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Health Savers Gold
Our goal is to provide you simple, transparent and affordable healthcare in today’s world where rapidly rising premiums, and unpredictable provider charges, make healthcare confusing and financially difficult to manage.
HSP Gold offers coverage with simple, transparent benefits for doctor visits, preventive care, surgeries, hospital stays and more. The plan helps meet the expectation of medical needs for you and your family, with real first dollar benefits being paid to providers with no deductible that will lower your out of pocket costs. A robust plan that offers a more long term solution to health insurance with minimal annual rate increases.
HSP Gold is a best of class Indemnity/Defined Benefit plans that pays benefits to providers based upon the type of medical care you receive. You may keep the plan as long as you like and choose any doctor, facility or hospital. Along with its base coverage HSP Gold also offers access to free TeleDoc, Karis 360 and ScriptSave WellRX.
Reward Yourself FOR Smart Healthcare Management. We compare prices for almost everything we buy and we should be doing the same for healthcare. HSP gold puts you in charge of your healthcare spending dollars and rewards consumers who practice smart healthcare management. No matter what the provider,
doctor, or facility charges, your insurance benefits remain the same. Therefore a smart consumer could receive excess benefit dollars directly in their pocket.
For the best plan add a short term plan from National General/Aetna for big claim protection. The combination gives you the best coverage available in the individual health insurance market.
Hospital Indemnity Benefits – Facility Fees
| Deductible Applies |
Plus (Two Unit) |
Preferred (Three Unit) |
| Confinement in a Hospital as a Result of a Covered Injury or Sickness Indemnity Benefit Includes Observation Unit stay for 24-hours or more |
Per Day | Per Day |
| Covered Sickness Benefit | $3,000 | $4,500 |
| Covered Injury Benefit | $4,500 | $6,750 |
| Confinement in a Hospital’s Intensive Care Unit (ICU) Indemnity Benefit Up to twenty (20) days per Calendar Year as a result of a covered Injury or Sickness. |
Per Day | Per Day |
| Covered Sickness Benefit | $4,500 | $6,750 |
| Covered Injury Benefit | $5,000 | $7,500 |
| Confinement in a Hospital for Mental Illness, Alcohol and/ or Substance Abuse Dependency Indemnity Benefit Limited to a maximum of sixty (60) days per Insured person per Calendar Year. |
Per Day $400 |
Per Day $600 |
| Confinement in a Rehabilitation Facility or a Skilled Nursing Facility Indemnity Benefit Does not include Mental Illness, Alcohol and/or Substance Abuse Dependency. |
Per Day $1,500 |
Per Day $2,250 |
| Outpatient Hospital or Ambulatory Surgical Center Services When Surgery is Performed Indemnity Benefit | Per Day | Per Day |
| Benefit for Surgery Performed Under General Anesthesia | $3,500 | $5,000 |
| Benefit for Surgery Performed not Requiring General Anesthesia | $1,500 | $2,250 |
| Outpatient Radiation Therapy, Chemotherapy and lmmunotherapy Indemnity Benefit | Per Day $1,500 |
Per Day $2,250 |
Professional Services |
Plus | Preferred |
| Inpatient Physicians Care Indemnity Benefit When medical care is from a physician other than an operating surgeon. |
Per Day $100 |
Per Day $150 |
| Surgery Indemnity Benefit for Covered Services When Performed in a Hospital or in an Ambulatory Surgical Per procedure for your provider location. |
Per Day 2X Surgical Schedule |
Per Day 3X Surgical Schedule |
| Inpatient Pathology /Radiology Indemnity Benefit for Covered Services Per procedure for your provider location. |
Per Day $160 |
Per Day $240 |
| Assistant Surgeon Surgical Services Indemnity Benefit for Covered Services | Per Day 2X Surgical Schedule |
Per Day 3X Surgical Schedule |
| Anesthesia Indemnity Benefit for Covered Services | Per Day 2X Surgical Schedule |
Per Day 3X Surgical Schedule |
Additional Outpatient Benefits |
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| Plus (Two Unit) |
Preferred (Three Unit) |
|
| Aggregate Calendar Year Maximum for Outpatient Benefits Per Insured person. |
Per Year $6,000 |
Per Year $8,000 |
| Physician Indemnity Benefit For each day an Insured person sees a Physician in office or at an outpatient clinic. Maximum of twenty (20) benefit days including six (6) chiropractor and two (2) Specialist Physician visits per Insured person per Calendar Year. |
Per Day $120 |
Per Day $160 |
| Specialist Physician Indemnity Benefit Maximum of two (2) benefit days paid at the Specialist Physician rate per Insured person per Calendar Year. After the first two Specialist Physician Benefits are paid at this rate, you will be paid the Physician Indemnity Benefit amount, assuming that you have not met your maximum of twenty (20) benefit days per Insured person per Calendar Year. |
Per Day $150 |
Per Day $200 |
| Surgery Benefit in a Physicians/Specialists Office or Outpatient Clinic Maximum of two (2) benefits per Insured person per Calendar Year. |
Per Day $200 |
Per Day $300 |
| MRI, PET, CAT Scan or Nuclear Testing Indemnity Benefit | Per Day $500 |
