It’s time for a change…

The company behind the change…

Philadelphia American Life Insurance Company (PALIC)

has a history dating back to 1904 and is now part of the New Era Life family of insurance companies

Over $300,000,000 of annually premium income.

Over $120,000,000 of Health Premium annually Philadelphia American Life Company is licensed in 47

….states.

The man behind the companyDr. Bill Chen, our president, and CEO, earned

his doctorate in theoretical statistics from Purdue University in 1970 and became a Fellow in the Society of Actuaries in 1978. He has spent nearly 30 years in the life and health.

insurance industry. He has been honored by numerous organizations including Ernst and Young, Merrill Lynch Regional and was recognized as Entrepreneur of the Year in 1994 by Inc. Magazine.

It’s a new world of Defined Benefit plans and supplemental benefits.

Now, WE are required to be more pro-active in controlling our medical expenses AND be equally pro-active in the management of our personal health.

It’s a new world of Defined Benefit plans and supplemental benefits.

Now, WE are required to be more pro-active in controlling our medical expenses AND be equally pro-active in the management of our personal health.

For a growing number of American's, the days of $20 co-pays are coming to an end.

The Key to Controlling Healthcare Costs is More Than Co-Pays and Deductibles

The Key to Controlling Healthcare Costs is More Than Co-Pays and Deductibles

It’s about providing the “right” plan at the right time to help guide personal decisions.

It’s about providing the “right” plan at the right time to help guide personal decisions.

Welcome to Health Saver Plus 1Your Guide to the Next Generation of Affordable Health Insurance In today’s market where health insurance is often

unavailable or unaffordable, Health Savers Plus 1 can help provide you and your family with peace of mind by proving health insurance benefits you can afford.

The idea is that affordable, quality healthcare is achievable if you the consumer, have the basic knowledge and willingness to make informed decisions by discussing treatment plan and costs with the healthcare professional of your choice.  

www.vimo.com/hospital

Hip replacement

77002

25

Access the best quality healthcare at the lowest possible cost.

Welcome to Health Saver Plus 1 Your Guide to the Next Generation of Affordable Health Insurance

Key Features Include

• $5,000,000 Lifetime Maximum

• Choose from three benefit options .Pick your Base Plan Deductible Calendar Year Benefit Maximum Level Number of Benefit Units to fit your needs

• Use any Doctor or Hospital you choose “Without Penalty”

Three Calendar Year Deductibles .\

1st Choose a deductible you can afford

Three Calendar Year Deductibles .\

1st Choose a deductible you can afford1. $ 1,000

2. $ 2,500

3. $ 5,000

1. $ 1,000

2. $ 2,500

3. $ 5,000

Annual Maximu

m

Annual Maximu

m

Annual Maximu

m

Maximum Covered Benefits Per Covered Person per Calendar Year $100,000 $250,00

0$1,000,000

Maximum Number of Days Per Covered Persons 30 60 180

2nd Choose an Annual Maximum Benefit .

Hospital Indemnity Benefits – Facility Fees 3rd Pick the number of Benefit Units .Select The Number of Benefit Units 1

Unit2

Units3

Units

Daily Indemnity Benefit For Hospital Confinement $1,50

0

$3,000 $4,500

Confinement in a Hospital Intensive Care Unit (ICU) (Up to 20 days per Calendar Year $2,25

0$4,500 $6,750

Daily Indemnity Benefit For Hospital Confinement For Mental Illness, Alcohol and/or Substance Abuse $

750$1,500 $2,250

Daily Indemnity Benefit For Hospital Confinement in a Rehabilitation Facility or Skilled Nursing Facility $

750$1,500 $2,250

Daily Indemnity Benefit For Outpatient Radiation or Chemotherapy $

750$1,500 $2,250

Daily Indemnity Benefit for Outpatient Hospital or Ambulatory Surgical Center services when surgery is performed

