SUMMARY OF HMO BENEFITS 2024
BDO STAFF EMPLOYEES
JANUARY 1 - DECEMBER 31, 2024
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 2024 easily accessible to you.
We are pleased to inform you of the enhancements for 2024 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 2024 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
Allhospitalsincluding6majorhospitals,exceptTMCCongressionaland TrinomaBranchesandallHealthwayClinics
COVID-19 OUT-PATIENT CARE
Anyreasonablenumberofconsultationsduringregularclinichours whetherFacetoFaceorin-clinicconsultationsorTeleconsult,excluding prescribedmedicines.Member'soptionifhe/sheoptstoconsultan accreditedspecialistforTELECONSULT.
MentalHealthconsultationswithaccreditedPsychiatrist (ValuCare's Teleconsult)
X-rays,Laboratoryexaminationsanddiagnosticproceduresprescribedby accreditedspecialists
Referralstoaffiliatedspecialists
Preandpost-natalconsultations(excludinglabexams)
Emergencyroomcare
ForSymptomaticPatients
RT-PCR(SWABTEST)forsymptomaticpatientswithprescription fromanInfectiousDiseaseSpecialistandfollowingDOHcriteria
NON-COVID-19 OUT-PATIENT CARE
Anyreasonablenumberofconsultationsduringregularclinichours whetherFacetoFaceorin-clinicconsultationsorTeleconsult,excluding prescribedmedicines.Member'soptionifhe/sheoptstoconsultan accreditedspecialist.
MentalHealthconsultationswithaccreditedPsychiatrist(ValuCare's Teleconsult)
Eye,Ear,NoseandThroatCare
Treatmentforminorinjuriessuchaslacerations,mildburns,sprains& strains,fractures,etc.excludingthecostofmedicines
X-rays,Laboratoryexaminationsanddiagnosticproceduresprescribedby accreditedspecialists
Referralstoaffiliatedspecialists
Minorsurgicalproceduresnotrequiringconfinement
PreandpostnatalconsultationsshallbecovereduptoMBL(excludinglab exams)
Emergencyroomcare
PhysicalTherapy(Coveredupto20sessions/yr.)
SpeechTherapy(forstrokepatientsonly,Coveredupto20sessions/yr)
COVID-19 IN-PATIENT CARE
MAXIMUM BENEFIT LIMIT
₱200,000/member/illness/year
PPEKit(CovereduptoPhp3,000.00)
Useofoperatingroomandrecoveryrooms
Professionalservicesofallattendingaccreditedspecialists
Drugs,medicinesandinjectables
Bloodtransfusionsandintravenousfluids
X-rays,Laboratoryexaminationsanddiagnostictestorderedbythe valucareattendingphysician
Dressings,plastercasts,suturesandotheritemsdirectlyrelatedtothe medicalmanagementofthepatient
Standardadmissionkitincludingicecap/weebag
ICUconfinement
Anesthesiaandmedications
Oxygenanditsadministration
Standardnursingservices
Ambulanceservice(CovereduptoPhp15,000.00/conduction,hospitalto hospital)
AllotherhospitalchargesdeemednecessarybyaccreditedPhysicianinthe treatmentofthepatient
RegularPrivate(Open)
ROOM AND BOARD
PREVENTIVE CARE
Immunization,excludingthecostofvaccinesandrelatedmaterials
Medicalmanagementofhealthproblems
Healtheducationandcounselingondietsandexercises
Familyplanningandcounseling
Recordkeepingofmedicalhistory
6Wellnesslecturesessions/year AnnualPhysicalExamination(APE)
PhysicalExamination
ChestX-ray
Fecalysis
Urinalysis
CompleteBloodCount
ECGoptional:formembersaged35yearsoldabove
PapSmearoptional:forfemalesaged35yearsoldabove
EMERGENCY CARE
InAccreditedHospitals:
Accrediteddoctor'sservices
Emergencyroomfees
Medicinesadministeredduringtreatmentorfor immediaterelief
Oxygenandintravenousfluids
Dressings,castsandsutures
Laboratorytests,x-raysanddiagnosticexaminations
directlyrelatedtotheERmanagementofthepatient Nebulization(includingcostofnebules)
