HEALTHCARE BENEFIT

ORIENTATION
for
GOLDEN ABC
 Service Assurance Mechanisms

 Deployed Liaison Officers

– Registered Nurses that look into member’s concerns during
confinement
 Physician Coordinators
– Assigned to each affiliated hospital to oversee patients overall
medical care
 Account Management Officer
– Handles various concerns and plays a pro-active role in ensuring
customer satisfaction
 “MED-ASSIST”
– Pre-Arranged Referral Letters/Letters of Authority (LOA) to ensure
members’ convenience
PHILAMCARE’S PROVIDER NETWORK
Region IV
DLSU-Poblete Memorial Hospital Alfonso, Cavite

PHILAMCARE NETWORK
De La Salle University Medical Center Dasmarinas, Cavite
Our Lady of the Pillar Medical Center Imus, Cavite
Our Savior Hospital Rosario, Cavite
St. Dominic General Hospital Bacoor, Cavite
Molino Doctors Hospital Bacoor, Cavite
Metro South Medical Center Bacoor, Cavite
Cavite Medical Center Cavite City
Bautista Hospital Caridad, Cavite City
Hospital of the Holy Cross Calapan, Oriental Mindoro
Zapanta Maternity and General Hospital Occidental Mindoro
Palawan Adventist Hospital P. Princesa City, Palawan
Quezon Diagnostic Mini-Laboratory Quezon, Palawan
Del Rio Sarmiento Medical Clinic Narra, Palawan
Roxas Medical Clinic Roxas, Palawan
Region V
Ago Foundation Hospital Naga City, Camarines Sur
Ago General Hospital Legaspi City, Albay
Estevez Memorial Hospital Legaspi City, Albay
VISAYAS
Region VI
St. Paul’s Hospital General Luna, Iloilo
Our Lady of Mercy Hospital Bacolod City, Negros Occidental
(formerly Tiong Bi Medical Center)
The Doctors Hospital (Bacolod Doctors) Bacolod City, Negros Occidental
Riverside Medical Center Bacolod City, Negros
Occidental
(formerly Dr. Pablo Torre, Sr. Memorial Hospital)
Region IV
DLSU-Poblete Memorial Hospital Alfonso, Cavite

PHILAMCARE NETWORK
De La Salle University Medical Center Dasmarinas, Cavite
Our Lady of the Pillar Medical Center Imus, Cavite
Our Savior Hospital Rosario, Cavite
St. Dominic General Hospital Bacoor, Cavite
Molino Doctors Hospital Bacoor, Cavite
Metro South Medical Center Bacoor, Cavite
Cavite Medical Center Cavite City
Bautista Hospital Caridad, Cavite City
Hospital of the Holy Cross Calapan, Oriental Mindoro
Zapanta Maternity and General Hospital Occidental Mindoro
Palawan Adventist Hospital P. Princesa City, Palawan
Quezon Diagnostic Mini-Laboratory Quezon, Palawan
Del Rio Sarmiento Medical Clinic Narra, Palawan
Roxas Medical Clinic Roxas, Palawan
Region V
Ago Foundation Hospital Naga City, Camarines Sur
Ago General Hospital Legaspi City, Albay
Estevez Memorial Hospital Legaspi City, Albay
VISAYAS
Region VI
St. Paul’s Hospital General Luna, Iloilo
Our Lady of Mercy Hospital Bacolod City, Negros Occidental
(formerly Tiong Bi Medical Center)
The Doctors Hospital (Bacolod Doctors) Bacolod City, Negros Occidental
Riverside Medical Center Bacolod City, Negros
Occidental
(formerly Dr. Pablo Torre, Sr. Memorial Hospital)
Region VI
The Doctors Hospital (Bacolod Doctors) Bacolod City, Negros Occ.