$1,500

$3,000 $4,500

Outpatient Benefits .CALENDAR YEAR DEDUCTIBLE $500 per insured

Calendar Year Maximum $2,000

Units 1 Unit

2 Units

3 Units

Outpatient Office Visit $ 25 $ 50 $ 75

Other Outpatient Services (per test)• MRI, CAT Scan or Nuclear testing• Other diagnostic testing or X-rays• Laboratory testing• Injections

$ 1754010

5

$ 350802010

$ 525120

3015

Generic Prescription (per prescription filled) $ 5 $ 10 $ 15

Brand Name Prescription (per prescription filled) $ 10 $ 20 $ 30

Well Care Maximum $ 50 per visit up to $150 per calendar year

Professional Services.

Assistant Surgical Services We will pay 20% of the amount listed in the fee

schedule

Anesthesia Benefit for covered services We will pay 25% of the amount listed in the fee

schedule

Inpatient Physician Hospital Visit per visit $50 $100 $150

Emergency Ambulance for each trip due to a covered injury or Sickness that results in a hospital confinement.

$250.00 per trip

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 a eligible Accident or Sickness. The reimbursement schedule is the Medicare RBRVS (Resource-Based Relative Value Scale) per procedure based on your providers location.

1 X the Current RBRVS

Schedule

 

2 X the Current RBRVS

Schedule

3 X the Current RBRVS

Schedule

Inpatient Pathologist / Radiologist: The plan will pay this benefit if any Covered Person undergoes an Inpatient Pathologist / Radiologist procedure as a result of a Covered Accident or Sickness. The reimbursement schedule is the Medicare RBRVS (Resource-Based Relative Value Scale) per procedure based on your providers location.

1 X the Current RBRVS

Schedule

2 X the Current RBRVS

Schedule

3 X the Current RBRVS

Schedule

Professional Services (Texas Only).

Assistant Surgical Services We will pay 20% of the amount listed in the fee

schedule

Anesthesia Benefit for covered services We will pay 25% of the amount listed in the fee

schedule

Inpatient Physician Hospital Visit per visit $50 $100 $150

Emergency Ambulance for each trip due to a covered injury or Sickness that results in a hospital confinement.

$250.00 per trip

Texas Only 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 a eligible Accident or Sickness.  

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 undergoes an Inpatient Pathologist / Radiologist procedure as a result of a Covered Accident or Sickness.

1 X the Policy

fee schedule

2 X the Policy

fee schedule

3 X the Policy fee schedule

* 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

Hospital Indemnity

Pays based on Define Benefit Schedule

Deductible is Applied Against

Eligible Benefits

Major Medical

Pays based on Expense Incurred

Deductible and Co-Payment is Applied

Against Eligible Expenses

Medical Plan Comparison .

PHCS Network Composition Summary By MSA

Health Saver Plus 1 Prostate Cancer 3 Day Hospital Stay $1,000 Deductible

Inpatient Hospital 3 daysEligible Benefit Deductible

3 UnitsPayable

Out of Pocket

Eligible Benefit Deductible

2 UnitsPayable

Out of Pocket

Hospital Bill $17,215.17 $13,500.00 $1,000.00 $12,500.00 $4,715.17 $9,000.00 $1,000.00 $8,000.00 $9,215.17

Surgery 55845 $2,530.00 $4,104.81 $4,104.81 ($1,574.81) $2,736.54 $2,736.54 ($206.54)

Assistant Surgery 55845 $650.00 $820.96 $820.96 ($170.96) $547.31 $547.31 $102.69

Anesthesia55845 $2,394.00 $1,026.20 $1,026.20 $1,367.80 $684.14 $684.14 $1,709.86

