Documente Academic
Documente Profesional
Documente Cultură
(PhilGASEA)
COA Compound, Commonwealth Avenue, Quezon City
Website: http://coaw2k3ws01/philgasea/
Email add - philgasea@yahoo.com.ph / Tel. No. - 9328184
SINCE 1990
GEORGE S. TAMAYO
Dear Asst. Commissioner Sy:
Auditor
Good Day!
SHARON C. CONTARCIEGO
R.R.O.
In line with PhiIGASEA's commitment for the wellness of its members, the
Association is now offering one of its new projects, a corporate account health
BOARD OF DIRECTORS:
card to be provided by MediCard. It will cater to all our members' needs
nationwide at a very affordable price being under a Corporate Account.
ATT{. RICHARD C. FULLEROS
Chairperson
The main/salient features of the said Health card are as follows:
RACHEL M. ABENDANIO
Vice Chairperson 1. Hospitalization Confinement
2. Out-Patient Care
Members:
3. Preventive Health Care
4. Emergency Care
ENGR. LAURENCE T. TATO 5. Members' Financial Assistance
6. Dental Health Care
MARY GRACE G. SERENIO
7. Emergency Assistance and Response Service (EARS) hotlines
JAZMIN C. MACABANGON which is available 24 hours a day, 365 days a year
8. Services are also available in FOREIGN COUNTRIES
ATTY. REYNALDO C. DARANG
9. Additional Benefits such as Open Heart Surgery within the
Am. FABIAN K. DELOS SANTOS, HI Dreaded Disease Limit (DDL except cost of pacemaker); Organ
ATTY. JEREMY H. GARIANDO
Transplant within the DDL, except cost of organ and donor's
expense
DR. KARLO A. CAYETANO 10.Executive Check-up
11.And other benefits
ATTY. ROCHELLE C. LANCANAN
MediCard has offered the following initial plans/packages exclusively for
PhilGASEA members and COA employees:
With AHMC, MMC, SLMC (QC), TMC, and CSMC, but without SLMC-
Global City
For further inquiries, please visit or call the PhilGASEA office at 9328184.
Attached herewith are the enrollment forms and a copy of the complete
proposal from MediCard.
Copy Furnished:
Single . Parent up to age 65, unemployed and dependent on the principal member
Siblings 30 days up to 21 years of age who are not gainfully employed, unmarried and are living under the
same roof as the principal member
, . .
Single Parent Child 30 days and up to 21 years of age whom are not gainfully emplOyed, unmarried and are living under the
same roof as the princijal member
Note:
The choice of enrolling dependents must follow a hierarchy. This means that the spouskfirst must be enrolled followed by the eldest child,
second child and so on for married personnel. Under single employees, the parents must be enrolled first followed by eldest brother/sister
and s'o on.
There shall be no cancellation of dependent enrollment within the contract year while the Principal member is still actively enrolled.
Over aged enrollees from 66 to 70 years old shall be accommodated with an additional 100% load on premium.
...
Will apply PHILHEALTH?
Relation to
(applicable for Non-Philhealth
Date of Birth Employee
Room Plan members, ex. Parents below 60
Last Name First Name M.I. Gende (MM-DD- Civil Status (ex. Mother,
and Limit y.o.) If yes, with additional P 2700
YYYY) daughter, brother,
in premium rates
etc.)
YES/NO
4 1;.
. .
E ......... L -
III
WAIVER
, on my behalf, and on behalf of my dependent/s, hereby consent to the
disclosure by MediCard and its representatives of any or all of my and my dependent/s' medical utilization/diagnosis to my
COMPANY, its officers, directors, employees, and/or other authorized agents/representatives, which may result in the course of
providing their medical services to me or my dependent/s, as PATIENT. 1 understand. that any information which they may
acquire and/or receive relating to the said utilization/diagnosis will no longer be covered by confidential/privileged
communication upon execution of this waiver:1-hus, I, on my behalf, and on behalf of my dependent/s, hereby waive any claim
of confidential/privileged communication against MediCard, its officers, directors, employees, and/or other authorized
agents/representatives, its Medical Service Units/Teams and its Accredited Hospitals/Clinics, and hereby release them from any
liability which may arise as an incident of the said disclosure to my COMPANY.
We are pleased to submit our offer for the Comprehensive Health Care Package
of your valued officers, employees and
their dependents.
