CORPORATE / GROUP

In-Patient Benefits

In case a Member suffers an ailment which requires hospital admission, he/she shall be entitled to the hospitalization benefits listed below.

In-Patient Care Benefits:

  • Room and Board Accommodation
  • Professional fees of attending physician/specialist
  • Standard Nursing Services
  • Use of operating room and recovery room, Intensive Care Unit (ICU), isolation room (if prescribed by the attending Affiliated Physician)
  • Medicines for in-patient use (prescribed by the attending physician)
  • Blood products,  transfusions and intravenous fluids, including blood screening and cross matching  if  the  member/ patient  is          the  recipient (excluding expenses for donor screening services)
  • X-Ray, laboratory examinations, routine diagnostic and therapeutic procedures incidental to confinement
  • Dressings, conventional casts (plaster of Paris) and sutures
  • Anesthesia and its administration
  • Oxygen and its administration
  • Standard Admission kit
  • All other items directly related in the medical management of the patient, as deemed medically necessary by the Attending Affiliated Physician

MEDICAL PROCEDURES
The following procedures are covered subject to the limit of the plan and the pre-existing conditions (PEC) if applicable:

  1. Routine Procedures
    • Complete Blood Count
    • Blood Chemistries
    • X-ray
    • Fecalysis
    • Urinalysis

  2. Immunologic and Special Laboratory Examinations
    • 24-hour protein determination
    • ANA (Anti-Nuclear Antibody) Profile
    • Glycosylated Hemoglobin
    • Hepatitis Profile
    • Prostate Specific Antigen (PSA)
    • SLE Test, FAT Widal Test, ASO Titer, Serum Ig-Ci, Alpha-Feto Protein, ESR
    • Thyroid Profile
    • TORCH Profile, e.g., Anti-Toxoplasma Gondi (IgM), Anti-Cytomegalo-Virus (Total Ig), Anti Rubella
    • Troponin
    • Urine/blood culture & sensitivity test
    • Allergy testing /allergy Screening and other related examinations
    • Tuberculin test

  3. Special Diagnostic Procedures
    • 3D Imaging
    • Breast Scintigraphy
    • Computed Tomography (CT) Scan / Computed Axial Tomography Scan(CAT) (All types)
    • Echocardiography (all types)
    • Electroencephalography
    • Electromyelography with Nerve Conduction Tests
    • Fluorescein Angiography or Angioscopy of Eye Total
    • Mammography and Sonomammogram
    • Stress Testing (All types)
    • Nuclear Imaging
    • Total Body Scan, Bone Scan, Renal Scan, Pulmonary Scan, Thallium Scan, Thyroid Scan, Parathyroid Scan
    • Ultrasonography (Chest, Abdominal, Thyroid, Renal, Breast, Pelvic or Trans-vaginal)
    • Magnetic Resonance Imaging (MRI) shall be covered up to P10,000

  4. Treatments
    • Physical Therapy and Occupational Therapy (except for scoliosis and developmental disorder) up to P25,000.00 per member per year
    • Lithotripsy  up to an accumulated limit of P35,000.00 per member per year
    • Dialysis
    • Radiotherapy
    • Chemotherapy

  5. Other Procedures
    • 1st  dose of anti-rabies, anti-venom and anti-tetanus vaccines up to P18,000.00
    • Other forms of Nuclear Medicine covered up to P35,000.00 per member per year
    • Laparoscopic Procedures covered up to P35,000.00 per member per year
    • Endoscopic Procedures
    • Arthroscopic Procedures
    • Other medically necessary diagnostic or therapeutic procedures not mentioned above and those for which there are no comparable, conventional or traditional counterparts are covered up to P10,000.00 per procedure per member per year

OTHER BENEFITS:

  • Involuntary room upgrade to the next higher room category (except for Suite room) is allowed in case of non-availability of member’s assigned room within the first 24 hours. After twenty-four (24) hours, the MEMBER must transfer to his/her designated room category, otherwise incremental charges shall be billed to the MEMBER from day one (1) confinement.
  • Motor Vehicle Accidents (subject to the exclusions and limitations clause) covered as charged subject to Plan Limits
  • Unprovoked Assault, including domestic violence, whether initiated by the Member or by a known or unknown third party - covered as charged subject to Plan Limits

 

Out-Patient Benefits

When by reason of any member’s illness or injury, not requiring hospital confinement, the following services are rendered to the member

Out-Patient Care Benefits:

  • Consultations and treatment prescribed by an affiliated physician or specialist
  • Pre and Post Natal consultations (excluding laboratory and diagnostic procedure related to pregnancy)
  • Eye, ear, nose and throat (EENT) treatment prescribe by an accredited  physician/specialist
  • Treatment for minor injuries and minor surgery except out-patient medicines
  • Dressings, conventional casts (plaster of Paris) and sutures
  • X-ray, laboratory examinations, routine diagnostic and therapeutic procedures prescribed by an accredited Physician/Specialist
  • Minor surgery not requiring confinement prescribed by an accredited Physician/Specialist

