Philadelphia American Life Member User Guide
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.
Beginning January 1, 2023, these plans will have access to the First Health Limited Benefit Plan network. 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:
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.
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: policyholderservice@neweralife.com
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/
NOTE: 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. From your member portal click on the “Fair Pricing” and “Valuable Member Benefits” tabs for more information.
Claims Filing Instructions
If you are paying cash and filing for reimbursement PALIC has updated the steps for this process. The current steps to filing a claim are as follows:
1. Login to your Policyholder Portal
2. From the Main Navigation menu, select Quick Request
3. In the Policy section, select the policy for which you are filing a claim
4. For Request Type, select New Claim
5. From the Patient drop down, select the policyholder you are filing a claim for
6. Select Click to upload file(s) to upload applicable document(s)
In addition to the following information, you may need to also submit this PALIC Claim Form. This is only necessary for the first claim you file.
From your member portal you will find written instructions for filing a claim along with a video tutorial.
If you need assistance submitting your claim online, please contact Claims Customer Service at 1-888-748-3040 prompt 2
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
NOTE: After submitting claims, if you would like to check the status or any other claims/benefit related questions, you can email them at: claimscustomerservice@neweralife.com
Additional Included Benefits
As discussed in all previous information that I have sent, the following benefits are included within your PALIC Fixed Benefit plan.
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
Telemedicine: NEW! Effective 11/1/2022 there is a new telemedicine benefit. Please download the flyer to read about all the services offered byNew Era Telehealth.
Prescription Savings:
Also included in the Philadelphia American Fixed Benefit plans is a prescription drug discount benefit called PAL Rx Saver (Powered by Drexi). To use this service you will need to create a Drexi member account. With this account you will get the following:
Automatic search results in your area letting you easily find the best price whether at home, work or traveling
Helpful pharmacy characteristic to help you find the best pharmacy for your needs
Maximum savings by providing suggested generic drug alternatives when available
Multiple avenues for filing prescriptions by showing you available coupons, mail order options, and more
Help tracking your current and past prescriptions
To create an account visit newera.drexi.com. Select Enroll and follow the prompts
After creating your account, you can find all the additional information in your policyholder portal (see above for portal information)
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 robtavis@ushealthinsurancesolutions.com.