The main feature of the program includes services and benefits for:
Hospitalization Confinement or In-patient Members' Financial Assistance
Out-patient Care Dental Health Care
Preventive Health Care
Emergency Care
Aside from being known in the industry for flexibility and quality services, may we present the following advantages your
company will benefit if and when you wit give us the opportunity to administer your health care program:
1. MediCard is a pioneer in the HMO industry established in 1987.
It is also one of the six founding members of the
Association of Health Maintenance Organizations of the Philippines, Inc. (AHMOPI).
2. MediCard is the only HMO being rein and operated by doctors.
3. MediCard is the only HMO awarded with the ISO 9001: 2008 Certification
in the Philippines and in Asia.
4. MediCard is the largest HMO in the Philippines in terms of membership base totaling to more than 500,000, a very
significant factor to support claims.
5. Our hospital-based system or open-door policy, in contrast to clinic-based and designated hospital,
enables
members to avail of hospitalization and out-patient services in any of our more than 1,000 accredited
hospitals/clinics backed-up by 40,000 doctors & specialists nationwide that is most convenient and accessible to
them. Leading the list are Asian Hospital and Medical Center, Makati Medical Center, St. Luke's Medical Center,
The Medical City and Cardinal Santos Medical Center.
6. MediCard has a team of well-trained liaison officers who assist members during confinement and before discharge.
7. MediCard has Emergency Assistance and Response Service (EARS) Hotlines-available 24 hrs. a day, 365 days a
year.
8. Savings on administrative time and costs compared to the insurance/self-administered type of medical coverage.
You can now channel your administrative's time and efforts to other more productive areas. NO MORE TEDIOUS
DOCUMENTATION PROCEDURES. It is almost trouble-free.
9. Since our professional fees are based on HMO-industry standards, it will take longer for members to maximize the
limitations of their benefits. Unlike other HMOs, our maximum limit for the dreaded disease is on a per illness per year
basis and not on an aggregate, lifetime or entire membership limit,
10. MediCard is known for the quality services we have been extending to our clients for the past years as proven by our
renewal persistency rate of 88%. Some of our more than 2,300 corporate clientele are 24/7 Customer Philippines,
Inc., Citibank, N.A., CTBC Bank (Philippines) Corp., GMA Network Group of Companies, KGB Phils., Inc. (formerly
INFONXX), Toyota Motor Phils., Phil. Daily Inquirer, Philippine Star Daily, Kodak Phils. Ltd., Landbank of the Phils., etc.
We hope that you will find our proposal convincing and that the package meets your requirements. Should you need
further clarification, please call the undersigned. Thank you for allowing us the opportunity to present our offer. We look
forward to the pleasure of servicing the health care needs of the officers, employees and the dependents of PHILIPPINE
GOVERNMENT AUDIT SERVICE EMPLOYEES ASSOCIATION (PHILGASEA- COA).
Administered medicines
Covered within DDL
ICU confinements
Covered within DDL
. . -^ '
..1
Chemotherapy, Radiotherapy & Dialysis 12 sessions within DDL
Brachytherapy
12 sessions within DDL
PT / Speech Therapy
. Up to 12 sessions within DDL
Allergy Testing
up to P2,500
MRI / MRA
Covered within DDL
CT scan
Covered within DDL
Ultrasound
Covered within DDL
Serum chemistry panels (eg. Chem 23, Spec M, etc.) Covered within DDL
Angiography (e.g. Coronary, cerebral, retinal, pulmonary,
GI, etc.) Covered within DDL
Myelogram
Covered within DDL
Diagnostic Arthroscopy
Covered within DDL
____________
Diagnostic Hysteroscopy
Covered within DDL
Plasma/Unnary Cortisol, Plasma Aldosterone,
Adrenocortical Function, etc. Covered within DDL
Genetic studies
Covered within DDL
Robotic Surgery
Covered within DDL
- .
Endovenous Laser Therapy (except for cosmetic
purposes) Covered within DDL
Stapled Hemorrhoidectomy
Covered within DDL
Photodynamic Therapy
Covered within DDL
Pap Smear Under APE; For women age 35 and above, or if prescribed
Once a year APE shall be conducted at any Medicard Stand Alone Clinics or at the COMPANY premises
through a Medicard Mobile Medical Team on a scheduled basis for a minimum of 50 principal members. For
provincial-based accounts, APE may be conducted at designated hospitals with prior coordination.