Pathology Bills88305-26 $480.00 $175.74 $175.74 $304.26 $117.16 $117.16 $362.84 88309-26 $495.00 $327.78 $327.78 $167.22 $218.52 $218.52 $276.48 88331-26 $408.00 $282.12 $282.12 $125.88 $188.08 $188.08 $219.92 86850-26 $7.26 $0.00 $0.00 $7.26 $0.00 $0.00 $7.26 86901-26 $13.31 $0.00 $0.00 $13.31 $0.00 $0.00 $13.31 86900-26 $8.47 $0.00 $0.00 $8.47 $0.00 $0.00 $8.47 80061-26 $26.02 $0.00 $0.00 $26.02 $0.00 $0.00 $26.02 83735-26 $13.31 $0.00 $0.00 $13.31 $0.00 $0.00 $13.31 80048-26 $18.15 $0.00 $0.00 $18.15 $0.00 $0.00 $18.15 85025-26 $10.89 $0.00 $0.00 $10.89 $0.00 $0.00 $10.89 83735-26 $13.31 $0.00 $0.00 $13.31 $0.00 $0.00 $13.31

Radiology bills74000-26 $36.00 $21.75 $21.75 $14.25 $14.50 $14.50 $21.50

Hospital Visits $110.00 $150.00 $150.00 ($40.00) $100.00 $100.00 $10.00 $110.00 $150.00 $150.00 ($40.00) $100.00 $100.00 $10.00 $110.00 $150.00 $150.00 ($40.00) $100.00 $100.00 $10.00 $200.00 $150.00 $150.00 $50.00 $100.00 $100.00 $100.00

Totals $24,848.89 $20,859.36 $1,000.00 $19,859.36 $4,989.53 $13,906.25 $1,000.00 $12,906.25 $11,942.64

Re-priced @ 20% PHCS $19,879.11 $19.75 $7,936.47 Re-priced @ 30% PHCS $17,394.22 ($2,465.14) $4,487.97 Re-priced @ 40% PHCS $14,909.33 ($4,950.03) $2,003.08

3 Units @ a Daily Hospital Benefit of $4,500

2 Units @ a Daily Hospital Benefit of $3,000

Medical Discount Plan Only $19.95/ month for you

and your family

PHCS Physician & Hospital Network*• Inpatient services 10% to 50%• Outpatient services 10% to 40%• Ancillary services 15% to 55%• Physician services 23% to 46%

* PHCS Network is not available in MA, MD and WV Imaging Network

Over 3,200 outpatient radiology facilities• Save an average of 40% to 75% less than the usual costs

for MRI, CT and PET scans

Lab Services 10% to 80% savings on regular retail pricing of blood test with over 3,000 certified labs nationwide.

Pharmacy DiscountsAccess to over 60,000 participating pharmacies nationwide.• Average savings 31% generic drugs and 13% off

brand ...name prescriptions

Other Great Services Include• My eWellness – web-based health & wellness• eDocAmerica – online access to physicians• NurseLine – 24 hour Registered Nurse

Advisor Help Line• Discounts on Chiropractic Services and

Durable Medical• Discounts on Diabetic Supplies Discount listed above are for illustrative purposes only please refer to Careington’s brochure NEL-DMP or the membership booklet for more details about the Discount Medical Plan. - This Is Not Insurance -

Critical Illness RiderProvides immediate cash for your customers when they are diagnosed with a covered medical crisis.They can use the money for:

• Treatment not covered by HSP1 including deductible and …..expenses in excess of the coverage selected.

• Non-medical expenses like travel, childcare, and spouse’s …..time off from work.

• Expensive alterations to your home or vehicle for special …..needs.

• Or, any way you choose. There are NO restriction on how …..you spend your money.

Critical Illness RiderA Lump-sum Benefit is paid upon the diagnosis of:

Covered Illness % Benefit Paid

Heart Attack 100%

Stroke 100%

Cancer (Internal Cancer) 100%

End Stage Renal Failure 100%

Major Organ Transplant 100%

Non-Invasive Carcinoma In-situ

25%

Coronary Artery Bypass 25%If a partial benefit is paid the remainder of the benefit will be payable upon the diagnosis of another covered Critical Illness.

