BENEFITS 2023
STAFF
JANUARY
- DECEMBER 31, 2023 1
SUMMARY OF HMO
BDO
DEPENDENTS
1
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 RT-PCR (SWAB TEST) for symptomatic patients with prescription from an Infectious Disease Specialist and following DOH criteria For Symptomatic Patients : PREMIUM BASED PROGRAM No access in all major hospitals except for St Luke's Global/Quezon City, Cardinal Santos Medical Center, TMC Clark & TMC Iloilo With access in TMC Satellite Clinics Except TMC Congressional & Trinoma Branches; No access in all Fortmed Medical Clinics and Healthway Medical Clinics Access to accredited hospitals Access to accredited clinics HOSPITAL BASED HMO PLAN 2
COVID-19/NON-COVID
CARE SERVICES 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 Consultations 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 (excluding lab exams) Emergency room care Physical Therapy (Covered up to 15 sessions/yr) Speech Therapy (for stroke patients only, Covered up to 15 sessions/yr) NON-COVID-19 OUT-PATIENT CARE 3
IN-PATIENT
COVID-19/NON-COVID IN-PATIENT CARE SERVICES 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 other diagnostic examinations Dressings, plaster casts, sutures and other items directly related to the medical management of the patient Admission kit including ice cap/wee bag ICU confinement Anesthesia and medications Oxygen and its administration Standard nursing services All other hospital charges deemed necessary by accredited Physician in the treatment of the patient ROOM & BOARD MBL Semi Private or up to Php 1,90000 / Day Php 175,000.00 MBL / Member / Illness / year COVID/NON-COVID-19 IN-PATIENT CARE 4
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 Annual Physical Examination (APE) Physical Examination Chest X-ray Medical History Visual Acuity Fecalysis Urinalysis Complete Blood Count ECG optional: for members aged 35 years old above Pap Smear optional: for females aged 35 years old above 5
COVID-19/NON-COVID IN-PATIENT CARE SERVICES In Accredited Hospitals: 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 15,000.00/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) EMERGENCY CARE 6
COVID-19/NON-COVID IN-PATIENT CARE SERVICES Maximum Benefit Limit from Php 165,00000 to Php 175,00000 Room and board accommodation: from Semi-Private or Php 1,80000/day to Semi-Private or Php 1,90000/day PPE for In-Patient only is covered from Php 2,50000 to Php 3,000.00 per confinement Ambulance services are covered from Php 10,000.00 to Php 15,00000 per conduction Anti-rabies / anti-venom are covered from Php 20,00000 (Active only) to Php 30,00000 (Active and Passive) vaccine Scoliosis is covered from Php 50,00000 to Php 60,00000 Tuberculin test is covered up to Php 5,00000 outright coverage Laser Prostatectomy is covered up to Php 65,,000.00/member/yr MBL of enrolled dependents beyond 6 months is covered from pro-rated 50% 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". With access to TMC Satellite clinics except Congressional and Trinom Branches Enhancements in HMO Benefits 2023 7
Anti tetanus (Covered up to Php 20,00000) Congenital illnesses (Covered up to Php 40,00000/member/year) Slipped disc, spondylosis and spinal stenosis Epilepsy and Seizure Disorder (Covered up to Php 50,000.00/member/year) Endocrine abnormalities, septicemia not related to maternity,epilepsy and seizure disorder Chronic Dermatoses and Scabies Consultations Involuntary Room Upgrading-allowed to upgrade to the next higher priced room category except suite room Covered within 24 hours (Except Suite Room) Sports related injuries (non-company sponsored, subject to general exclusions and limitations of the contract) Unprovoked/provoked assault Isolation Cases (if prescribed by an HMO accredited doctor and deemed medically necessary) Multiple Sclerosis ADDITIONAL BENEFITS 8
COVID-19/NON-COVID IN-PATIENT CARE SERVICES 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 Emergency desensitization of hypersensitive teeh Orthodontic consultation Aesthetic dental consultation Permanent Light cure filling (Four (4) surfaces / fillings/year Temporo Mandibular Joint consultation (clicking of jaws) DENTAL CARE 9
COVID-19/NON-COVID IN-PATIENT CARE SERVICES FOR FIRST DEPENDENTS: All Existing Enrolled Dependents / All Newly Enrolled 6 months and above (Covered up to MBL) All newly enrolled below 6 months (Covered up to 50% of MBL) FOR 2ND, 3RD ET AL DEPENDENTS: All Existing Enrolled Dependents (Covered up to MBL) All Newly Enrolled (Covered up to 50% of MBL) Definition of Pre-Existing Conditions An illness or injury is considered to be in existence prior to the effective date of the member coverage PRE-EXISTING CONDITIONS (PEC) Dependents Philhealth Integrated PHILHEALTH 10
MEDICAL CONCIERGE Viber Nos: 0917-6382393 0917-8315289 0917-1243039 0917-3241363 0917-3231364 Landline (02)5310-1818 powered by: 11