1,7175Fgx
Doctor's services
Covered within DDL
Medicines used during treatment or for immediate relief Covered within DDL
4-
Oxygen and intravenous fluids Covered within DDL
Laboratory, x-ray and other diagnostic examinations Covered within DDL; directlyCreoivaete emergency management of the
In Non-Accredited Hospitals
For emergency medical services in non-participating hospitals and clinics, members must advance payment
and later file reimbursement from MediCard. Reimbursement shall be based on the table below:
Hospital Bills
In Foreign Countries
For emergency medical services in foreign territories, members must advance payment and later file
reimbursement from MediCard based on MediCard Relative Value and Philippine Currency. Reimbursement
shall be based on the table below:
T
Hospital Bills
4:6 0**
Natural Death P 10,000
f-
Accidental Death P 20,000
Provided, that the death or injury results from causes that are covered and are not under the exclusions or
uncovered pre-existing condifions as stated in the MediCard Membership Contract.
Also, total annual premium for the contract year should have been paid at the time of availment. Otherwise,
all remaining unpaid premium will be deducted from the amount of assistance.
Tooth extractions Limited to simple tooth extraction; excluding surgery for impacted or ankylosed
_ tooth, etc.
Temporary fillings
Covered
Permanent amalgam and/or Light cure filling Up to two (2) teeth per member per year
Adjustment of dentures
Covered
G. Additional Benefits
Organ transplant i within DDL excluding cost of organ and donor's expense
,--.^..--^,-Try ^
Experience refund benefit Computation of the EXPERIENCE DISCOUNT shall be according to the
following formula:
The refund will be computed three (3) months after the contract is
renewed.
The COMPANY shall be entitled to a refund on membership fees except when
the reason for pre-termination is the fault of the COMPANY. The followingshall
be the schedule of refund:
1.General Surgeon
2. Obstetrician Gynecologist
3. Pediatrician
4. Family Medicine
5. General Practitioner
Free consultations at MediCard owned clinics 6. General Internist
Above consult will not be charged to the member's Maximum Benefit Limit.
Members can also avail of the free consultations even for conditions which are
classified under general exclusions or pre-existing conditions which are not
covered.
Applying is simple too. Just fill out the application form, pay for the
corresponding amount and get your card in an instant.
Salient benefits which you may avail in any of our MediCard-owned clinics
include:
RxER
Unlimited check-ups with primary care physicians, Pediatricians,
Medical Internists and OB Gynecologists
Flat rate of P350.00 for specialists
One FREE Oral Prophylaxis
Dental consults with dentists
30% discount on dental procedures
30% discount on diagnostics and tests
One-time basic 5: CBC, Urinalysis, Stool Exam, Chest X-ray and
Physical Exam
Emergency Care* for trauma cases in all MediCard accredited
hospitals nationwide
H. Other Benefits
Any illness, injury or any adversemedical condition shall be considered pre-existing if during the entire period prior'and within the first
twelve (12) months from the effectivity date of this Agreement:
a. Any professional advice orconsultation and/or treatment was made given as a result of such illness, injury or adverse medical
condition; or
b. The MEMBER was aware orshould reasonably have been aware of the signs or symptoms of such illness, injury or adverse medical
condition; or
c. The pathogenesis or onset of such illness, injury or adverse medical condition has been started during the contestability period for
membership in this Corporate Health Program as determined by MEDICARD's Medical Director or accredited physicians.
2. Without necessarily limiting the following enumeration, the following are automatically considered as pre-existing conditions if
consultation or treatment is sought within the first twelve (12) months of coverage:
J. Dreaded Disease
Dreaded diseases are potentiallyor actually life-threatening conditions or illnesses which may require prolonged or repeated hospitalization
or intensive care management. MediCard shall pay for hospitalization services up to the maximum limit subject to the pre-existing
conditions coverage.
K. Membersh
-
Principal Member At least 18 years old up to age 65 and employed by the company.
NOTES:
The choice of enrolling dependents must follow a hierarchy. This means that the spouse first must be enrolled followed by the eldest
child, second child and so on for married personnel. Under single employees, the parents must be enrolled first followed by eldest
brother/sister and so on.
There shall be no cancellation of dependent enrollment while the Principal member is still
actively enrolled.
Application forms and Medical evaluation are waived.
Over aged enrollees from 64to 70 shall be accommodated with an additional 100% load on premium.
