Health Saver Plus Gold
- Ebony A. Brady
- Jan 3
- 8 min read
Updated: Jan 16
Briefing on Philadelphia American Life Insurance Company (PALIC) Offerings
Executive Summary
This document provides a comprehensive overview of the insurance products, underwriting guidelines, and value-added services offered by Philadelphia American Life Insurance Company (PALIC), a subsidiary of New Era Life Insurance Companies. The core offering is the Health Saver Plus (HSP) Gold Edition, a fixed indemnity benefit health plan designed as a customizable, consumer-driven alternative to traditional major medical insurance.
Key takeaways include :
Product Nature: PALIC's plans are indemnity benefit policies, providing set, first-dollar benefits for specific medical services. They are explicitly designated as "excepted benefit plans" and do not meet the minimum essential coverage requirements of the Affordable Care Act (ACA)
Customization and Control: The HSP Gold plan is structured around three benefit levels (Value, Plus, Preferred) and multiple deductible options, allowing consumers to tailor coverage to their budget and healthcare needs. The model encourages "smart healthcare management," as policyholders can potentially receive excess benefit dollars by choosing cost-effective providers
Underwriting: All applicants, including spouses and dependents, are subject to full medical underwriting. A 12-month pre-existing condition limitation applies, excluding coverage for conditions treated or recommended for treatment in the 12 months prior to the policy's effective date. The company maintains a detailed Health Impairment Chart and a list of unacceptable medical conditions and occupations that result in declined applications
Value-Added Services: Policyholders gain access to a suite of no-cost healthcare saving tools, including 24/7 telehealth services for $0, a provider network (First Health LBP) for discounts, a prescription savings card (ScriptSave WellRX), and advocacy services for medical bill negotiation (Medical Bill Eraser)
Agent and Applicant Responsibilities: The application process involves detailed medical questions, potential prescription and medical history checks, and a mandatory telephone interview or electronic verification. Agents are responsible for accurately recording information, while applicants must disclose all material health information to avoid future claim denials or policy voidance.
Corporate Structure and Underwriting
Philadelphia American Life Insurance Company (PALIC), based in Houston, Texas, underwrites the insurance products detailed in the source materials. PALIC is a subsidiary of the New Era Life Insurance Companies, which also includes New Era Life Insurance Company and New Era Life Insurance Company of the Midwest. The group holds an A- (Excellent) rating from AM Best
Health Saver Plus (HSP) Gold Edition Plan
The HSP Gold Edition is a fixed-benefit health protection plan designed to provide transparent and affordable coverage for doctor visits, hospital stays, surgeries, and preventive care. It is not a major medical plan
Core Plan Features
Lifetime Maximum: $5,000,000 per policy.
Calendar Year Maximums: Options of $250,000, $500,000, or $1,000,000 per insured person.
Deductible Options: Calendar Year Confinement Deductible options range from $100 to 10,000 per insured person (maximum of 3 deductibles per policy). Higher deductible plans (2,500+) include a First Day Hospital Admission Benefit.
Benefit Levels: The plan is offered in three tiers, which determine the indemnity benefit amounts:
Gold Value (One Unit)
Gold Plus (Two Unit)
Gold Preferred (Three Unit)
Provider Freedom: Policyholders can use any doctor or hospital of their choice. Access to the First Health (LBP) Network is provided for potential additional savings
Hospital Indemnity Benefits (Facility Fees)
Benefit Description | Value (One Unit) | Plus (Two Units) | Preferred (Three Units) |
Hospital Admission Benefit (for deductibles ≥$2,500) | $1,000 (for $2.5k ded) / $2,000 (for $5k ded) | $1,000 (for $2.5k ded) / $2,000 (for $5k ded) | Varies by deductible in Outline |
Hospital Confinement (Sickness / Injury) | $1,500 / $2,250 per day | $3,000 / $4,500 per day | $4,500 / $6,750 per day |
ICU Confinement (Sickness / Injury) (Up to 20 days/year) | $2,250 / $2,500 per day | $4,500 / $5,000 per day | $6,750 / $7,500 per day |
Mental Illness/Substance Abuse Confinement | $200 per day | $400 per day | $600 per day |
Rehab/Skilled Nursing Facility Confinement | $750 per day | $1,500 per day | $2,250 per day |
Outpatient Surgery (General Anesthesia) | $2,000 per day | $3,500 per day | $5,000 per day |
Outpatient Surgery (No General Anesthesia) | $750 per day | $1,500 per day | $2,250 per day |
Outpatient Radiation/Chemo/Immunotherapy | $750 per day | $1,500 per day | $2,250 per day |
Professional Services & Outpatient Benefits
Benefit Description | Value (One Unit) | Plus (Two Units) | Preferred (Three Units) |
