STAFFSOB 2023

SUMMARY OF HMO BENEFITS 2023 BDO STAFF EMPLOYEES JANUARY 1 - DECEMBER 31, 2023

1

Dear Valued BDOEA-ALU Members, Greetings of good health!

This e- brochure was designed to make the summary of the details of the HMO benefits for 2023 easily accessible to you.

PREMIUM BASED PROGRAM

We are pleased to inform you of the enhancements for 2023 for both employees’ and dependents’ coverage under Valucare.

Your BDOEA-ALU Medical Concierge , exclusive for the BDOEA Members/ dependents, will continue to assist you on your healthcare needs. The contact numbers are herein presented for your convenience.

Stay healthy in 2023 and beyond.

Sincerely yours, Nestor P. Perez President BDOEA-ALU Riza S. Gargallo Executive Vice President BDOEA-ALU Chairperson- Welfare Committee

2

HOSPITAL BASED HMO PLAN Access to accredited hospitals/clinics All hospitals including 6 major hospitals, except TMC Congressional and Trinoma Branches and all Healthway Clinics

PREMIUM BASED PROGRAM

COVID-19 OUT-PATIENT CARE Any reasonable number of consultations during regular clinic hours whether Face to Face or in-clinic consultations or Teleconsult ,excluding prescribed medicines . Member's option if he/she opts to consult an accredited specialist for TELECONSULT. Mental Health consultations with accredited Psychiatrist (ValuCare's Teleconsult) X-rays, Laboratory examinations and diagnostic procedures prescribed by accredited specialists Referrals to affiliated specialists Pre and post-natal consultations (excluding lab exams ) Emergency room care For Symptomatic Patients : RT-PCR (SWAB TEST) for symptomatic patients with prescription from an Infectious Disease Specialist and following DOH criteria

3

NON-COVID-19 OUT-PATIENT CARE Any reasonable number of consultations during regular clinic hours whether Face to Face or in-clinic consultations or Teleconsult ,excluding prescribed medicines . Member's option if he/she opts to consult an accredited specialist.

Mental Health consultations with accredited Psychiatrist (ValuCare's Teleconsult) Eye, Ear, Nose and Throat Care Treatment for minor injuries such as lacerations, mild burns, sprains & strains, fractures, etc. excluding the cost of medicines X-rays, Laboratory examinations and diagnostic procedures prescribed by accredited specialists Referrals to affiliated specialists Minor surgical procedures not requiring confinement Pre and post natal consultations shall be covered up to MBL (excluding lab exams) Emergency room care Physical Therapy (Covered up to 20 sessions/yr.)

Speech Therapy (for stroke patients only, Covered up to 20 sessions/yr)

4

COVID-19/NON-COVID IN-PATIENT CARE COVID/NON-COVID-19 IN-PATIENT CARE SERVICES ROOM & BOARD MBL Regular Private (open)

Php 200,000.00 MBL / Member / Illness / year

PPE Kit (Covered up to Php 3,000.00) Use of operating room and recovery rooms Professional services of all attending accredited specialists Drugs, medicines and injectables Blood transfusions and intravenous fluids X-rays, Laboratory examinations and diagnostic test ordered by the valucare attending physician Dressings, plaster casts, sutures and other items directly related to the medical management of the patient Standard admission kit including ice cap/wee bag ICU confinement Anesthesia and medications Oxygen and its administration Standard nursing services Ambulance service (Covered up to Php 15,000.00 / conduction, hospital to hospital) All other hospital charges deemed necessary by accredited Physician in the treatment of the patient

5

PREVENTIVE CARE Immunization, excluding the cost of vaccines and related materials Medical management of health problems Health education and counseling on diets and exercises Family planning and counseling Record keeping of medical history 6 Wellness lecture sessions/year Annual Physical Examination (APE) Physical Examination Chest X-ray Fecalysis Urinalysis Complete Blood Count ECG optional: for members aged 35 years old above Pap Smear optional: for females aged 35 years old above

6

COVID-19/NON-COVID EMERGENCY CARE In Accredited Hospitals: IN-PATIENT CARE SERVICES

7

Accredited doctor's services Emergency room fees Medicines administered during treatment or for immediate relief Oxygen and intravenous fluids Dressings, casts and sutures Laboratory tests, x-rays and diagnostic examinations directly related to the ER management of the patient Nebulization (including cost of nebules) Ambulance service (hospital to hospital covered up to Php 15K/conduction) In Non-Accredited Hospitals: Reimbursement of actual hospital bills and Professional Fees based on HMO rates (100% HB & 100% PF based on HMO RVS up to MBL In Foreign Territories: Reimbursement of actual hospital bills and Professional Fees based on HMO rates (100% HB & 100% PF based on HMO RVS up to MBL) In Areas Without Accredited Hospitals Reimbursement of actual hospital bills and Professional Fees based on HMO rates (100% HB & 100% PF based on HMO RVS up to MBL) Involuntary Room Upgrading-allowed to upgrade to the next higher priced room category except suite room (ER cases leading to confinement, covered up to 24hrs)

Enhancements in HMO Benefits 2023

8

Maximum Benefit Limit from Php 175,000.00 to Php 200,000.00 PPE for In-Patient only is covered from Php 2,500.00 to Php 3,000.00 per confinement Ambulance services are covered from Php 10,000.00 to Php 15,000.00 per conduction Sclerotherapy is covered from Php 5,000.00 to Php 10,000.00 per leg/year Anti-rabies / anti-venom (active & passive) are covered from Php 50,000.00 to Php 60,000.00 Cauterization of warts is covered from Php 1,500.00 to Php 2,500.00 per member/year, excluding genital warts and not for aesthetic purposes Allergy testing/screening is covered from Php 15,000.00 to Php 20,000.00 Tuberculin test is covered from Php 10,000.00 reimbursement basis to outright coverage Scoliosis shall be covered up to MBL if pre-existing condition; If congenital, coverage is from Php 50,000.00 to Php 65,000.00 Laser Prostatectomy is covered up to MBL MBL of enrolled member beyond 6 months is covered from pro-rated to 100% Motorbike, scooter, bicycle accidents under Motor Vehicular Accident is covered up to MBL from "going to and from work" to "work and non-work related"., Subject to government regulations.