Ambulanceservice(hospitaltohospitalcoveredupto Php15K/conduction)
InNon-AccreditedHospitals:
ReimbursementofactualhospitalbillsandProfessionalFeesbasedon HMOrates(100%HB&100%PFbasedonHMORVSuptoMBL
InForeignTerritories:
ReimbursementofactualhospitalbillsandProfessionalFeesbasedon HMOrates(100%HB&100%PFbasedonHMORVSuptoMBL)
InAreasWithoutAccreditedHospitals
ReimbursementofactualhospitalbillsandProfessionalFeesbasedon HMOrates(100%HB&100%PFbasedonHMORVSuptoMBL)
InvoluntaryRoomUpgrading-allowedtoupgradetothenexthigher pricedroomcategoryexceptsuiteroom(ERcasesleadingtoconfinement, coveredupto24hrs)
DIAGNOSTIC PROCEDURE
24HourHolterMonitor
2DEchowithDoppler
AdrenocorticalFunctionTest
Angiography(includingMRA)
Anti-nuclearAntibody,C-ReactiveProtein(rheumaticconditionsandits complications),LupusCellExam
ArterialBloodGas
Arthrocentesis
ArthroscopicProcedures(includingorthopedicarthroscopy)
AudiogramandTympanogram
BenignProstaticHyperthropy
BoneDensitometryScanorDexascan
BoneMineralDensityStudies
Brachytherapy
CardiacStressTest
CataractSurgey(exceptofcostoflens)
Chemotherapy/Radiotherapy
Cryosurgery
CTPulmonaryAngiography
CTScan
Dialysis
Electroencephalogram(EEG)Monitoring
Electromyography,NerveConductionVelocityStudies
EndoscopicProcedures(colonoscopy/gastroscopy)
EsophagealManometry
EyeLaserTherapy(forcataractextraction,retinaldetachmentand glaucoma,exceptforcorrectionoferrorofrefractionsuchasmyopia, astigmatismandhyperopia)
DIAGNOSTIC PROCEDURE
FluoresceinAngiogram
GammaKnifeSurgery(basedonCobalt/Radiotherapy)
HeartSurgery/Angioplasty/Angiogram(CoronaryArteryBypassGraft)
Hemorrhoidectomy(i.e.conventional/scalper/stapled)
Herniorrhaphy(AcquiredHernia)
HysteroscopicProcedures-HysteroscopicMyomaResection
HysteroscopicallyguidedD&C
ImpedancePlethysmography
InhalationTherapy
IntensityModulatedRadiationTherapy(IMRT)
LaparoscopicProcedures
LaryngealStroboscopy
LaserProstatectomy
Lithotripsy(ESWL)
LungFunctionStudies
MagneticResonanceImaging
MammographyandSonomammogram
Mammotome/Ultrasound-guidedMammotomeBiopsy
Myelogram
Neuroscan
NuclearRadioactiveIsotopeScan(NRIS)
PercutaneousUltrasonicNephrolithotomy
PhotodynamicTherapy
PlasmaUrinaryCortisol,PlasmaAldosterone
PulmonaryPerfusionScan
RadioisotopeScansandFunctionStudies
RadionuclideVentriculography
StereotacticBodyRadiotherapy(SBRT)
DIAGNOSTIC PROCEDURE
StereotacticBrainBiopsy
StereotacticBreastBiopsy
Thoracentesis
ThalliumScintigraphy
TransurethralMicrowaveTherapy(TUMT)ofProstate
TreadmillStressTest
Ultrasound(exceptpregnancyrelated)/diagnosticultrasounds;2Decho, DoplerandLungs
VideoGastroscopy
VolumetricArcModulatedTherapy(VAMT)
The following procedures are covered based on the limits specified, subject to MBL
Out-PatientPhysicalTherapy(maximumof20sessions)
RoboticSurgery-₱50,000.00)
SpeechTherapy(fornoncongenitaldisorders)(maximumof20sessions)
Sclerotherapy-₱10,000.00perleg
ADDITIONAL BENEFITS
PPEforIn-Patientonly-₱3,000.00perconfinement
Ambulanceservices-₱15,000.00perconduction
Anti-rabies/anti-venom(active&passive)-₱60,000.00
Cauterizationofwarts-₱2,500.00topermember/year,excludinggenital wartsandnotforaestheticpurposes
Allergytesting/screening-₱20,000.00
Tuberculintest-₱10,000.00
ScoliosisshallbecovereduptoMBLifpre-existingcondition;If congenital,coverageis₱65,000.00
MBLofenrolledmemberbeyond6monthsiscovered100%
Motorbike,scooter,bicycleaccidentsunderMotorVehicularAccidentis covereduptoMBLfrom"workandnon-workrelated".,Subjectto governmentregulations.
