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Why Medicard
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).
MediCard is the only HMO being run and operated
by doctors.
MediCardis the only HMO awarded with the ISO 9001:
2008 Certification in the Philippines and in Asia.
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.
Benefit
No deposit upon admission
Room and board
Remarks
(All limits subject to PEC)
Covered
According to type of plan enrollment
within DDL
within DDL
within DDL
within DDL
Administered medicines
within DDL
within DDL
within DDL
within DDL
ICU confinements
within DDL
Benefit
Regular consultations & treatment
Referral to specialists
Remarks
(All limits subject to PEC)
within DDL;
except prescribed medicines
within DDL; except prescribed medicines
within DDL
within DDL
within DDL
PT / Speech Therapy
Laser treatment of Glaucoma & Retinal Detachment
within DDL
Except labs
up to P5,000
up to P1,000
Allergy Testing
up to P2,500
up to P5,000 each
up to P1,000
Covered
Covered
Complex Diagnostic
Procedure*
Benefit
Remarks
(All limits subject to PEC)
MRI / MRA
Up to P 5,000
CT scan
Up to P 5,000
Ultrasound
Up to P 5,000
Up to P 5,000
Up to P 5,000
Up to P 5,000
Up to P 5,000
Up to P 5,000
Up to P 5,000
Up to P 5,000
Myelogram
Up to P 5,000
Up to P 5,000
Diagnostic Arthroscopy
Up to P 5,000
Diagnostic Hysteroscopy
Up to P 5,000
Up to P 5,000
Up to P 5,000
Up to P 5,000
Immunologic Studies: Anti-nuclear antibody (ANA), CReactive protein, Lupus cell exam
Up to P 5,000
Remarks
Covered
Under APE
Urinalysis
Under APE
Under APE
Chest X-Ray
Under APE
Electrocardiogram
Pap Smear
Routine Immunization
Covered
Covered
Covered
Remarks
(All limits subject to PEC)
Doctors services
within DDL*
within DDL*
within DDL*
within DDL*
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
:
Benefit
Remarks
Remarks
Natural Death
P 10,000
Accidental Death
P 20,000
P 10,000
P 5,000
Additional Benefits
Remarks
(All limits subject to PEC)
Benefit
Unprovoked Assault
Up to DDL
Congenital Illnesses
Hyperventilation syndrome
APE Promo
Pre-employment services
APE Package for members 35 years old and above shall include Fasting Blood Sugar (FBS) and Total
Cholesterol if availed during on-site APE conducted by Uro Industrial Clinic or at MediCard Clinics
only. This offer is valid from May 1, 2014 to April 30,2015.
P 400.00 per head for pre-employment physical examinations (paid up front) at designated
MediCard owned clinics.
If the applicant is hired and enrolled under MediCard, this will serve as his annual physical
examination and MediCard shall refund the said amount back to the company.
Free consultations at MediCard owned clinics from the following primary physicians and specialists:
1.
2.
3.
4.
5.
6.
General Surgeon
Obstetrician Gynecologist
Pediatrician
Family Medicines
General Practitioner
General Internist
Above consults will not be charged to the members 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.
On top of this, members can avail of discounts on laboratory examinations up to 20% for cases
which are not covered.
NOTE: Except for TPA
You may also want to extend the benefits of having a MediCard plan to your employees dependents.
Through RxER, MediCard's latest emergency product, they get a specialized healthcare maintenance
service that covers emergency, preventive and outpatient care for one year for P1,998.00.Best of
all, there's no age-limit, no medical exam required, and no hierarchy to be followed.
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 MediCardaccredited hospitals nationwide
Other Benefits
Benefit
Remarks
Text MediCard
Vaccines
Access to the special discounted prices on vaccines through the MediCardGlaxoSmithKline (GSK) adult vaccination campaign(Influenza, Hepa A & B,
Typhoid, etc.).
Member
Coverage
Members
Year of membership
1st year
2nd year
Amount of Coverage
Up to P 5,000 per illness per member per year
Up to P 5,000 per illness per member per year
provided that the pathogenesis or onset of such
illness, injury or adverse medical condition
started prior to or during the contestability
period; otherwise, up to DDL.
Dreaded Disease
Dreaded diseases are potentially or 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.
Membership Eligibility
Member
Type
Principal
Member
Eligibility
Membership Fees
https://www.humana.com/individual-and-family/products-and-services/medical-plans/hmo-vs-ppo