PHILCARE HEALTHCARE COVERAGE
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1 PHILCARE HEALTHCARE COVERAGE 1. Special Modalities of Treatment Customer hotline : Special modalities of Treatment Officers (15 years and above in service) Other members Laparoscopic Cholecystectomy MBL limited to once per year P35,000 limited to one per contract year Lithotripsy MBL limited to once per year P30,000 limited to once per contract year Magnetic Resonance Imaging (MRI) MBL P5, Nuclear / Radioactive Isotope Scan MBL P5, Hysterescopic Myoma Resection MBL P20, Laparoscopic Adrenalectomy (Unilateral) MBL P75,000/00 or subject to maximum limit, whichever is lesser Laparoscopic Adrenalectomy (Bilateral) MBL P85, or subject to maximum limit, whichever is lesser Transnurethral Mircowave Therapy MBL limited to once per year P30,00.00 limited to once per year of Prost Hysterospically-guided D&C MBL P10,000 Percutaneous Ultrasonic Nephrolihotomy MBL limited to once per year P40, limited to once per contract year Ureterolithotripsy MBL limited to once per year P35,000 limited to once per contract year Stereotactic Brain Biopsy MBL P120, 000 or subject to maximum limit, whichever is lesser Cyrosurgery P1,000/area limited to once per contract year P1,000/area limited to once per contract year Sleep Study MBL P5, Neuroscan MBL P5, Sclerotherapy for varicose vein as MBL P5, prescribed by an affiliated physician Pelvic Laparoscopy (for MBL P25, endometriosis) All special modalities of treatment and/or diagnostic procedures for which there are no comparable conventional or traditional equivalent or counterparts P5, P5,000.00
2 2. Outpatient Benefits 2.1. Annual Physical Examination Taking of Medical History Physical Exam Chest X-ray Routine Urinalysis Routine Stool Exam CBC ECG for members 35 years old and above Pap smear for members 35 years old and above 2.2. Preventive Health Care Wellness program Immunization and allergy desensitization (cost of vaccines, allergens and determinations of susceptibility are not included) Health education and counseling on diet or exercise Periodic monitoring of health problems Family planning counseling 2.3. Out-Patient Services such as but not limited to: Consultation, including specialist s evaluation First aid treatment of injury or illness Necessary x-rays and laboratory examinations Eye, ear, nose and throat care Transfusion of blood and other blood elements except the cost of blood screening Pre-natal and post consultations at Philcare free standing clinics Dialysis, chemotherapy, physical therapy and similar treatment procedures except occupational therapy. 3. Hospitalization Benefits Plan Type Accredited Major Hospitals Exclusion Emerald Emerald w/ Makati Medical Center, The Medical City, St. Luke s Medical Center-QC and Cardinal Santos Medical Center St. Luke s Medical Center Global and Asian Hospital Diamond Makati Medical Center, The Medical Asian Hospital City, St. Luke s Medical Center-QC and Cardinal Santos Medical Center, St. Luke s Medical Center-Global ** Please refer to the booklet for the list of other affiliated / accredited hospitals / clinics
3 ** Refer to your card with regard to your Maximum Benefit Limit (MBL) and Room Accommodation 3.1. Services of physician including surgical services 3.2. Room and Board according to the type of room accommodation and subject to the maximum rate of daily room and board 3.3. General nursing service 3.4. Use of operation and recovery room 3.5. Drug and medication during confinement 3.6. Anesthesia and its administration 3.7. Confinement in ICU up to maximum limit 3.8. Other services deemed medically necessary (but not limited to: oxygen, dessing, lab tests, x-rays, etc.) 4. Emergency Benefits in affiliated hospital (may directly contact Philcare for queries) 5. Emergency Benefits in non-affiliated hospital (may directly contact Philcare for queries) 6. Accidental Death and Disablement Benefits P50, for principal member 7. Group Life Benefit P25, for principal member 8. Dental Benefits 8.1. Annual dental examinations and consultations 8.2. Emergency out-patient dental treatment to be availed at accredited dental clinics 8.3. Annual oral scaling and polishing (cleaning or prophylaxis), twice per year 8.4. Simple tooth extraction 8.5. Restorative and prosthodontics teeth 8.6. Simple adjustment of dentures 8.7. Recementation of loose crowns, inlays and onlays 8.8. Dental health education 8.9. Dental nutrition and dietary counseling Pre-natal check of gums and teeth Temporo mandibular joint consultation Gum treatment for cases like inflammation or bleeding