Critical Illness Rider  MONTHLY RATES

Issue Age $10,000 $20,000 $30,000 $40,000 $50,000

  NTU TU NTU TU NTU TU NTU TU NTU TU                     

Under 30 $ 3.20 $ 4.50 $ 6.40 $ 9.00 $ 9.60 $ 13.50 $ 12.80 $ 18.00 $ 16.00 $ 22.50

30 - 39 $ 5.80 $ 8.70 $ 11.60 $ 17.40 $ 17.40 $ 26.10 $ 23.20 $ 34.80 $ 29.00 $ 43.50

40 - 44 $ 11.20 $ 17.90 $ 22.40 $ 35.80 $ 33.60 $ 53.70 $ 44.80 $ 71.60 $ 56.00 $ 89.50

45 - 49 $ 12.60 $ 21.40 $ 25.20 $ 42.80 $ 37.80 $ 64.20 $ 50.40 $ 85.60 $ 63.00 $ 107.00

50 - 54 $ 20.80 $ 37.40 $ 41.60 $ 74.80 $ 62.40 $ 112.20 $ 83.20 $ 149.60 $ 104.00 $ 187.00

55 - 59 $ 23.40 $ 44.50 $ 46.80 $ 89.00 $ 70.20 $ 133.50 $ 93.60 $ 178.00 $ 117.00 $ 222.50

60 - 64 $ 35.70 $ 71.40 $ 71.40 $ 142.80 $ 107.10 $ 214.20 $ 142.80 $ 285.60 $ 178.50 $ 357.00

                     

  $10,000 Benefit Amount              

0 - 26 Per Dependent Child $ 1.40              

Family Term Life RiderACTUAL AGE

AT DEATH   INSURED

INDIVIDUAL’SDEATH BENEFIT*

  INSURED SPOUSE’S

DEATH BENEFIT**

18-29 

$ 50,000.00   $ 10,000.00

30-34   $ 40,000.00   $ 10,000.00

35-39   $ 30,000.00   $ 10,000.00

40-44   $ 20,000.00   $ 10,000.00

45-49   $ 15,000.00   $ 7,500.00

50-54   $ 10,000.00   $ 5,000.00

55-59   $ 7,500.00   $ 3,750.00

60-64   $ 5,000.00   $ 2,500.00

ACTUAL AGEAT DEATH

CHILDREN’SDEATH BENEFIT

0 -14 days $ 0.00

15 days to 6 month $ 500.00

6 months—age 17 $ 3,000.00

Monthly Rates

Insured Only $10.00

Insured & Children $12.50

Family $15.00

* Death Benefit is based on Insured’s attained age. ** Spouse’s Death Benefit is based on Insured’s attained age

Enhanced Accident Expense Plan . 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

Enhanced Accident Expense Plan .

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

Monthly Bank Draft Rates Issue Ages for Accident Plan 0-75Issue Ages for Accident Disability Rider 18-64 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

It’s time for a change…

Underwriting

Simplified Issue Application

Simplified Issue Application .

Simplified Issue Application .

Simplified Issue Application .

Simplified Issue Application .

It’s time for a change…

Underwriting

“Made Easy”

It’s time for a change…

Underwriting Tip -1

To help you ensure we are receiving accurate information from the applicant, you might let them know that a representative from the home office will call and review the application and their prescription history that you are about to review with them. You might tell them as your agent you are going to:

• “Ask them a series of questions about their medical history and ask them what medications they have taken in the last 12 months. These will be the same questions that the Company will ask you on a recorded phone call when they process your application.”

• Please be as thorough as possible to ensure consistency between their application and the recorded quality assurance call. This will help in getting their application processed in a timely manner.

Explain to the applicant how we handle Pre-existing Conditions to ensure they understand how it works

What is a Pre-Existing Condition?

“A condition for which 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.

