Philadelphia American Life Member User Guide
Your NAHP Alternative Health Plan is simply a bundle of products that when stacked together provide comprehensive health coverage at significantly lower prices. It is NOT an “all in one” - - that is Obamacare with all its problems. Your plan includes a Philadelphia American Fixed Benefit plan combined with other supplemental plans from Philadelphia American and/or other companies on our US Supplemental Coverage page.
To get the most out of this plan, it takes a little effort on behalf of the member. It is very important that you read the Outlines of Coverage so that you better understand the coverage. However, while it may take a little getting used to, the plan is simple and will save you a ton of money. It consists of the following:
Philadelphia American (PALIC) Fixed Benefit Plan
The Philadelphia American Fixed Benefit health plan provides you coverage for inpatient and outpatient services. You can use any provider you want, but using a network provider lowers your out of pocket costs by providing a pre-negotiated rate on services.
PALIC Additional Plan Information
For additional information please go to our Philadelphia American page. They have asked us not to leave their plan brochures on our Philadelphia American page. So, if you need another copy of your plan's outline of coverage, just let me know and I will forward a link to download a plan brochure for your specific plan.
PALIC PPO Network
The Philadelphia American Fixed Benefit plans allow you to go to any provider without restriction. However, these Fixed Benefit plans also include the PHCS/Multiplan nationwide PPO network. If you see in network providers, you are going to see significant discounts on the bills you receive.
Here are instructions to look up providers. First go to:
In the top right corner, click the dropdown that says “Provider Search.” Choose the plan you have. Either Health Saver Plus (HSP) Gold, HSP Gold with Specified Disease, Health Choice Select or Health Saver Plus III.
For HSP Gold, Health Choice Select and Health Saver Plus III, a new window will open with two buttons to enter as a guest or a policy holder. Choose to enter as a guest. From here you can search using multiple different criteria.
IMPORTANT NOTE: When you have the HSP Gold with Specified Disease this gives you access to the full PHCS PPO network, which is larger than the network used by the Fixed Benefit plans (above). This also means that the link to look up providers will open a different website than the other plans. On this site, first click "OK" at the bottom. Next click "Enter Zip" to enter your zip code. Then, enter the provider information in the search bar and click to search. After that you can adjust your search using the navigation tools that come up.
Please let me know if you need help!
General and Customer Service Information
Your PALIC IDs cards and policies will be mailed directly to you. You should receive them 7 to 10 working days after your approval date. You should read your all policy information carefully.
PALIC Customer Service:
If your policy number begins with "66": 1-888-748-3040
Press 2 for policyholder services.
All other policy numbers and inquiry types: 1-800-552-7879
Press 1 for policyholder services.
Policyholder email address: firstname.lastname@example.org
Online Member Portal
To register and create member account go to the: PALIC Member Portal
You'll need your member (policy) ID number. When you register on the member portal you will see your policies.
After creating your member account, you can login at the main Member website: https://apps.neweralife.com/site/
Click on the policy link that says, "Health Ticket." Print it out and it gives you an overview of your coverage and instructions for providers to verify benefits.
NEW! Philadelphia American has added several tools to help you with finding fair prices for your healthcare needs. They include Healthcare Bluebook, MD Save, ShopHealth from the Free Market Medical Association and several prescription pricing tools. They have also added several Preferred Providers offering fair pricing for their services.
Claims Filing Instructions
If you are paying cash and filing for reimbursement you will simply file a claim with PALIC by completing a claim form (attached to email with this document), attach the medical bill/prescription receipt and email to PALIC at: email@example.com
When submitting a claim directly, in addition to the following information, you will need to also submit this PALIC Claim Form.
Following these instructions will avoid unnecessary delays in claim processing. Please provide the following information.
· An itemized statement showing the full name, address and Tax ID number of the provider of service. This itemized statement should include the patient’s name, date of service and amount charged for each service.
· The diagnosis (ICD) code for each date of service (this will be a 3 to a 8 digit code number and the procedure (CPT or HCPCS) code for each service rendered (this will be a 5 digit code number.
· An Emergency Room or Outpatient Hospital bill should include the Revenue Codes which are the 3-digit codes that indicate the charges for services rendered in each department of the hospital.
· If the claim is incurred in the first 12 months of coverage please complete the attached Claim Form and Authorization and submit with your claim. When submitting a claim that is incurred after your policy has been in force for 12 months you will not need to complete this form unless your claim is for an accident.
