HEWSPECS-PIDS Baseline
Study on Private
b. c.
Hospitalization Reimbursement days confined.
C.
PROFILE
There occupation, 764.
D.
OF are age,
SERVICE
of
HeaLth Insurance
Page 157
in accredited private hospital; and hospitalization expenses subject to
limits
based
on
number
of
MEMBERS no available sex, marital
UTILIZATION
data status,
PATTERN,
on covered employees in 1991, nor etc. The number of covered employees
data about in 1992 was
BY MEMBERS
NO data were available on the services used by members. However, information on the leading causes of hospitalization listed the following: i) Pharyngitis, 2) Bronchitis, 3) Upper respiratory tract infection, 4) Urinary tract infection, and 5) T.B. The average length of confinement per member is 3-5 days. The shortest is 2 days and the longest is 8 days.
E.
MANAGEMENT I.
for and
AND
_arketinq
OPERATING and
Employees covered at least a year with have undergone drug 2.
b. c. d.
a. b. c.
Recruitment
by the health benefits are all union the company, have passed the physical test, all of which are pre-employment
Senefits/Availment/Claims
Procedures a.
SYSTEM
for
extending
members who have worked and medical examination requirements.
Processinq
health
benefits
to
employees
include:
claiming reimbursement of accident/hospitalization expenses from the company on behalf of the employees; direct services from company clinic and accredited health providers; reimbursement of medical expenses corresponding to cash equivalent confined up to maximum of PI,000 per employee per illness; and salary deduction of expenses shouldered by employer. Processing
of
claims
submission review and release of
of required approval of payment
Processing
of
claims
include
the
following
insurance
of
days
procedures:
documents; claims; and,
requires
the
submission
of
:
a. b. c. d.
clearance or endorsement from respective department head; hospital bill/statem_nt of account; medical certificate if not hospitalized; and, insurance processing form, if claiming from insurance company.
service benefit average
All claims submitted are subjected to a medical review for appropriateness provided done by the doctor or nurse; financial review for application ceilings; and, an accounting review of receipts, bills, vouchers, etc. time to process claims and effect payment is from 2 weeks to 1 month.
of of The