PHILAMCARE NETWORK
Riverside Medical Center Bacolod City, Negros Occ.
(formerly Dr. Pablo Torre, Sr. Memorial Hospital)
Bacolod Sanitarium & Hospital Bacolod City, Negros Occ.
St. Joseph’s Hospital Victorias, Negros Occ.
Southern Negros Doctors Hospital Kabankalan, Negros Occ.
St. Anthony College Hospital Roxas City, Capiz
Region VII
Borja Family Clinic Bohol
Ramiro Community Hospital, Inc. Tagbilaran City, Bohol
Tagbilaran Community Hospital Tagbilaran City, Bohol
Lim Community Hospital Jagna, Bohol
Cebu Doctors Hospital Cebu City
Cebu Velez General Hospital Cebu City
Chong Hua Hospital Cebu City
Perpetual Succour Hospital Cebu City
Visayas Community Medical Center Cebu City
Sacred Heart Hospital Cebu City
North General Hospital Cebu City
HV Miller Sanitarium and Hospital Cebu City
Vicente Gullas Memorial Hospital Mandaue City, Cebu
Cortes General Hospital Mandaue City, Cebu
Mactan Community Hospital Mactan, Cebu
Siliman University Medical Center Dumaguete City
Holy Child Hospital Dumaguete City
Region VIII
Bethany Hospital Tacloban, Leyte

PHILAMCARE NETWORK
Divine Word University Hospital Tacloban, Leyte
Remedios Trinidad Romualdez Hospital Tacloban, Leyte
OSPA-Farmers Medical Center Ormoc City, Leyte
St. Camillus Hospital Calbayog, Samar
Borongan Doctors Hospital Borongan, Samar

MINDANAO
Region IX
Brent Hospital Zamboanga City, Z. del Sur
ZAEC Community Medical Center, Inc. Zamboanga City, Z. del Sur
Pagadian City Medical Hospital Pagadian City, Z. del Sur
Dipolog Medical Center Dipolog City, Z.del Norte
Misamis University Medical Center Ozamis City, Misamis Occ.
Medina General Hospital Ozamis City, Misamis Occ.
Dr. Uy Hospital, Inc Iligan City, Lanao del Norte
Mercy Community Hospital Iligan City, Lanao del Norte
Mindanao Sanitarium & Hospital Iligan City, Lanao del Norte
Region X
Cagayan de Oro Medical Center Cagayan de Oro City, Misamis Or.
Cagayan de Oro Polymedic General Hospital Cagayan de Oro City, Misamis Or.
Madonna and Child Hospital Cagayan de Oro City, Misamis Or.
Maria Reyna Hospital Cagayan de Oro City, Misamis Or.
Capitol College General Hospital Cagayan de Oro City, Misamis Or.
Gingoog Sanitarium & Hospital Gingoog City, Misamis Or.
Bukidnon Doctors Hospital Valencia, Bukidnon
La Viña General Hospital Valencia, Bukidnon
Region X
St. Joseph Southern Bukidnon Hospital Maramag, Bukidnon

PHILAMCARE NETWORK
Kisolon Emergency Hospital Sumilao, Bukidnon
Simbulan Santo Niño Hospital Don Carlos, Bukidnon
Bethel Baptist Hospital Malaybalay, Bukidnon
CARAGA (Agusan del Norte )
Miranda Family Hospital Surigao City, Surigao del Norte
Surigao Medical Center Surigao City, Surigao del Norte
Butuan Doctors Hospital Butuan City, Agusan del Norte
Manuel J. Santos Hospital Butuan City, Agusan del Norte
Region XI
Bishop Joseph Regan Memorial Hospital Tagum, Davao del Norte
Medical Mission Group Hospital Tagum, Davao del Norte
Tagum Doctors Hospital, Inc Tagum, Davao del Norte
Boiser Medical Children’s Clinic Sto.Tomas, Davao del Norte
Ricardo Limso Hospital Sto.Tomas, Davao del Norte
Matutes Clinic and Hospital Panabo, Davao del Norte
Somoso General Hospital Panabo, Davao del Norte
Rivera Medical Center Panabo, Davao del Norte
(formerly Clinica Rivera Multitest Laboratory
Pharmacy & Hospital)
Davao Doctors Hospital Davao City, Davao del Sur
San Pedro Hospital Davao City, Davao del Sur
Brokenshire Integrated Health Ministries, Inc. Davao City, Davao del Sur
Compostela Valley Hospital Davao City, Davao del Sur
Community Health and Dev. Coop. Hospital Davao City, Davao del Sur
Administration of Reimbursement Claims