With AHMC, MMC, SLMC Q.C. , TMC and CSMC but without SLMC-Global C'
Ward
Without AHMC P 7,690 P 60,000
Semi-Private
Without AHMC 9,961 80,000
NOTE:
Rates presented are inclusive of 12% VAT.
The foregoing premium is applicable for an initial enrollment of 3,000 employees and 3,000 dependents,
reduction by more than 10%
Shall be subjected to a recomputation.
Non-PhilHealth/Medicare members (he, unemployed parents below 60 years old, etc.) must pay an additional P2,700.00 per head
upon inception of membership or shall pay the corresponding portion during confinements and out-patient surgical procedures
out-patient cataract extraction). (i.e.
Above rates are valid within 6Odays from date of proposal.
Services availed by a MEMBEN in excess of the coverage or allowable limit shall be settled by the MEMBER directly with the hospital.
Failure of the MEMBER to settlei the excess charges shall necessitate MediCard to bill the MEMBER, through the COMPANY, all excess
charges with corresponding twenty percent (20%) service fee, payable within fifteen (15) calendar days from receipt of billing.
Otherwise, a corresponding *ally of 3% per month will be incurred. If the bills remain unpaid after thirty (30) days, the concerned
MEMBER shall cease to be eqdlited for coverage until after bills have been settled in full
For in-patient services at The Medical City (TMC) where there is no Semi-Private Room category, members enrolled under Semi-Private
Room Plan may avail of theltandarcl A & B considered as Small Private Room. Excess in RIB shall be shouldered by the member. If the
member opts to stay in DelUx* or Superior Room considered as Large Private, the room difference and incremental charges shall be
shouldered by the member.
Legend:
HOSPITALS
AHMC Asian Hospital:and Medical Center
MMC Makati Medical Center
SLMC Saint Luke's Medical Center
TMC The Medical City
CSMC Cardinal Santos Medical Center
OTHERS
DDL Dreaded Disease Limit
ore Canditions
MRV MediCard relaitive value (what it would have cost had the service been rendered in an accredited hospital through
the services clan accredited doctor).
Inclusive of operating room charges, professional fees and other incidental expenses relative to the procedure
A. HOSPITALIZATION
1. All confinement shall be upon recommendation of the corporate health program holder's MediCard accredited Physician, or the
MediCard Medical Director or the Emergency Room Resident Physician of the MediCard Accredited Hospital who decides to admit
MediCard patient-member in cases of life threatening emergencies.
2. Hospital bills for the following hospital services shall be charged to the account of the MediCard patient-member: services of a
private nurse or doctor, use of extra food and/or bed, T.V., electric fan, VCD. ID bracelet, thermometer, admission kit and all other
items not directly related to the medical management of the patient.
4. MediCard is not responsible and will not recognize any hospital bills incurred by a corporate health program holder in hospitals not
accredited by MediCard, except for emergency care services under the terms provided in this Agreement.
5. Cost of hospitalization, medical services, medicine and other expenses incurred as a result of a member's decision to avail of such
hospitalization, medical services, treatment or procedure, not prescribed or contrary to what has been prescribed by the attending
MediCard provider, or without MediCard's express written report shall not be shouldered by MediCard.
B. OUT-PATIENT SERVICES
1. Prescribed medicines on an out-patient basis are not provided by MediCard Medical Center or Medical Service Units.
2. The absolutely no charge out-patient medical and health care services are provided only during clinic hours of Medical Service
Units.
3. Second opinions and cost of treatment incurred in non-accredited hospital or clinic should the member,unilaterally decide to seek
such recourse.
C. ELIGIBILITY
1. Deadline for enrollment of dependents:
a. For new & renewing, accounts - 30 days from the effectivity date of the agreement.
b. For dependents who meet the eligibility requirements within the agreement period - 30 days from the date dependent
become eligible formembership. (copy of birth certificate or marriage agreement must be submitted)
c. For additional principal members of the company, dependent/s must be enrolled together with the principal.
d. Any additional dependents other than the above can be enrolled upon the renewal of agreement, within the one (1)
month enrollment period.
After the lapse of the periods specified above. MediCard will no longer receive, evaluate and accept any designation or
application to be a qualified dependent from any PRINCIPAL MEMBER.
If the company opts to specify an effectivity date, the advice for inclusion/addition should be received two (2) weeks before the
desired effectivity date. Otherwise, the Underwriting cut-off dates will apply.