Per Day $700 |
| X-rays or Other Diagnostic Testing Indemnity Benefit | Per Day $160 |
Per Day $240 |
| Laboratory Indemnity Benefit | Per Day $80 |
Per Day $120 |
| Injection Indemnity Benefit | Per Day $60 |
Per Day $90 |
| Emergency Department Indemnity Benefit Maximum of one (1) benefit per Insured person per Calendar Year. Maximum of two (2) benefits combined Emergency Department Benefit/Urgent Care Center Benefit per Insured person per Calendar Year. |
Per Day | Per Day |
| Facility Fee/Charges | $300 | $400 |
| Professional Services | $300 | $400 |
| Urgent Care Center Indemnity Benefit Maximum of two (2) benefits per Insured person per Calendar Year. Maximum of two (2) benefits combined Emergency Department Benefit/Urgent Care Center Benefit per Insured person per Calendar Year. |
Per Day $300 |
Per Day $400 |
| Urgent Care Center Indemnity Benefit Maximum of two (2) benefits per Insured person per Calendar Year. Maximum of two (2) benefits combined Emergency Department Benefit/Urgent Care Center Benefit per Insured person per Calendar Year. |
Per Day $1,000 (Ground) $2,500 (Air) |
|
| Generic Prescription Indemnity Benefit Per Insured person per prescription filled. |
Per Day $20 |
Per Day $30 |
| Brand Name Prescription Indemnity Benefit Per Insured person per prescription filled. |
Per Day $40 |
Per Day $60 |
| Preventive Care Indemnity Benefits Coverage starts sixty (60) days after the Effective Date of each Insured person. Limit of one (1) benefit per Insured person per Calendar Year. Not subject to the Pre-Existing Conditions Exclusion. |
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| Mammograms | Per Calendar Year $250 |
|
| Colonoscopy Without Finding Any Polyps | Every Three Years | |
| Policy Years One (1) Through Three (3) Beginning the Fourth (4th) Policy Year |
$500 $750 |
|
| All Other Preventive Care Services Including but not limited to pap smears, PSA tests, chest X-rays and cholesterol testing. Coverage starts sixty(60) days after the Effective Date of each Insured person. to the Pre-Existing Conditions Exclusion. |
Per Calendar Year $250 |
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Regardless of the charge for the inpatient, professional, or outpatient medical services you receive, we pay the listed benefit amount for eligible services.
Daily time periods are twenty-four (24) or more consecutive hours.
How It Works (how claims are processed)
Step 1: Policyholder will present both PALIC ID card and Aetna card at the time of service.
Step 2: Doctor/Hospital will verify coverage based upon information on card.
Step 3: Policyholder will get the best negotiated price of both plans, claim will be repriced with network discount.
Step 4: Allowable amount counts towards your deductible with Aetna, then HSP Gold pays benefit to provider.
Step 5: If HSP Gold policy pays more than the billed charges less the PPO discount, allowable amount sent to the provider and policyholder receives the difference.
As you work through this process, Free Market Health Plans (FMHP) will provide you our Claims Management assistance and provide you the tools and help to minimize your overall out of pocket expenses.
Real Claim Examples
A listing or real claim example from real life experiences:
| Claim Type | Billed Amount | Negotiated Rate | Benefit (HSP2 Plus) | Out of Pocket |
| Primary Care Office Visit | $129.00 | $95.65 | $120.00 | $0.00 |
| CAT Scan | $910.58 | $441.13 | $500.00 | $0.00 |
| Outpatient Surgery – Kidney Stone |
$8,678.00 | $4,680.00 | $3,500.00 | $1,680.00 |
| Office Visit Specialist – Urologist | $265.00 | $147.52 | $150.00 | $27.52 |
| Outpatient Test – Upper GI | $4,695.00 | $2,635.00 | $3,500.00 | $0.00 |
| Diagnostic X Ray | $736.00 | $460.28 | $160.00 | $300.28 |
| Office Visit Specialist – Ortho | $265.00 | $98.53 | $150.00 | $0.00 |
BIG Claim Examples
| Claim Type | Billed Amount | Negotiated Rate | Benefit | Out of Pocket |
| Heart Surgery – Multiple Bypass | $101,855.00 | $88,864.00 | $30,000.00 | $58,864.00 |
Value Added Benefits
All available to you at no additional charge with your HSP Gold policy.
The quality of care you need, in the convenience of your home. If you are feeling unwell you can receive convenient, quality care from a large network of health professionals 24 hours a day, 365 days a year, by web, by phone or mobile app. www.teledoc.com
Scriptsave allows you to locate the lowest discounted price for your medication. You can access to use the prescription savings card, or app, to receive instant savings on both brand name and generic prescription medication. Scriptsave WellRX is accepted at over 62,000 pharmacies. Our group number is 2242. www.scriptsave.com
Patience advocacy before, during and after a healthcare event. Members gain a resource and concierge-style service to help them navigate through the confusion often associated with the healthcare marketplace. This includes services such as finding providers and healthcare facilities, pricing for non-emergency surgeries, and a personal advocate to help lower the patient’s medical costs. www.thekarisgroup.com
Need Assistance?
Simply call us at 855-222-7033 and we can guide you and answer any questions.