These hospitalization benefits shall be available subject
to the following conditions except for emergency illness or injury
wherein the Emergency Benefits provision of the Agreement shall apply:
-
The hospitalization must be arranged or
approved by the Philamcare authorised personnel prior to the
confinement.
-
The confinement shall be in an affiliated
hospital and the type of hospital room accommodation shall be in
accordance with the Member's benefit classification and maximum
rate allowance.
-
Professional services shall be provided only
by Philamcare physician(s) or affiliated physician(s).
-
If discharge from the hospital has been
authorised by a physician and the member fail or refuse to do so,
Philamcare shall not be responsible for any charges for hospital
services rendered after the day and time for which discharge has
been authorised.
100% coverage on out-patient medical
consultation.
Free laboratory examination.
Complete Annual Physical Examination.
Preventive health care programs.
No deposit admission
Outstanding selection of clinics,
hospitals and specialists.
Partial reimbursement of expenses in
a non-affiliated hospital
Optional benefits
No medical examination for applicants 50 years
old and below.
Service Assurance Mechanisms
100%
coverage on out-patient medical consultation
PhilamCare
members are entitled to an unlimited number of medical consultations
with PhilamCare out-patient clinic doctors and affiliated medical
specialists. PhilamCare 100% of professional fee incurred. 
Free
laboratory examination
Necessary
laboratory examinations will be covered 100% if done in any PhilamCare
full service out-patient clinic or when referred to a full service
hospital or affiliated hospital by a PhilamCare physician.
Complete
Annual Physical Examination
As
soon as coverage takes effect, a member will be entitled to a complete
physical examination. This examination includes:
-
Review
of medical history
-
Physical
examination
-
Chest
X-ray
-
Urinalysis
-
Stool
examination
-
Complete
Blood Count
-
E.C.G.
for members 35 years old and above
-
Pap
Smear for female members 35 years old and above
Preventive
health care programs
-
Administration
of vaccine (except the cost of the vaccine and procedures to
determine your susceptibility to the vaccine)
-
Advice
on diet, exercise and other health habits
-
Periodic
monitoring of health problems
-
family
planning counseling
-
Wellness
program
No
deposit admission
Absolutely
no cash outlay when you check-in at PhilamCare full service and
affiliated hospitals. PhilamCare will cover 100% of your room and
board, necessary hospitalization services of affiliated hospitals and
professional fees of affiliated doctors.
Hospitalization
benefits include:
-
Room
and Board according to your Plan.
-
Professional
fees of Physicians, surgeons or specialists, including surgery.
-
Drugs
and medications for use while confined.
-
X-ray,
laboratory tests, and other diagnostic procedures.
-
Use
of operating room and recovery room.
-
Dressing,
plaster casts, and other medical supplies.
-
Anesthesia
and its administration.
-
Transfusion
of blood and other blood elements.
-
Oxygen
and its administration.
-
Dialysis
up to the Plan limit.
-
General
nursing services.
-
Confinement
in Intensive Care Unit (ICU) up to the maximum Plan limit.
No
maximum limit on benefits for ordinary illnesses. Provided a member
stays within his Plan package, there is no limit to the confinement
benefits a member may receive incases no requiring ICU confinement and
in cases of ordinary diseases (non-dreaded).
Outstanding
selection of clinics, hospitals and specialists
PhilamCare's
modern out-patient full service clinics provide immediate diagnosis
and treatment and has over 100 hundred first-rate affiliated hospitals
providing prompt and quality service. Members have access to
over 3,500 affiliated specialists certified by their board.
Partial
reimbursement of expenses in a non-affiliated hospital on
emergency
cases
In
case of emergency, members may seek treatment in any hospital
here or abroad. PhilamCare will reimburse up to 100% of what it would
have cost PhilamCare had you been treated by an affiliated doctor in
an affiliated hospital or P12,500 whichever is lesser.
Optional
Benefits
Dental
service
-
annual
dental examination
-
annual
oral scaling and polishing
-
simple
tooth extraction
-
treatment
of pain, lesions, wounds, and burns
-
gum
treatment except alveolectomy and gingivectomy
-
re-cementation
of fixed bridges, crowns, jackets, inlays and onlays
-
temporary
filling
-
consultation
No
medical examination for applicants 50 years old and below
Members
will not undergo physical examination unless deemed necessary by a
PhilamCare physician who evaluates application for a health
insurance.
Service
Assurance Mechanism
24-Hr
Medical Advisory
PhilamCare's
round-the-clock phone service is manned by nurses who handle medical
questions and service inquiries at any time of the day.
Liaison
Officers
Liaison
Officers are also nurses. They are assigned in affiliated hospitals in
Metro Manila and in major cities in the provinces to look into the
members' concerns during confinement.
Physician
Coordinators
Physician
Coordinators in each affiliated hospital make daily rounds to patients
to ensure that they are referred to the proper designated specialists.
They also entertain complaints from patients and oversee their overall
medical care.
Individual
Servicing Officers
The
Membership Relations Department (MRD) was established to receive
complaints, answer inquiries and handle administrative concerns. An
individual servicing officer is assigned to look into the individual's
and family members' concerns and play a pro-active role in ensuring
customer satisfaction.
