The Philadelphia American Optimum Health Saver plan is a unique plan giving YOU more control of your health insurance than ever before.
It is an indemnity plan. What that means is there is a specified amount the insurance company will pay for each service, office visit or procedure. Many are outlined in the Indemnity Benefit Plan Brochure including 20 Dr visits per person, per year, excellent lab benefits and hospital benefits and some chiropractic benefits as well. The dollar amounts listed on the left column, Value, (the plan I quoted for you) is the amount the company will pay for the specified service. Please see brochure (click here) as I have highlighted benefits mentioned above.
For instance for a Dr visit there is $160 available. If you were to visit your Dr without insurance and have to pay cash it would probably run around $200. With insurance that rate is reduced anywhere between 40-60% usually. So let’s say it is reduced 50% bringing it to $100 for the visit. The company will pay the $100 to the Dr office and then in turn you would be responsible for the remaining $60.
There is also accident protection built into the plan to help protect against coming out of pocket. For each accident each person will have $4000 of benefit to be used int he ER or Urgent Care before you will be required to come out of pocket, out side of a possible $50 copay at the ER. Keep in mind though that all care will be run through the contracted rate, if facility is in network, so that $4000 goes a lot further than if paying cash. There are also benefits built in for extended health issues if needed.
Again please remember the dollar amount listed are what the company pays, not what you pay. You will only pay if the specified amount does not cover the cost, which is hard to do if you stay in network.
This plan is a nationwide PPO plan, meaning you can choose your Dr and hospital, if you stay in network the better discount you will get and the further your benefit dollars will go of course.
Please click here (or below) for entire brochure.