· If the claim is for an accident, please complete the Claim Form and Authorization. If the accident was related to a motor vehicle accident, we need a copy of the MVA Report.
· If a claim form is not required as indicated above, please make sure the insured name, the patient name and the policy number is included on all documentation submitted.
· If you are hospitalized and your confinement is expected to be for more than 3 days, please contact our Customer Service Department at the number below for assistance.
If you prefer not to email your claims information, completed Claim Forms and claims can be mailed or faxed to our offices.
Philadelphia American Life Insurance Company
Attention: Claim Department
PO Box 4884
Houston, TX 77210-4884
You can also fax your claims to: 281-368-7382
If you have any questions please call our Customer Service Department at 800-552-7879 extension 1331.
NOTE: After submitting claims, if you would like to check the status or any other claims/benefit related questions, you can email them at: firstname.lastname@example.org
Additional Included Benefits
As discussed in all previous information that I have sent, the following benefits are included within your PALIC Fixed Benefit plan.
NEW! Assist Health Group - Assist Health offers networks of providers nationwide offering significant discounts for:
- Lab Tests (100 lab tests under $10)
- Radiology (MRI, CT, X-Rays, Ultrasound, Mammogram)
- Gastroenterology (Colonoscopy, GI, Sigmoidoscopy)
As a policyholder, all you do is call their nationwide hotline (888-996-0650).Mention Philadelphia American and select a provider from their network. Assist Health verifies your benefits and schedules you for an appointment.
The Karis360 services are designed to assist at each stage of your healthcare experience. Karis360 provides unlimited access to a suite of dedicated services and a team of expert Patient Advisors work with members to assist in navigating the confusing and expensive world of healthcare. Karis360 provides the following services:
- Healthcare Navigator – Policyholders gain a resource and concierge-style service to help them through the chaos and confusion often associated with the healthcare marketplace. Our expert advisors will find everything needed to quickly and thoroughly solve your needs, including finding doctors and healthcare facilities, obtaining best available pricing for procedures, or help shop for better pricing on prescription drugs, imaging services or lab tests.
- Karis Surgery Saver - For those planning non-emergency surgical procedures, our team works to save money by “shopping” the local and regional market for healthcare facility options that combine affordability and quality services for a given non-emergency surgery.
- Karis Bill Negotiator - Is available to address your out-of-pocket portion of medical bills incurred after healthcare services are performed—this element of our service is quite valuable and often reduces the amount owed by the customer.
NOTE: We believe that the Karis360 services will significantly improve your experience using the PALIC Fixed Benefit plans by simplifying the process, reducing the stress involved and even lowering the end cost of just about ANY health care situation that might come up. Please take advantage of this service for ALL future healthcare situations!
***Karis360 contact number for PALIC Fixed Benefit plans: 1-800-556-8452
Read more about Karis360 here: https://thekarisgroup.com/services/karis360
Included in all Philadelphia American Fixed Benefit Plans program is the Teladoc benefit at no additional premium or copay to use if you are sick. It will save you money and time from not having to go to the doctor’s office when you have a simple illness like cold or flu. You will receive information in your policy or you can call 1-800-TELADOC. Physicians are available by phone or Skype 24/7/365. You have unlimited use of this benefit at no cost.
Your package from Teladoc has your card so you can verify the number. This is received separately from your PALIC member packet.
Use this link to create your account: https://member.teladoc.com/registrations.
Helpful Teladoc links:
How Teladoc works.
What kind of health care issues can it be used for?
Answers to FAQ’s.
Also included in the Philadelphia American Fixed Benefit plans is a prescription drug discount benefit. You can look up the discounts by pharmacy and download an ID card at ScriptSave and enter group code #2242. The differences in costs can be substantial.
ScriptSave: Answers to FAQ’s
Additional discounts for Diagnostic Imaging, Diabetic Supplies, Gym Membership, Hearing, Hearing Aids, Lab Tests, Vision and Lasik are also available. Click here to learn more.
US Healthcare Resources and Shopping Services
In addition to the information above, don't forget to go to our US Healthcare Resources page for a detailed list of online healthcare shopping tools and resources. They include sites to help you shop for the best price (or fair price) on all different types of healthcare. There are also providers offering deeply discounted prices on multiple different types of care.
Contact Me Anytime for ANY Reason:
If you have ANY other issues or questions throughout the year, I am here to help! So, please contact me at ANY time! You can schedule a call on my online calendar by clicking the link above that says CALL ME and picking a day and time that works best for you. You can also call or text me at the number in the top right corner of this website or send me an email to email@example.com.