4 FREQUENTLY ASKED QUESTIONS: 1. Who are entitled to Philcare benefits? 1. Regular employees. 2. Contractual employees depending on the terms of the contract. Probationary employees are not entitled yet. 2. What are my HMO benefits? 3. What is the Maximum Benefit Limit? 4. Who are entitled to Dental Benefits 5. When will I receive my Member Card? 6. Where can I get the list of Affiliated Hospitals / Clinics? 7. How to schedule Annual Physical Examination (APE)? Please refer to the above-mentioned text. Please refer to your Philcare Member Card All Philcare-holders 1. HR will process the enrolment which will take approximately two (2) weeks from date of hire / regularization. 2. Once HR received the member cards delivered by Philcare, these cards will be distributed to employees. Upon receipt of your Member card, a yellow Member Guide (pamphlet) should have been handed to you. It contains lists of all accredited hospitals / clinics For regular employees : 1. Select your desired accredited hospitals/clinics from the pamphlet previously given to you. 2. Every start of the year, HR will ask you to her your preferred hospital / clinic for APE and your birth month. 3. The request will be forwarded by HR to Philcare. Endorsement letter will be given to you on or before your birth month. For contractual employees and those who are hired or regularized after February : 1. Select your desired accredited hospitals/clinics from the pamphlet previously given to you. 2. Call Philcare Customer Hotline at (02) to set an appointment seven (7) working days before your desired date of examination. This will give ample time for the customer support to forward your request to your preferred clinic / hospital. 3. You may do the follow-up three or four working days before the
5 date of your examination to ensure that your endorsement letter has already been forwarded to the clinic. 4. You may also request them to forward you a copy of the endorsement letter by asking them to send it through your personal or fax: (02) if you are assigned at Quadstar Building or directly to the available fax number where you are currently assigned if you are deployed at the client s site. 8. How will I get the result of my APE? 9. Who should I ask about dental benefits? 10. Where can I get a list of Affiliated Dental Hospitals / Clinics You have the option to have it picked up at the clinic where you underwent your examination or have it delivered to CPI Office. You will be asked by the Customer Service Representative. For pick-up, you may directly ask the attending clerk when it is available. For delivery, it will be sent by the clinic to Philcare head office then send to CPI. It usually takes about three (3) weeks. You may directly contact HB-Dental Network and not Philcare Customer Hotline. Telephone Number is The list of affiliated dental clinics is sent through your . It is in Excel file. 11. How will I schedule Appointment with the Dentist? 12. What is the procedure for Non-Emergency Cases (Check-up/ Consultations)? 1. Select your preferred accredited dental clinic from the excel file sent to you. 2. Call directly the dental clinic to set your appointment. 3. If asked what is your health card, mention that our provider is HB Dental Network (refer to the back of your member card). 4. You may be asked to contact HB Dental Network for endorsement. Here is the number : / Go to any Philcare-owned / affiliated clinics / hospital. 2. Present your Philcare member card. 3. Secure an LOA. 4. Present the LOA to the affiliated provider / section. Note : You do not need prior appointment for this. See your Member Guide (Pamphlet) page What is the procedure for Emergency Cases (Confinement)? See your Member Guide (Pamphlet) page 7
6 14. What is the procedure for Emergency Cases (Affiliated Clinics / Hospitals)? 15. What is the procedure for Emergency Cases (Non-Affiliated Clinics / Hospitals)? 16. What is the procedure for filing of reimbursement claims? 17. What will I do if I lost my member card? 18. When will my membership expire? 19. It is printed on my card that it is valid only until December 15, 20XX. Does this mean, I can no longer use my card on December 16 onwards? 20. Is it possible to enroll dependents at my own expense? See your Member Guide (Pamphlet) page 8-9 See your Member Guide (Pamphlet) page See your Member Guide (Pamphlet) page Secure Affidavit of Loss. 2. Submit it to HR. 3. P40.00 (as card replacement fee) will be deducted from your payroll. 4. New card will be delivered to the employee once we received the new one. If you resigned or separated from the company, dismembership will take effect on your last day. We discourage resigned employee from using Philcare benefits upon separation from the company. Any amount incurred out of your use will be directly charged to the employee. Member card should be surrendered immediately to HR. The company is on the process of renewal but you can still avail of the benefit even after December 15. New member card will be given to you once the renewal process is completed. No.
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HMO-1 Primary Care Physician Visits Office Hours After-Hours/Home Specialty Care Office Visits Diagnostic OP Lab/X Ray Testing (at facility) with PCP referral. Diagnostic OP Lab/X Ray Testing (at specialist)
National Guardian Life Insurance Company Maine College of Art Student Health Insurance Plan Coverage Period: 09/01/2015-08/31/2016
J3A59 National Guardian Life Insurance Company This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com
Petersen ACCIDENT ONLY MAJOR MEDICAL PLAN. Benefits Designed For. US Citizens and US Residents while in the USA. International Underwriters
Benefits Designed For US Citizens and US Residents while in the USA International Underwriters Petersen 23929 Valencia Boulevard, Second Floor Valencia, California 91355 Telephone (800) 345-8816 E-mail:
Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?
: VIVA HEALTH Access Plan Coverage Period: 01/01/2015 12/31/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document