MEDICAL PROCEDURES
The following procedures are covered as prescribed by the HC&D’s accredited physician, subject to the limit of the plan and the pre-existing conditions (PEC) if applicable

  1. Routine Procedures
    • Complete Blood Count
    • Blood Chemistries
    • X-ray
    • Fecalysis
    • Urinalysis

  2. Immunologic and Special Laboratory Examinations
    • 24-hour protein determination
    • ANA (Anti-Nuclear Antibody) Profile
    • Glycosylated Hemoglobin
    • Hepatitis Profile
    • Prostate Specific Antigen (PSA)
    • SLE Test, FAT Widal Test, ASO Titer, Serum Ig-Ci, Alpha-Feto Protein, ESR
    • Thyroid Profile
    • TORCH Profile, e.g., Anti-Toxoplasma Gondi (IgM), Anti-Cytomegalo-Virus (Total Ig), Anti Rubella
    • Troponin
    • Urine/blood culture & sensitivity test
    • Allergy testing /allergy Screening and other related examinations
    • Tuberculin test

  3. Special Diagnostic Procedures
    • 3D Imaging
    • Breast Scintigraphy
    • Computed Tomography (CT) Scan / Computed Axial Tomography Scan(CAT) (All types)
    • Echocardiography (all types)
    • Electroencephalography
    • Electromyelography with Nerve Conduction Tests
    • Fluorescein Angiography or Angioscopy of Eye Total
    • Mammography and Sonomammogram
    • Stress Testing (All types)
    • Nuclear Imaging
    • Total Body Scan, Bone Scan, Renal Scan, Pulmonary Scan, Thallium Scan, Thyroid Scan, Parathyroid Scan
    • Ultrasonography (Chest, Abdominal, Thyroid, Renal, Breast, Pelvic or Trans-vaginal)
    • Magnetic Resonance Imaging (MRI) shall be covered up to P10,000

  4. Treatments
    • Cauterization of warts up to P2,000.00 per member per year neck down only except genital warts and condyloma acuminate (OP only) 
    • Botox which is not cosmetic in nature nor for beautification purpose up to an accumulated limit of P10,000.00 per member per year (OP only)
    • Sclerotherapy for deep varicose veins (except medicines and for cosmetic purposes) to be availed through accredited vascular surgeons up to an accumulated limit of P10,000.00 per member per year (OP only)
    • Speech Therapy (for stroke patients only) up to an accumulated limit of P10,000.00 per member per year (OP only)
    • Physical Therapy and Occupational Therapy (except for scoliosis and developmental disorder) up to accumulated limit of P25,000.00 per member per year
    • Eye laser therapy only for retinal tear, retinal hole, retinal detachment and glaucoma up to an accumulated limit of P25,000.00 per member per year (except eye correction such Lasik, PRK and the like)
    • Cataract extraction shall be covered up to Plan Limit (excluding cost of lens)
    • Lithotripsy  up to an accumulated limit of P35,000.00 per member per year
    • Dialysis
    • Radiotherapy
    • Chemotherapy

  5. Other Procedures
    • 1st  dose of anti-rabies, anti-venom and anti-tetanus vaccines up to P18,000.00
    • Other forms of Nuclear Medicine covered up to P35,000.00 per member per year
    • Laparoscopic Procedures covered up to P35,000.00 per member per year
    • Endoscopic Procedures
    • Arthroscopic Procedures

Other medically necessary diagnostic or therapeutic procedures not mentioned above and those for which there are no comparable, conventional or traditional counterparts are covered up to P10,000.00 per procedure per member per year

 

Emergency Care Benefits

If the emergency care treatment will be provided to the Member, he shall be entitled to the benefits listed below

Emergency Care Benefits:

  • Doctor's services
  • Emergency room fees
  • Medicines used for immediate relief during treatment (excluding prescribed out patient medicines)
  • Oxygen, intravenous fluids and blood products
  • Dressings, conventional casts (plaster of Paris) and sutures
  • X-ray, laboratory, and diagnostic examinations, and other medical services related to the emergency treatment of the patient.
  • Ambulance Service up to P2,500.00 per member per year if medically necessary from hospital to hospital on a reimbursement basis

IN NON-ACCREDITED HOSPITALS
Reimbursable up to 80% of hospital bills & professional fees based on HMO rates up to P15,000.00 per member per case.


OUTSIDE THE PHILIPPINES
Reimbursable up to 100% of hospital bills & professional fees based on HMO rates up to P15,000.00 per member per case. (at prevailing exchange rates)


AREAS WITHOUT ACCREDITED HOSPITAL
Reimbursable up to 100% of hospital bills & professional fees based on HMO rates up to the plan limit.


INVOLUNTARY ROOM UPGRADE (IF EMERGENCY CASE LEADS TO CONFINEMENT)
Involuntary room upgrade to the next higher room category (except for Suite room) is allowed in case of non-availability of member’s assigned room within the first 24 hours. After twenty-four (24) hours, the MEMBER must transfer to his/her designated room category, otherwise incremental charges shall be billed to the MEMBER from day two (2) of confinement onwards.