In 1987, A Group of Eminent Physicians
Content
History
In 1987, a group of eminent physicians from the most distinguished medical centers in the country, concerned at the ability of working people to pay for much needed quality health care, consolidated their resources together to put up MEDICard Philippines, Inc. MEDICard is a pioneer in the industry. The owners have been in the health care service for years. The country had suffered badly during the waning years of Marcos rule. Health costs were rising, but incomes were falling. Even middle income families were finding difficulty in putting money for emergencies. Thus, if sickness occurred the necessary funds were just not available to receive treatment and pay for medicines. MEDICard was born out of a desperate need. One of the founders, who was to become the first president, Dr. Nicanor D. Montoya M.D., held a very simple philosophy. It was that if a person could just put away P3.00 per day, (not a large sum, even then), he could afford hospitalization. From this premise, MEDICard was created. An organization was formed, MEDICard (Philippines) Inc., that would provide quality comprehensive health care services to a large number of Filipinos, at a cost that they could afford. Just one year later, operating from the 9th floor, Sagittarius Building, H.V. dela Costa Street, Salcedo Village, Makati City, the company commenced marketing the scheme. Recruitment of members was slow at first until it was realized that more could be reached more quickly by enlisting companies who were large employers. The advantages of this scheme to all participants were so obvious that the marketing strategy was immediately successful. The scheme was then expanded to appeal to company executives and middle managers as well as the rank and file. By 1990, the success of the scheme enforced the opening of further offices in Cagayan de Oro, Cebu and Davao City. These offices were tasked with the coordination of accredited providers and giving assistance to members. The expansion of the Company meant continual updating of systems and procedures. The founders and operating officers being mainly from the medical profession have given MEDICard a uniqueness that is difficult to be matched by other organizations that offer medical insurance. Being of the profession, more attention is given to the service than the finances. Investment is constantly being made to make quality health care services available to its
ever-growing membership throughout the country. It is the dedication to good health and services as envisioned by the founding doctors that has made MEDICard a company whose members can always rely on. Since its inception, the concept of service-oriented total health care has been the molding ideal of MEDICard. The competition is vast, and the benefits being offered by the competitors are tempting. However, MEDICard has taken the lead in providing innovative and productive ideas that cut down the cost of health maintenance without compromising its quality. And our predominantly corporate- based clientele totaling about 300,000 members from more than 1700 companies can attest to the quality of service afforded to them by our network of more than 240 hospitals and approximately 3000 doctors and dentists nationwide. MEDICard is a Health Maintenance Organization that provides a comprehensive health care program for its members. This includes emergency care, hospital confinement, preventive health care, dental care and out-patient consultation services. MEDICard is not an insurance company because unlike an insurance company where you pay your bills for reimbursement later, MEDICard guarantees all your medical expenses, including that all-important hospital deposit. Then you need not worry about money. All you need is your MEDICard ID. MEDICard will take care of everything else for you. Today, with a total of more than 448,000 members, MEDICard Philippines, Inc. is associated with over 8,000 accredited doctor, specialists and dentists, operating out of over 300 hospitals and clinics nationwide. Operating 24 hours each and every day, MEDICard Philippines, Inc. provides a quality healthcare service to all its members.
