STAFFSOB 2023

BDO STAFF EMPLOYEES

JANUARY 1 - DECEMBER 31, 2023

Dear Valued BDOEA-ALU Members,

Greetings of good health!

PREMIUM BASED PROGRAM

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

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

HOSPITAL BASED HMO PLAN

Access to accredited hospitals/clinics

PREMIUM BASED PROGRAM

All hospitals including 6 major hospitals, except TMC Congressional and Trinoma Branches and all Healthway Clinics

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

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)

COVID/NON-COVID-19 IN-PATIENT CARE

IN-PATIENT CARE SERVICES

ROOM & BOARD MBL

Regular Private (open)

Php 200,000.00 MBL / Member / Illness / year

PPE Kit (Covered up to Php 3,00000)

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 15,00000 / conduction, hospital to hospital)

All other hospital charges deemed necessary by accredited Physician in the treatment of the patient

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

EMERGENCY CARE

In Accredited Hospitals:

IN-PATIENT CARE SERVICES

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

Maximum Benefit Limit from Php 175,00000 to Php 200,00000

PPE for In-Patient only is covered from Php 2,50000 to Php 3,00000 per confinement

Ambulance services are covered from Php 10,00000 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 50,00000 to Php 60,00000

Cauterization of warts is covered from Php 1,50000 to Php 2,50000 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 10,00000 reimbursement basis to outright coverage

Scoliosis shall be covered up to MBL if pre-existing condition; If congenital, coverage is from Php 50,00000 to Php 65,00000

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

Anti tetanus (Covered up to Php 40,00000 /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

50,00000/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)

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

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

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

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