3. New enrollees who are approaching age of ineligibility must be enrolled at least six (6) months counting from the date of effectivity
up to the date that the enrollees become ineligible for them to be accepted as members. All pre-existing condition/ dreaded
disease limits will be computed on a prorated basis (i.e. If age of eligibility is up to 60 years old, only applicants who are 60 years and
6 months old and younger Will be accepted for membership).
4. Renewing members who will become age ineligible within the next renewal agreement year will be allowed to renew regardless of
the remaining months that the member will remain eligible. However, pre-existing condition/dreaded disease limits will be computed
on a prorated basis (i.e. If age of eligibility is up to 60 years old, a renewing member who is 60 years and 9 months old will still be
renewed but pre-existing condition/dreaded disease limits will be computed based on the following formula:
Total months thatpember remains eligible X PEC/DD limit = Pro-rated Limit
12
D. EXCLUSIONS
1. Services which a member receives from a non- MediCard Physician, non- MediCard Accredited Hospital or other provider of care,
except as described in the emergency care in non- MediCard hospitals, as provided for in this Agreement;
4. Plastic and reconstructive surgery for cosmetic purposes and for physical congenital deformities and abnormalities;
5. Dermatological care for aesthetic purposes such as electrocautery or chemical treatment for skin tags, xanthelasma, milia, keloids,
scars, etc. on any exposed areas of the body;
6. Guillain-Barre syndrome, multiple sclerosis, demyelinating disease, Parkinson's disease, Alzheimer's disease, Myasthenia Gravis,
epilepsy, seizure disorder and other autoimmune neurological disease:
8. AV malformation and aneurysms which are considered congenital except only those unequivocably proven to be acquired
secondarily;
9. Corrective eye surgery for error of refraction including laser surgery for correction of myopia and hypermyopia;
12. Services to diagnose and/or reverse infertility or fertility and virility/potency (erectile dysfunction);
13, Open heart surgeries, angioplasties, valvulaplasties, permanent pacemaker insertion, intro coronary thrombolysis, balloon
valvuloplasties, transvenous endocardial biopsy, percutaneous intraaortic balloon pump insertion, balloon atrial septostomy,
previous craniotomy sequelde, organ transplantation and complication and other surgeries related to the heart;
15. Purchase or lease of durable medical equipment, oxygen dispensing equipment and oxygen except during hospital confinement
under the Hospital Confinement Benefit;
17. Human blood products like platelets, packed RBC, plasma, gamma globulin, etc. and its processing;
18. Psychiatric and psychological illnesses including neurotic and psychotic behavior disorders;
19. Treatment for alcoholic intoxication and drug addiction or overdose reaction to use of prohibited drugs including illnesses directly
related to it and other injuries attributed as a result of it;
22. Sexually transmitted diseases such as AIDS, Hepatitis B, condyloma, gonorrhea, syphilis, herpes etc. and their attendant
complications;
24. HIV/AIDS:
26. Physical examinations required for obtaining or continuing employment, insurance or government licensing;
27. Injuries or illnesses resulting from participation in war-like or combat operations, riots, insurrection, rebellion, strikes and other civil
disturbances;
28. Treatment of self-inflicted injuries or injuries attributable to the MEMBER'S own misconduct, gross negligence, use of alcohol and/or
drugs, vicious or immoral habits, participation in act of crime, violation of a law or ordinance, unnecessary exposure to imminent
danger or hazard to health and hazardous sports related injuries;
29. Matemity care and other conditions as a result of pregnancy unless specifically provided;
31. Oral surgery for purposes of beautification. temporomandibular joint disease (TMJ) surgery done by dental practitioner;
33. Treatment of injuries sustained in a motor vehicle accident if the member or his guardian fails or refuses to execute the deed of
Subrogation specified in Article VII hereof;
36. Cost of vaccines for active and passive immunization except as otherwise provided for in this Agreement;
37, Laboratory examinations for screening sexually related illnesses and injuries;
38, Any condition or illness waived upon membership except as otherwise provided for in this Agreement;
CONFIRMATION:
This is to signify that all benefits, exclusions and premium incorporated to this proposal are amenable to us. By this, we
have decided to avail the services of MediCard Philippines, Inc. for the health maintenance program of PHILIPPINE
GOVERNMENT AUDIT SERVICE EMPLOYEES ASSOCIATION (PHILGASEA- COA) effective
(CONTRACT SIGNATORY
(SIGNATURE OVER PRINTED NAME)
DESIGNATION/POSITION)
.14.1
, 4444
COMPANY
SIGNATORY