Aggregate Outpatient Max per Year | $4,000 | $6,000 | $8,000 |
Inpatient Physician Care (Non-Surgical) | $50 per day | $100 per day | $150 per day |
Surgery (Hospital/ASC) | 1X RBRVS | 2X RBRVS | 3X RBRVS |
Inpatient Pathology/Radiology | 1X RBRVS | 2X RBRVS | 3X RBRVS |
Physician Office Visit (Max 20/year) | $80 per day | $120 per day | $160 per day |
Specialist Physician Visit (Max 2/year) | $100 per day | $150 per day | $200 per day |
MRI, PET, CAT Scan, Nuclear Testing | $300 per day | $500 per day | $700 per day |
X-rays / Other Diagnostic Testing | $80 per day | $160 per day | $240 per day |
Laboratory Services | $40 per day | $80 per day | $120 per day |
Emergency Department (Facility/Professional) (Max 1/year) | $200 / $200 per day | $300 / $300 per day | $400 / $400 per day |
Urgent Care Center (Max 2/year combined with ER) | $200 per day | $300 per day | $400 per day |
Ambulance (Ground / Air) | $1,000 / $2,500 | $1,000 / $2,500 | $1,000 / $2,500 |
Prescription (Generic / Brand Name) | $10 / $20 per Rx | $20 / $40 per Rx | $30 / $60 per Rx |
Preventive Care Benefits
Coverage for preventive care begins 60 days after the effective date and is not subject to the pre-existing condition exclusion. Benefits are limited to one per insured person per calendar year
Mammograms: $250 per calendar year.
Colonoscopy (no polyps): $500 every three years (policy years 1-3), increasing to $750 every three years (beginning year 4).
All Other Preventive Services: $250 per calendar year
Optional Riders and Other Available Products
PALIC offers a range of plans that can be bundled to create a customized insurance portfolio. Product availability varies significantly by state
Optional Critical Illness Rider
An optional rider can be added to the HSP Gold plan, providing a lump-sum cash benefit from $10,000 to $50,000 upon diagnosis of a covered condition. Covered conditions include:
Cancer (Internal)
Non-Invasive Carcinoma In Situ
Heart Attack
Stroke
Coronary Artery Bypass Surgery
Angioplasty
Pacemaker Implant
End Stage Renal Failure
Major Organ Transplant
Comprehensive Product Portfolio
The following plans and riders are available in various states, as indicated in the product availability grid:
Product Category | Plan / Rider Name |
Illness & Cancer Plans | Critical Illness, Specified Disease Plus, Specified Disease, Pink Ribbon Cancer Plan, Critical Illness (CI) Rider |
Accident Plans | Individual Accident Expense (Catastrophic), 24-Hour Enhanced Accident Expense (Indemnity), ER/UC Rider, Accident Disability Income Rider |
Indemnity Plans | Health Saver Plus Gold, Health Saver Plus III, Health Choice Select, Flex Choice Health Plan, Premier Health Saver, Optimum Health Saver |
GAP Plans | GAP (Indemnity) Plan |
Dental Plans | Dental Choice Plus |
Other Riders | Enhanced Benefit Rider, Preventive Rider, Term Life Rider, Medical Expense Rider |
State Availability Overview (as of 08.26.2025)
Product availability is widespread but not universal.
States with extensive offerings (most or all products available): AL, AZ, AR, GA, IL, IA, LA, MI, MS, MO, NC, OK, SC, TN, TX, WI.
States with limited or specific offerings: CA, WA, OR, KS, VA.
Other states have varying levels of product availability.
In states where HSP Gold is released, HSP III is only available for existing group business where approved.
Healthcare Saving Tools and Value-Added Services
Policyholders receive access to several healthcare saving tools at no additional cost.
Healthcare PALs: An experienced team of claims professionals, nurses, and care coordinators who guide policyholders to find quality care at a fair price and avoid surprise medical bills.
New Era Telehealth: Provides unlimited $0 Virtual Urgent Care visits with board-certified doctors, 24/7/365. Additional services like virtual dermatology, counseling, and psychiatric care are available at a special member rate.
First Health Network: Access to the First Health Limited Benefit Plan (LBP) Network for discounts on healthcare services.
Concierge (Powered by Healthcare Bluebook): A personal healthcare shopping service that schedules care, handles details, and bundles procedures to maximize savings on outpatient surgeries.
Fair Pricing Tool (Powered by Healthcare Bluebook): Allows consumers to check the "Fair Price" for medical services in their area to avoid overpaying.
The Benefit PAL Mobile App: Provides on-the-go access to ID cards, benefit information, and claims history.
ScriptSave WellRX: A prescription savings card/app providing discounts on brand name and generic medications at over 62,000 pharmacies. (Group number: 2242)
Medical Bill Eraser (Powered by CareGuide): An advocacy team dedicated to fighting on the policyholder's behalf to reduce or eliminate large medical bills through expert negotiation
Underwriting and Eligibility
Key Underwriting Principles
Full Underwriting: All applicants (primary, spouse, dependents) undergo full underwriting. Guaranteed Issue plans are no longer offered for most health plans.