PROCEDURES IN FILING OF REIMBURSEMENT CLAIMS

(Member must file within 30 days from date of discharge)

Avail of Medical Services

Pay corresponding charges

Secure Reimbursement Claim Form (RCF) from HR

Accomplishment of RCF:
1. Member fills out Part I of the RCF
2. Attending Physician fills out Part II of the RCF
3. Company fills out Part III of the RCF

Submit the enumerated documents to PhilamCare:

1. RCF
2. Professional Fee Official Receipt (OR)
3. OR of the Hospital Bill
4. Hospital Statement of Account
5. Charge Slips
6. Admitting History Report (for In-Patient Claims)
7. Operative Report (if surgical case)
 General Exclusions

• All expenses incurred by the Member in the process of donating

organs
• Injuries or illnesses resulting from hazardous activities
• Physical exams for obtaining or continuing employment, insurance
or government licensing, or not related to the health maintenance of
the client
• Illnesses due to military service or suffered under conditions of war
• Executive check-ups and confinement which are for purely
diagnostic purposes
• Injuries or illnesses wherein the care or reimbursement of services is
provided by law or a government program, up to the stipulated limits
• Self-inflicted injuries or illness, or incurred as a result of the
commission of a crime
• Take-home medicine, immunizing agents and out-patient medicines
 General Exclusions

• Vaccines, whether elective or administered during an emergency

treatment
• Medical Fees incurred after the day & time of authorized discharge
from the hospital
• Laser Treatment for the purpose of corrective eye refraction
• Medico-Legal Fees
• Ionizing Radiation or contamination by radioactivity from any nuclear
fuel or from any nuclear waste from the combustion of nuclear fuel
• Treatment involving sophisticated procedures where comparable
traditional/conventional modes of treatment exist
• Respiratory Therapy and Occupational Therapy
• Treatment of Veneral Disease and other STDs and AIDS
• Treatment of Benign prostatic hypertrophy, guillain-barre syndrome,
chronic glomerulonephritis, spinal stenosis or vitiligo, epelepsy,and
chronic dermatoses
MEDICAL REIMBURSEMENT
BENEFIT
ORIENTATION
for
RANK and FILES
 BENEFITS FOR R&F
BENEFITS COVERAGE
Room & Board per day (max. of 31 500
days)
Special Hospital Services 8,000

Surgical fee 12,000

Doctor’s call per day (max. of 31 500
days)
Anesthesiologist’s fee (35% of 4,200
surgeon’s fee)
Specialist’s fee per day (max. of 5 500
days)
Maximum limit 60,000
Administration of Reimbursement Claims

PROCEDURES IN FILING OF REIMBURSEMENT CLAIMS

(Member must file within 30 days from date of discharge)

Avail of Medical Services

Pay corresponding charges

Secure Reimbursement Claim Form (RCF) from HR

Accomplishment of RCF:
1. Member fills out Part I of the RCF
2. Attending Physician fills out Part II of the RCF
3. Company fills out Part III of the RCF

Submit the enumerated documents to PhilamCare:

1. RCF
2. Professional Fee Official Receipt (OR)
3. OR of the Hospital Bill
4. Hospital Statement of Account
5. Charge Slips
6. Admitting History Report (for In-Patient Claims)
7. Operative Report (if surgical case)