Underwriting Tip - 2

New BusinessFlow Chart

It’s time for a change…

FaxApplication

PaperApplication

LSPPolicy System

Reviewed ForProcessing

MissingForms

ContactAgent

All Forms

Checked forLegibility

Ask Foranother Fax

orOriginal

App To BeMailed

No

YES

Yes

Manually KeyInto System

E-APP

UnderwriterReview

APS orOther

Requirement

ConditionalOffer

No Requirements orAfter Review of new

information

Decline

YES

NO

+ Issue Policy + Draft Premium

Pre-Screen

QAC

IntelliScript

Underwriter’s Desk

IntelliScript

Prior 2007 2008 2009 2010

Quality Assurance Call

1. The Quality Assurance Desks will be open from 8:00 am to 5:00 pm CST Monday thru Friday.

2. The purpose of this call is to allow the applicant to add any information that may have forgotten to disclose to the agent

3. A “Thank You ” email is sent from the home office upon receipt of the application to let the applicant know that we will be calling them and if they have not heard from us we invite them to call the toll free number to complete the call.

• Let them know about the Quality Assurance Call and

how important it is.

• Let them know that we will be ordering an RX history showing prescriptions they have had filled and the doctor’s name.

• Make sure you charge the correct rate ups. If they are not on the application, you will find them located in the Underwriting Guide –This relates specifically to question 13!

How Do I Get Quick Issue

Let your client know what underwriting will be expecting

In the last 12 months, other than conditions listed on the application, has any applicant had any medical or surgical advice or treatment or including prescriptions or operations or been advised to have medical tests or surgery that has not yet been performed, or is awaiting medical tests? If YES-you will need to refer to the Underwriting guide to determine if any action is necessary.

How Do I Get Quick Issue

Stress The Importance of Question #13

WHAT ABOUT CONDITIONS NOT ON THE APPLICATION?

The application ask about common conditions, but not all medical conditions! Please use the UW Manual if conditions are disclosed but not asked on the application. Question 13 ask about “Other” conditions.

ANEMIA- Within 2 Years since recovery = 2 Points Between 2-5 years since recovery = 1 Point More than 5 years = STD

Otherwise = DEC

GASTRIC BYPASS SURGERY-

Within the last 12 months = 2 Points 1 Year-3 Years-full recovery = 1 Point More than 3 years, full recovery = STD With Complications = DEC

• If the Rx history and the Quality Assurance Call are ...consistent with the information on the application-you ……..can expect QUICK turnaround

• If information is developed through any of these ..…

sources that is not consistent with the application, an ……..APS may be ordered which may delay issue several …….weeks.

• Getting complete information, avoids underwriting … …requiring the agent to go back later which may cause …you to have to “Resale” the program

How Do I Get Quick Issue

Get complete information

Underwriting Made Easy

healthunderwriting@neweralife.comTobacco Rate

My client stopped smoking five years ago. He smoked 2 packs a day but now only smokes an occasional cigar once or twice a week, can I quote him the non-tobacco rate?

ThanksSuccessful Agent

Get quick answers to your Underwriting Questions?

Underwriting Made Easy

In Summary-Explain to the client

• How Pre-Existing Condition’s are applied

• How the surgical schedule works with the based on the number of units they selected

• The application process including the Quality Assurance ...... Call

• How important complete medical and prescription history

is in completing the application.

Underwriting is always available to help at

healthunderwriting@neweralife.com

Register Today Atwww.neweralife.com

Now You Can Login To Online Agent Service

Atwww.neweralife.com

Manage Your Agent Profile

SalesForms

Online Applications

CommissionStatement

Pending Business

Online Applications

Medicare Supplement

Health Saver Plus

Dave Collett

Download a copy of your completed Application

Manage Your Agent Profile

SalesForms

Online Applications

CommissionStatement

Pending Business

Online Applications

Medicare Supplement

Health Saver Plus

Use 60000Demo as your agent number while you are familiarizing yourself with the eApp otherwise it will assume a life application

Receive Benefits From Three Pools

.

Patient Protection and Affordable Care Act