philadelphia American offers Fixed Benefit plans that have NO deductible and others that have deductibles that ONLY apply to inpatient hospital stays. 

To enhance your overall coverage, Philadelphia American offers several supplemental benefits (see further down this page). You can also add any or all the following supplemental benefits available on our US Supplemental Coverage page to make your overall plan as comprehensive as you want:

• Accident Protection Plans
• Critical Illness Plans
• Cancer Treatment Plans
• First Day Hospital/ICU Stay Protection
• 100% Preventive Care (Per ACA/Obamacare guidelines)
• Prescription Drug coverage
• Dental and Vision

Philadelphia American Fixed Benefit Plans and State Availability

Philadelphia American has 5 different Fixed Benefit plans: 

Health Saver Plus (HSP) Gold – This is their best overall coverage plan. As with each of the other plans, there are 3 levels of coverage to choose from. Gold Value (1 Unit), Gold Plus (2 Units) and Gold Preferred (3 Units). 

HSP Gold Available States: AL, AR, AZ, DE, FL, GA, IA, IL, IN, LA, MD, ME, MI, MO, MS, NC, NE, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV WY

Optimum Health Saver – This is one of their two newest plans. As with each of the other plans, there are 3 levels of coverage to choose from. Value (1 Unit), Plus (2 Units) and Preferred (3 Units). One of the biggest differences and advantages of these plans is that they pay higher hospital Confinement benefits for the first four days in the hospital. The highest amount in days 1-3, a reduced amount in day 4 and a further reduced amount from day 5 on. I really like this plan because the average hospital stay is not longer than 4 days. 

Optimum Health Saver Available States: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MO, MS, NC, NE, NV, OH, OK, SC, SD, TN, TX, UT, WI, WV WY

Premier Health Saver – This is one of their two newest plans. As with each of the other plans, there are 3 levels of coverage to choose from. Value (1 Unit), Plus (2 Units) and Preferred (3 Units). The coverage is very similar to HSP Gold with a few exceptions. Outpatient services benefits are overall lower than with HSP Gold. Premier Health Saver offers two higher hospital deductibles than HSP Gold. Because of these differences, the premiums are lower than HSP Gold plans. 

Premier Health Saver Available States: AL, AR, AZ, DE, FL, GA, IA, IL, LA, MI, MS, NC, NV, OK, SC, TN, TX, WI, WV

Health Choice Select (HCS) – This plan offers similar protection as HSP Gold for higher cost care like hospitalization and surgery with a little less coverage than HSP Gold on outpatient services. HCS offers 3 levels of coverage – 1 Unit, 2 Units and 3 Units. In select states there is also a rider available to increase most outpatient benefits by up to two times, and a rider to increase emergency room coverage by up to three times. 

HCS Available States: AL, AR, AZ, CA, DE, FL, GA, IA, IL, IN, KY, LA, MD, ME, MI, MO, MS, NC, NE, NV, OK, OR, PA, SC, SD,TN, TX, UT, VA, WA, WI, WV WY
Health Saver Plus (HSP) III – This plan is the lowest cost and slightly lower overall coverage than the other two plans. There are also 3 levels of coverage – 1 Unit, 2 Units and 3 Units. There is also a rider available to increase preventive care benefits, doctor office visits and lab services, and a second rider to increase emergency room coverage by up to three times. 

HSP III Available States: OR

NOTE: In states where HSP Gold is available, if one or both of the other plans was available before, that plan will be discontinued and HSP Gold will be the only plan in that state. If HSP Gold is NOT available in a state, the other plan(s) will remain unless/until HSP Gold is approved.
Flex Choice Health – This is one of their two newest plans. These plans have lower coverage levels and are designed to be more of a supplement to major medical health plans. They have lower Value (1 Unit) and Plus (2 Units) coverage levels, but not a Preferred (3 Units).
Flex Choice Health Available States: AL, AR, AZ, DE, GA, IA, MI, MS, NV, SC, TX, WV

Preferred Provider (PPO) Network

The North American Health Plans program with Philadelphia American allows you to go to any provider without restriction. However, the Fixed Benefit plans include the First Health Limited Benefit Plan nationwide PPO network. If you see in network providers, you are going to see significant discounts on the bills you receive. Why First Health?