Individual and Family Plan
Without AHMC, MMC, SLMC, MCGH & CSMC
PLAN 550 Limit for Dreaded Disease Principal member Only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 or more dependents P 50,000 ANNUAL P 6,767 12,267 18,082 23,900 29,715
PLAN 800 P 60,000 ANNUAL P 7,592 13,754 19,843 25,931 32,023
All Hospitals PLAN 1500 * Limit for Dreaded Disease Principal member Only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 or more dependents P 100,000 ANNUAL P 11,877 21,508 31,704 41,897 52,088 PLAN 2500 P 120,000 ANNUAL P 13,805 24,969 36,187 47,404 58,621
* Without Asian Hospital and Medical Center (AHMC) MEMBERSHIP ELIGIBILITY PRINCIPAL MEMBER Company or self-employed individual 18 years old up to age 60. DEPENDENTS For Married Principal Member 1. The legal spouse at least 18 years old up to age 60
2. Legitimate and/or legally adopted children above 90 days up to 21 years of age unmarried and unemployed and living under the same roof as the principal member For Single Principal Member 1. Parents up to age 60, unemployed and dependent upon the principal member 2. Brothers and sisters above 90 days up to 21 years of age who are not gainfully employed, unmarried and are living under the same roof as the principal member
Enrollees age 41 and above are required to undergo a medical evaluation at the MPI head office clinic, 9th floor Sagittarius Bldg., H.V. de la Costa St., Salcedo Village, Makati City with a minimal fee of P 450.00 per head. 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. For single personnel, the parents must be enrolled first followed by eldest brother/sister and so on. Note :
•
Non-PhilHealth/Medicare members (e.g. parents below 60 and unemployed, etc.) shall pay the corresponding portion during confinements
•
For confinements and availments in Makati Medical Center which has a blanket authority policy, all disapproved charges and excess in limits shall be settled directly with the hospital upon exhaustion of limit. Failure of patient to settle the excess bill shall necessitate MEDICard to bill the member with corresponding 20% service fee and payable within ten
(10) working days from receipt of billing.
•
Above rates are inclusive of 2.4% VAT, representing 12% of 20% of the total premium as proposed by AHMOPI wherein 80% is being earmarked for medical-related services.
AHMC - Asian Hospital and Medical Center, SLMC - St. Luke's Medical Center, CSMC - Cardinal Santos Medical Center, MMC Makati Medical Center, MCGH - Medical City General Hospital
VIP Program
Plan 2500 Dreaded Disease Limit Pre-existing Conditions Coverage Emergency care in non-accredited, 80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor (vitamins & maintenance meds are excluded) May use own doctor (Reimbursement Type) 100,000 In-patient: standard Out-patient: covered up to P 5,000 per illness per year. 75,000
1000 per year Out-patient: max. of 5 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 1,500. MPI head office clinic or mall satellite clinic with 8 Blood Chem (6BC) plus consultation with 2 specialists. ANNUAL 17,624
Annual Out-Patient Executive CheckUp
Principal Member only
Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents)
31,881 46,978 61,296 77,174 15,637
Plan 3500 Dreaded Disease Limit Pre-existing Conditions Coverage 150,000 In-patient: standard Out-patient: covered up to P 8,000 per illness per year
Emergency care in non-accredited, 100,000 80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor 1500 per year (vitamins & maintenance meds are excluded) May use own doctor (Reimbursement Type) Out-patient: max. of 8 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 2,500. MPI head office clinic or mall satellite clinic with 8 Blood Chem (8BC) plus KUB, lower abdominal ultrasound and consultation with 2 specialists. ANNUAL Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents) 20,900 37,772 52,239 65,960 81,138 16,348
Annual Out-Patient Executive Check-Up
Plan 5000 Dreaded Disease Limit Pre-existing Conditions Coverage Emergency care in non-accredited, 80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor (vitamins & maintenance meds are excluded) 200,000 Covered up to P 10,000 per illness per year on the 1st year (In-patient & out-patient combined) 150,000
2000 per year Out-patient: max. of 10 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 3,000. In-patient: 80% up to P30,000 with P 1,500 deductible based on MRV** HUMANA Executive package B ANNUAL
May use own doctor (Reimbursement Type)
Annual Out-Patient Executive CheckUp Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents)
38,111 68,744 82,739 96,010 110,729 17,945
Plan 8000 Dreaded Disease Limit Pre-existing Conditions Coverage Emergency care in non-accredited, 300,000 Covered up to P 12,000 per illness per year on the 1st year (In-patient & out-patient combined) 200,000
80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor (vitamins & maintenance meds are excluded) 3000 per year Out-patient: max. of 15 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 5,000 In-patient: 100% up to P50,000 with P 3,000 deductible based on MRV** HUMANA Executive package of choice ANNUAL Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents) 55,786 100,555 113,914 126,580 140,630 18,448
May use own doctor (Reimbursement Type)
Annual Out-Patient Executive CheckUp
Note :
•
Non-PhilHealth members(e.g. parents below 60 and unemployed, etc.) shall pay the corresponding portion during confinements
•
Executive check ups are for principal member plus one (1) dependent only (if dependents are enrolled)
•
•
Medical evaluation for enrollees age 41 and above is waived. For confinements and availments in Makati Medical Center which has a blanket authority policy, all disapproved charges
and excess in limits shall be settled directly with the hospital upon exhaustion of limit. Failure of patient to settle the excess bill shall necessitate MEDICard to bill the member with corresponding 20% service fee and payable within ten (10) working days from receipt of billing. • Above rates are inclusive of VAT.
