Valucare-Individual-Family-rates.pdf

Valucare-Individual-Family-rates.pdf - HEALTHCARE PROPOSAL...

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HEALTHCARE PROPOSAL FOR INDIVIDUAL AND FAMILY ACCOUNT DELIVERY SYSTEM ¸ HOSPITAL BASED: Planholders can proceed directly to an accredited hospital. ¸ NETWORK ACCESS: Planholders can directly access the list of ValuCare accredited hospitals, coordinators and affiliate/accredited clinics. ¸ PHILHEALTH INTEGRATED: The plan is integrated with the Philhealth benefit; planholders are required to file and submit duly accomplished Philhealth forms at the billing section of the hospital. Planholders who are not members of Philhealth and/or not qualified under Philhealth provisions (e.g. foreigners, unemployed parents below sixty (60) year old, children 21 years old, etc.) are required to pay the Philhealth portion whenever necessary (e.g. confinement for not less than 24 hours, minor surgical procedures and chemotherapy, radiotherapy, hemodialysis, endoscopic procedures, and cataract extraction even on an OUT-PATIENT basis). MEMBERSHIP ELIGIBLITY ¸ PRINCIPAL MEMBER: from 18 years old up to below 60 years old. ¸ DEPENDENTS: 1 st Priority - Legal Spouse from 18 years old up to below 60 years old. 2 nd Priority - Children from 90 days old to below 21 years old single & unemployed. SERVICE AND BENEFITS PACKAGE A. OUT-PATIENT SERVICES ¸ Any number of necessary consultations and treatments during regular clinic hours (excluding the prescribed medications); ¸ Referrals to accredited specialists; ¸ X-ray, laboratory examinations and diagnostic procedures required and prescribed by the Primary/Accredited Physician; ¸ Ten (10) pre or post-natal consultations with ValuCare accredited obstetricians. B. PREVENTIVE CARE SERVICES ¸ Immunizations, excluding the cost of the vaccines; ¸ Medical management of health problems; ¸ Family planning consultations, health education and counseling on diets or exercise; ¸ ANNUAL PHYSICAL EXAMINATION (A.P.E.) : - Physical examination/physicians assessment; - Chest X-ray; - Complete blood count; - Urinalysis; - Stool Analysis (fecalysis); - Electrocardiogram (ECG) for all members at age 35yrs. and above; and - Pap’s Smear for female members at age 35 yrs. and above. Page 1
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C. IN-PATIENT SERVICES ¸ Room & board accommodation based on the planholders designated PLAN at any ValuCare accredited hospital; ¸ Use of operating room and recovery room; ¸ Professional fees for accredited: -Medical Coordinators -Medical Specialists; -Surgeons; -Anesthesiologists; ¸ Medicines and injectibles including prescribed drugs purchased outside the hospital when these are not available in the hospital pharmacy at the time of confinement. When purchased by the member, the cost thereof shall be reimbursed to him by ValuCare following the procedures for claims reimbursement; ¸ Blood transfusions (including human blood products) except gamma globulin; ¸ Intravenous (IV) fluids; X-ray, laboratory examinations, and diagnostic tests ordered by ValuCare attending physicians; ¸ Dressings, casts, and sutures; ¸ Standard nursing services; ¸ Inhalation therapy; ¸ Oxygen and its administration; ¸ ICU/CCU or its equivalent confinement, when required; ¸ All other items directly related to the medical management of the patient.
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