Pre-Existing Conditions: A 12-month limitation applies. A pre-existing condition is defined as one for which medical treatment was rendered or recommended, or for which drugs were prescribed, within 12 months prior to the effective date. A condition is no longer considered pre-existing after 12 consecutive months of coverage.
Contestability: The policy has a 2-year contestability period. After 2 years, no misstatements, except fraudulent ones, can be used to void the policy or deny a claim.
Medical History Verification: The company may order prescription and medical history on any applicant with proper authorization.
Telephone Interview/Electronic Verification: This is a key part of the application process to verify all information is correct, obtain authorization for medical record checks, and ensure the applicant understands the plan is not major medical coverage
Applicant Eligibility Criteria
Age Limits:
Applicants up to age 64.5.
Newborns must be at least 30 days old.
Dependent children are covered up to age 25.
Residency: All applicants from foreign countries must have resided in the U.S. for at least two years and possess a valid Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).
Other Coverage:
Optimum Health Saver cannot be sold with an ACA or major medical plan.
Specified Disease coverage is not offered if the applicant keeps an ACA or major medical plan.
Coverage is not offered to anyone on Medicaid, Medicare, or worker's compensation.
Applicants with VA benefits may apply for a limited health indemnity plan.
Pregnancy: If any applicant or dependent (whether applying or not) is currently pregnant, the entire household is ineligible for coverage
Unacceptable Risks
Applications will be declined for certain medical conditions, occupations, or avocations.
Unacceptable Medical Conditions (Regardless of Time Frame)
A partial list of conditions that result in an automatic decline includes:
Addison's Disease
AIDS, HIV positive, ARC
ALS (Lou Gehrig's Disease)
Alzheimer's Disease
Angioplasty/Bypass/Stent Placement
Cardiomyopathy
Cirrhosis of the liver
COPD
Crohn's Disease
Cystic Fibrosis
Dementia
Diabetes (Insulin-dependent or Juvenile onset)
Disabled or Receiving Disability
Heart Attack (Myocardial Infarction)
Hepatitis B
Kidney/Renal Failure
Leukemia
Lupus (Systemic)
Multiple Sclerosis
Muscular Dystrophy
Organ Transplant (Recipient)
Paralysis
Parkinson's Disease
Rheumatoid Arthritis
Stroke (CVA) or TIA
Unacceptable Occupations/Avocations
A partial list includes:
Adult Entertainers
Armed Services (Active Duty)
Asbestos/Toxic Chemical Workers
Professional Athletes (contact sports)
Explosive Workers
Oil Field Workers
Private Pilots
Stuntmen
Underground Workers
Rate-Ups and Counteroffers
For certain disclosed conditions not on the decline list, a "rate-up" may be applied. Each "point" equals a 15% rate-up on the premium.
Applicants requiring more than 10 points (150% rate-up) are ineligible for coverage.
Rate-ups are not commissionable.
If coverage is offered differently than applied for (e.g., with a rate-up), it is presented as a counteroffer that the applicant must sign to accept.
Policy Administration and Management
Policy Rewrite vs. Replacement
Rewrite Policy: An existing insured is rewritten to a brand-new policy while the original is still in-force.
The existing plan must be in-force for at least 12 months.
A new 12-month pre-existing condition period applies.
The insured must pass full underwriting again.
Generally, renewal commissions apply. First-year commissions are available only under specific circumstances (e.g., rewriting from an older HSP plan to a newer one after 12 months).
Replacement Policy: An insured applies for a new policy after their original policy has been terminated.
The insured must pass full underwriting.
Renewal commission applies if written 0-6 months after termination; first-year commission applies if written 7+ months after termination.
Policy Effective Date and Payments
Effective Date: Assigned by underwriting, can be requested up to 60 days from the application date.
Premium Draft: The first month's premium is drafted immediately upon final underwriting approval, even if this is before the effective date. This can be delayed to the effective date upon request (though the application fee may still be drafted). For credit card payments, both the fee and premium are charged on the effective date.
Exclusions and Limitations
The policy contains specific exclusions for which no benefits are payable. A summarized list includes losses resulting from:
Services not specified as a benefit
Suicide or intentionally self-inflicted loss
Cosmetic surgery (unless from a covered injury)
Routine exams and newborn care
Voluntary abortion (with exceptions)
Participation in a riot or felony
Voluntary use of intoxicants or narcotics (unless prescribed)
Experimental treatments
Services rendered outside the USA
Pregnancy and childbirth (except for defined complications)
Work-related injuries/sickness covered by Workers' Compensation
Acts of war