With access in Fortmed Medical Clinics and TMC Satellite Clinics except Congressional and Trinoma Branches

ADDITIONAL BENEFITS

9

Anti tetanus (Covered up to Php 40,000.00 /member/year) Eye laser therapy for cataract extraction, retinal detachment and glaucoma except for correction of error of refraction Congenital illnesses (Covered up to Php 50,000.00/member/year, subejct to PEC Limit) Point of Service (POS) - Covered through reimbursement 100% HB, 100% PF, based on Valucare rate Endocrine abnormalities, septicemia not related to maternity, epilepsy and seizure disorder up to MBL Slipped disc, spondylosis and spinal stenosis Sports related injuries (acquired during company sponsored events shall be covered up to MBL/member/year) Unprovoked/provoked assault (Covered subject to submission of Police report Work-related illnesses (Covered up to Php 50,000.00/member/year) Acquired (adult) hernia/congenital hernia Multiple Sclerosis Take home medicines (Medications that was dispensed during hospital discharge) Treatment for accidents or injuries obtained from earthquakes covered up to Php 20,000/contract yr Drug testing & x-ray for sanitary permit Donors expenses Chronic Dermatoses and Scabies (Covered, Consultations only) Isolation Cases (if prescribed by an Valucare accredited Doctor and deemed medically necessary)

DENTAL CARE Any number of consultations with an accredited dentists Treatment of dental related pain excluding cost of prescribed medicines Simple Oral Prophylaxis (2x a year) Simple tooth extractions, except surgery for impactions Gum treatment excluding the cost of prescribed medicines Recementation of jacket crown, inlays and onlays Treatment of lesions, wounds and burns Temporary fillings Annual Dental Examination Adjustment of dentures Relief and/or prescription for acute dental pain Desensitization of hypersensitive teeth (Covered up to Two (2) teeth/year) Orthodontic consultation Aesthetic dental consultation Light cure filling (Four (4) surfaces / fillings/year Temporo Mandibular Joint consultation (clicking of jaws)

10

PRE-EXISTING CONDITIONS (PEC) Definition of Pre-Existing Conditions An illness or injury is considered to be in existence prior to the effective date of the member coverage.

All Employees enrolled (covered up to 100% MBL/Illness/year)

PHILHEALTH Employees Philhealth Integrated

MATERNITY ALLOWANCE FEMALE EMPLOYEES ONLY P15,000 - Home Delivery, Normal Delivery, Miscarriage & abortion, Complications of pregnancy, such as tetanus, septicemia, eclampsia, hemorrhage P25,000 - Caesarian Delivery Laboratory exams shall be covered and shall form part of the specific limits above.

OUT-PATIENT MEDICINES ALLOWANCE P1,000 /Employee/Year

11

REIMBURSEMENT REQUIREMENTS MATERNITY BENEFITS Original official receipt Statement of Account Operative Record Marriage Certificate Birth Certificate of Child Authorization to Deposit CONFINEMENT Original official receipt (Hospital bill & Professional Fee) Statement of Account Itemized Breakdown of hospital charges Clinical Abstract Operative Record (if operation was done) Police Report (if vehicular accident) Authorization to Deposit

12

REIMBURSEMENT REQUIREMENTS OUT-PATIENT (CONSULTS & LAB PROCEDURES) Original official receipts Medical Certificate Statement of Account Itemized Breakdown of charges Referral form Police Report (if vehicular accident) Authorization to Deposit OUT-PATIENT MEDICINE Original official receipts Copy of Doctor’s Prescription Authorization to Deposit NOTE:: Claims for reimbursement must be submitted or forwarded to Valucare Head Office within thirty (30) days. Failure to do so shall invalidate the claim. ·Maternity reimbursement must be submitted to VALUCARE Head Office within one hundred twenty (120) calendar days after the discharge from the hospital. Failure to do so shall invalidate the claim.

13

REIMBURSEMENT REQUIREMENTS Where to send the Reimbursement Documents: 1. c/o Ms. Kristine Dela Rosa Valucare CSR VALUCARE-BDO CLINIC (MAKATI) BDO SHELL TOWER 156 Valero Street, Salcedo Villagem Makati City Tel. No. (02)8840-7000 loc. 51885 2. VALUECARE HEALTH SYSTEMS INC. Claims Administration Department VALUCARE Building #33 San Antonio, Pasig City 3. C/o Ms. Tiffannie Tan Ancheta & Ms. Vivian Chua Elano Valucare CSR VALUCARE-BDO CLINIC (CCO-ORTIGAS) BDO Corporate Center (Ortigas) 10th Floor, BDO Corporate Center #12 ADB Avenue, Ortigas Center, Pasig City Tel. NO. (02) 8702-6000 loc 44500

14

MEDICAL CONCIERGE Viber Nos: 0917-6382393 0917-8315289 0917-1243039 0917-3241363 0917-3231364 Landline (02)5310-1818 powered by:

15