• First Health provides great savings nationwide for doctor visits, surgeries, hospitals, urgent care centers, and facilities helping members stretch their benefits further
• First Health boasts broad access in urban, suburban, and rural markets
• With over 926,000 providers, 140,000 ancillary facilities, 6,100 hospitals, and 1,500,000 service locations, nearly 96% of the U.S. population has access to a First Health provider within 20 miles
• Doctors are carefully selected by First Health based on their demonstrated history of providing quality outcomes for patients 

Here are instructions to look up providers. First go to:

http://www.firsthealthlbp.com

To begin click the green “Start now” button. From here you can search using multiple different criteria. After you enter the criteria that you want, click “Search now.” For help navigating the search tool or questions about the provider directory, call First Health at 1-800-226-5116. Please let me know if you need help!

IMPORTANT NOTE: Specified Disease existing and new business plans will use the First Health Primary Network beginning 1/01/2023. The First Health Primary Network may only be used in conjunction with Specified Disease Plans. To search for a network doctor, hospital or other health care professional visit the First Health Primary Network online provider directory at http://www.myfirsthealth.com. For help navigating the search tool or for questions about the provider directory, call First Health at 1-800-226-5116.

Additional Benefits Included in the Philadelphia American Fixed Benefit Plans

Healthcare PALs Your PAL when it comes to healthcare! To get the most out of your benefits – and avoid surprise medical bills – call a Healthcare PAL before receiving care. Our experienced team of claims professionals, nurses and care coordinators can help guide you to quality care at a fair price.

Medical Bill Eraser Powered by CareGuide – This invaluable resource provides support to policyholders who find themselves facing unexpected medical expenses where they owe $2,500 or more out-of-pocket.

• A remarkable approach that has been proven to reduce medical bills by an impressive 62% on average — far surpassing the 19% average savings from our current vendor.
• Advocates who are dedicated to fighting your clients’ hefty out-of-pocket medical bills using proprietary technology and innovative negotiation techniques – often reducing or even eliminating their balance bill.
• Confidence that your clients were billed fairly and accurately for the care received.

New Era Telehealth Talk to a doctor, 24/7/365, for $0 with Virtual Urgent Care! This plan includes unlimited Virtual Urgent Care visits with board certified doctors at no cost to you! Talk to a doctor, get a diagnosis, and even a prescription when needed, all within minutes. Additional telehealth services available at a special member rate include: Virtual Dermatology Care, Virtual Counseling and Psychiatric Medical Care. Please download the flyer to read about all the services offered by New Era Telehealth.

Coral Bundled Care Saver Save thousands on outpatient surgeries and other medical services with Coral’s bundled pricing! Coral removes the middleman in healthcare by providing direct access to specialists and surgeons at top ranking facilities nationwide. All services are bundled into a single bill eliminating surprises and maximizing savings!

COMING SOON: Beginning May 1, 2025, Coral (above) will be replaced by Healthcare Bluebook Concierge. Healthcare Bluebook Concierge offers hands-on, personalized support to help members find Fair Price care and bundled savings on outpatient procedures and imaging services. Unlike the self-service Fair Pricing Tool, the Concierge team provides real human guidance every step of the way.

Fair Pricing Tool Stop overpaying for healthcare services! The cost of healthcare services varies significantly between providers. Our Fair Pricing Tool can help you determine the Fair Price in your area. That way, you’ll know if you are overpaying for care.

Prescription Discount Program:

Also included in the Philadelphia American plans is a prescription drug discount benefit. You can look up the discounts by pharmacy and download an ID card at ScriptSave WellRx The differences in costs can be substantial.

NOTE:  For other prescription discount programs as well as tools and resources to help you save money and become a better healthcare consumer by shopping for the best (or fair) prices on multiple types of healthcare services, please go to our  US Healthcare Resources  page. Also, please bookmark this page for future reference.

Philadelphia American Supplemental Benefits

Philadelphia American Life Enhanced Accident/Disability: 

This coverage provides immediate cash of up to $4,000 to help cover the costs of an accidental injury. You can also add disability benefits of up to $2,000/month for up to 24 months if you are disabled as a result of the accident. This can be written as a separate policy or added to one of the Fixed Benefit policies. (varies by state).