WithaccessinFortmedMedicalClinicsandTMCSatelliteClinicsexcept CongressionalandTrinomaBranches
Antitetanus-₱40,000.00
Congenitalillnesses(Coveredupto₱50,000.00/member/year,subjectto PECLimit)
PointofService(POS)-Coveredthroughreimbursement100%HB,100% PF,basedonValucarerate
Endocrineabnormalities,septicemianotrelatedtomaternity, epilepsyandseizuredisorderuptoMBL
Slippeddisc,spondylosisandspinalstenosis
Sportsrelatedinjuries(acquiredduringcompanysponsoredeventsshallbe covereduptoMBL/member/year)
Unprovoked/provokedassault(CoveredsubjecttosubmissionofPolice report
Work-relatedillnesses(Coveredupto₱50,000.00/member/year)
ADDITIONAL BENEFITS
Acquired(adult)hernia/congenitalhernia
MultipleSclerosis
Takehomemedicines(Medicationsthatwasdispensedduringhospital discharge)
Treatmentforaccidentsorinjuriesobtainedfromearthquakescoveredup to₱20,000/contractyr
Drugtesting&x-rayforsanitarypermit
Donorsexpenses
ChronicDermatosesandScabies(Covered,Consultationsonly)
IsolationCases(ifprescribedbyanValucareaccreditedDoctoranddeemed medicallynecessary)
DENTAL CARE
Anynumberofconsultationswithanaccrediteddentists
Treatmentofdentalrelatedpainexcludingcostof prescribedmedicines
SimpleOralProphylaxis(2xayear)
Simpletoothextractions,exceptsurgeryforimpactions
Gumtreatmentexcludingthecostofprescribedmedicines
Recementationofjacketcrown,inlaysandonlays
Treatmentoflesions,woundsandburns
Temporaryfillings
AnnualDentalExamination
Adjustmentofdentures
Reliefand/orprescriptionforacutedentalpain
Desensitizationofhypersensitiveteeth(CovereduptoTwo (2)teeth/year)
Orthodonticconsultation
Aestheticdentalconsultation
Lightcurefilling(Four(4)surfaces/fillings/year
TemporoMandibularJointconsultation(clickingofjaws)
PRE-EXISTING CONDITIONS
DefinitionofPre-ExistingConditions
Anillnessorinjuryisconsideredtobeinexistencepriortotheeffectivedateof themembercoverage.
AllEmployeesenrolled(coveredupto100%MBL/Illness/year)
PHILHEALTH
Employees
PhilhealthIntegrated
MATERNITY ALLOWANCE
FEMALEEMPLOYEESONLY
₱15,000-HomeDelivery,NormalDelivery,Miscarriage&abortion, Complicationsofpregnancy,suchastetanus,septicemia,eclampsia, hemorrhage
₱25,000-CaesarianDelivery
Laboratoryexamsshallbecoveredandshallformpartofthespecificlimits above.
OUT-PATIENT MEDICINE ALLOWANCE
₱1,000/Employee/Year
REIMBURSEMENT REQUIREMENTS
MATERNITYBENEFITS
Originalofficialreceipt
StatementofAccount
OperativeRecord
MarriageCertificate
BirthCertificateofChild
AuthorizationtoDeposit
CONFINEMENT
Originalofficialreceipt(Hospitalbill&ProfessionalFee)
StatementofAccount
ItemizedBreakdownofhospitalcharges
ClinicalAbstract
OperativeRecord(ifoperationwasdone)
PoliceReport(ifvehicularaccident)
AuthorizationtoDeposit
REIMBURSEMENT REQUIREMENTS
OUT-PATIENT(CONSULTS&LABPROCEDURES)
Originalofficialreceipts
MedicalCertificate
StatementofAccount
ItemizedBreakdownofcharges
Referralform
PoliceReport(ifvehicularaccident)
AuthorizationtoDeposit
OUT-PATIENTMEDICINE
Originalofficialreceipts
CopyofDoctor’sPrescription
AuthorizationtoDeposit
NOTE:
ClaimsforreimbursementmustbesubmittedorforwardedtoValucare HeadOfficewithinthirty(30)days.Failuretodososhallinvalidatethe claim.
·MaternityreimbursementmustbesubmittedtoVALUCAREHeadOffice withinonehundredtwenty(120)calendardaysafterthedischargefromthe hospital.Failuretodososhallinvalidatetheclaim.
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. 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
0917-1243039
0917-3231363
0917-3241363
MEDICAL CONCIERGE VIBER NUMBERS:
LANDLINE (02)5310-1818 powered by: