• 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

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PHILADELPHIA AMERICANLIFE INSURANCE COMPANYSM

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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