This plan also provides the following benefits for services related to an accident:

• Hospital inpatient benefit of $300/day
• $100,000 Accidental Death Benefit
• $10,000 Ground or Air Ambulance Benefit

Enhanced Accident Quotes

The Enhanced Accident/Disability plan is available in these states: 

AL, AR, AZ, FL, GA, IA, IL, IN, KY, LA, MO, MS, NC, NE, NV, OH, OK, OR, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY

Medical Expense Benefit Rider:

This is a NEW rider that is available to be added to your Enhanced Accident plan. In addition to the benefits paid under the Enhanced Accident plan (above), this plan will pay actual charges incurred for Inpatient and Outpatient treatment as a result of an accidental injury. It will pay for 2 accidents per person per year up to the following maximums:

• Outpatient Medical Expense Benefit Maximum – $2,000
• Combined Inpatient and Outpatient Medical Expense Benefit Maximum – $26,000

Medical Expense Benefit Rider Quotes

The Enhanced Accident/Disability Medical Expense Rider is available in these states: 

AL, AR, AZ, GA, IA, IL, LA, MO, MS, NC, NE, NV, OH, OK, SC, SD, TX, UT, VA, WI, WY

Philadelphia American Life Catastrophic Accident Expense Plan:

NOTE: This policy is only available with the purchase of a Philadelphia American Fixed Benefit plan.

This plan provides extra protection for more costly care related to an accidental injury. Such as complex surgery and extended hospitalization. When combined with a Philadelphia American Fixed Benefit plan you can feel good knowing that you are well protected against the high costs of treatment associated with these situations.

• The lifetime maximum benefit is $2,000,000.
• You choose a calendar year maximum benefit of $250,000 or $500,000.
• You choose a calendar year deductible of $25,000, $50,000, $75,000 or $100,000.

The Catastrophic Accident Expense plan is available in these states: AL, AR, AZ, DE, GA, IA, IL, IN, KY, LA, ME, MI, MO, MS, NC, NE, NV, OK, SC, SD, TX, WI, WY

Philadelphia American Life Critical Illness:

You can include from $10,000 to $50,000 per adult and $10,000 per child in lump sum coverage should anyone be diagnosed with a covered critical illness such as cancer, heart attack, stroke, etc. This can be written as a separate policy or as a rider to the Fixed Benefit policy (varies by state). 

Why a Critical Illness Plan?

For starters, it’s important to realize that no health insurance plan — “Cadillac” or otherwise — covers all the medical and nonmedical costs related to a serious illness. And second, the costs of a serious illness such as heart attack, stroke or cancer can be significant.

Second, the statistics related to the primary critical illnesses are significant:

• EVERY 34 SECONDS an American will suffer a heart attack. Heart attack hospitalizations cost patients a median of $53,000. If bypass surgery is needed, costs can skyrocket to the $86,000-to-$178,000 range.
• EVERY 40 SECONDS someone in the US has a stroke. According to the CDC, 1 out of 20 deaths in America are due to Stroke. Stroke hospitalizations cost patients a median of $31,000. 
• CANCER RISK for men in the US are about 1 in 2 lifetime of developing cancer. For women it is a little more than a 1 in 3 lifetime risk. As for cost, the average amount cancer patients lost of their savings was $92,098!

Add onto the above bills the additional expenses following hospitalization, including rehabilitation, therapy, ongoing medical care and drugs.

Also, as noted above, even the VERY BEST health insurance can leave people with significant non-medical costs related to a serious illness, such as home adaptations or equipment, travel for treatment, and lost income from missing work.
The Critical Illness plan is available in these states: AL, AR, AZ, FL, GA, IA, IL, IN, KY, LA, MI, MO, MS, NC, NE, NV, OH, OK, OR, PA, SC, SD, TN, TX, UT, WA, WI, WV, WY

Philadelphia American Specified Disease and Specified Disease Plus:

NOTE: These plans are only available with the purchase of a Philadelphia American Fixed Benefit plan.

With the improvement of modern medicine more Americans are surviving specified diseases than ever before. This plan provides extra protection for multiple specific critical illnesses and dread diseases. When combined with a Philadelphia American Fixed Benefit plan^^^ you can feel good knowing that you are well protected against the high costs of treatment associated with these specific diseases.

IMPORTANT NOTE: Specified Disease existing and new business plans will use the First Health Primary Network beginning 1/01/2023. The First Health Primary Network may only be used in conjunction with Specified Disease Plans. To search for a network doctor, hospital or other health care professional visit the First Health Primary Network online provider directory at http://www.myfirsthealth.com. For help navigating the search tool or for questions about the provider directory, call First Health at 1-800-226-5116.

As noted above under the Critical Illness plan, the statistics related to the primary critical illnesses are significant:

• Heart attack hospitalizations cost patients a median of $53,000. If bypass surgery is needed, costs can skyrocket to the $86,000-to-$178,000 range.
• Stroke hospitalizations cost patients a median of $31,000. 
• CANCER RISK for men in the US are about 1 in 2 lifetime of developing cancer. For women it is a little more than a 1 in 3 lifetime risk. As for cost, the average amount cancer patients lost of their savings was $92,098!

Coverage Combination: If you combine the Critical Illness plan (above) with this Specified Disease plan, most of your deductible on this plan can be covered by the Critical Illness lump sum benefit AND you will still be paid ALL benefits under your primary Fixed Benefit plan.

Philadelphia American Specified Disease Plus Plans:

These plans offer the following:

• The lifetime maximum benefit is $2,000,000.
• You choose a calendar year maximum benefit of $50,000, $100,000 or $250,000.
• You choose a calendar year deductible of $25,000, $50,000, $75,000 or $100,000.

Your Philadelphia American Fixed Benefit plan will pay for covered services related to any of these diseases while you are meeting the deductible on this plan. Once you have met your deductible, this plan will pay 100% of the actual charges paid by you or any other entity for services, treatment or material rendered up to the calendar year maximum benefit.

COVERED DISEASES, CONDITIONS & PROCEDURES:

• Heart Attack
• Stroke
• Cancer (Internal Cancer)
• Angioplasty
• Coronary Artery Bypass Surgery
• Pacemaker Implant
• 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 (Cerebral, Carotid or Aortic Aneurysm)

*** The maximum lifetime transplant benefit for all transplants is $100,000 per Insured person per policy.

The Specified Disease Plus plan is available in these states: 

AL, AR, AZ, DE, FL, GA, KY, LA, ME, MI, MO, MS, NC, NE, NV, OH, OK, SC, SD, TN, TX, WI, WV, WY

Philadelphia American Specified Disease Plans:

These plans offer the following:

• The lifetime maximum benefit is $2,000,000.
• You choose a calendar year maximum benefit of $250,000, $500,000 or $1 Million.
• You choose a calendar year deductible of $25,000, $50,000, $75,000 or $100,000.

Your Philadelphia American Fixed Benefit plan will pay for covered services related to any of these diseases while you are meeting the deductible on this plan. Once you have met your deductible, this plan will pay 100% of the actual charges paid by you or any other entity for services, treatment or material rendered up to the calendar year maximum benefit.

COVERED DISEASES, CONDITIONS & PROCEDURES:

• Heart Attack
• Stroke
• Cancer (Internal Cancer)
• Angioplasty
• Coronary Artery Bypass Surgery
• Pacemaker Implant
• 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 (Cerebral, Carotid or Aortic Aneurysm)

*** The maximum lifetime transplant benefit for all transplants is $100,000 per Insured person per policy.

STAT: An aneurysm occurs when arteries carrying blood to major organs splits or bursts. According to the CDC, aneurysms cause thousands of deaths each year but are treatable with surgery if found early. 

The Specified Disease plan is available in these states: 

IA, IL, IN 

Philadelphia American Life GAP Plan – Philadelphia American Life’s GAP plan helps bridge gaps in the coverage that exist in your current insurance plan by reducing or even eliminating the Out-of-Pocket expenses associated with hospital and doctors bills. The plan pays the difference in what your medical plan would pay and what you or a covered family member would owe.

Benefits are limited to the deductibles, co-pays and co-insurance amounts that you or each of your covered family members are required to pay under your Primary Medical Insurance and include:

 In-patient hospital expenses

 In-patient surgeries

 Physician’s hospital charges

 Plus 50% of covered Outpatient expenses which are considered eligible expenses under your Primary Medical Insurance policy.

Benefit Options:

To help bridge the coverage gap you can select an annual calendar benefit starting as low as $2,000 or a maximum benefit of $10,000. (Selections are in $1,000 increments)

Deductibles:

You have a deductible choice of $0, $250, $500 or $1,000.

NOTE: This plan pays for out of pocket costs that your primary insurance doesn’t pay. You will be required to submit an Explanation of Benefits (EOB) from your primary coverage in order to receive payment of benefits on this plan.

Philadelphia American Dental Choice Plus:

Philadelphia American Dental Choice Plus dental plan has two options. A Standard and Enhanced plan. Availability varies by state.

 See if one of our alternative health plan solutions is right for you

If you would like to discuss your health insurance options and see if one of these Philadelphia American Fixed Benefit plans (combined with one or more Philadelphia American supplemental plans and/or our other US Supplemental Plans) are right for you, please go to my online calendar and schedule a call with me on a day and time that works for you, and I will call you to review your options.