AHMC Asian Hospital and Medical Center SLMC St. Luke's Medical Center CSMC Cardinal Santos Medical Center MMC Makati Medical Center MCGH Medical City General Hospital **MEDICard Relative Value
Individual and Family Program
MEMBERSHIP ELIGIBILITY Principal Member: Any person at least 18 years old and up to 60 years old. Qualified Dependent Member:
1. For Married Principal Members
The legal spouse up to 60 years old Legitimate and/or legally adopted children 90 days and up to 21 years of age who are not gainfully employed and living under the same roof as the principal member.
2. For Single Principal Members
Parents up to age 60, unemployed and dependent on the principal
member. Brothers and sisters 90 days old and up to age 21 who are not gainfully employed and are living under the same roof as the principal member. Note: 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 principal member. For single, the parents must be enrolled first followed by the eldest brother/sister and so on. Deadline for enrollment of dependents:
•
For dependents who meet the eligibility requirements within the agreement period -30 days form the date dependent become eligible for membership. (copy of birth certificate or marriage contract must be submitted)
•
Any additional dependents other than the above can be enrolled upon the renewal of agreement.
•
After the lapse of the period specified above, MEDICard will no longer receive, evaluate and accept any designation or application to be a qualified dependent from any PRINCIPAL MEMBER.
Underwriting cut-off dates in assigning effectivity date: Date of Receipt of Application/Endorsement 11th to 25th of the month 26th to 10th of the month Effectivity Date 1st of the following month 16th of the same month
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 preexisting condition/ dreaded disease limits will be computed on a prorated basis (i.e. If age of eligibility is up to 60 years old, only who are 60 years and 6 months old and younger will be accepted for membership).
Renewing members who will become age eligible 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 conditions/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 that member remains eligible/12) x PEC/DD limit = Pro-rated Limit In relation to his dependents, the MEMBER shall be known as the PRINCIPAL and he shall be deemed to have undertaken to comply with all the requirements and obligations of individual regular membership under this MMA on behalf of said dependent/s, particularly the payment of all the required fees, dues and charges.
Group and Corporate Program
MEMBERSHIP ELIGIBILITY Group Program With 5 to 10 principal members of legal age, 18 up to 60 years old. Corporate Program With at least 11 principal members of legal age, 18 up to 60 years old. Request for a Quotation Click here to request for a quote for Group and Corporate Programs. Kindly specify the number of members to be included in the program.
VIP Program
EMERGENCY CARE IN NON- ACCREDITED HOSPITAL When a member is in immediate danger of losing a limb, eye or other parts of the body or is in severe pain that requires immediate relief and enters a
non MEDICARD accredited hospital for treatment, MEDICARD agrees to reimburse only eighty percent (80%) of the total hospital bills inclusive of professional fees and based on relative values for MEDICARD accredited hospitals, but not to exceed the amount of P60,000.00. OTHER BENEFITS
1. Prescribed out-patient medicine reimbursement shall be covered up to
P1,000.00 per member per year excluding vitamins and maintenance medicines provided official receipt and prescription from MEDICard physician must be submitted.
2. POINT OF SERVICE PROGRAM
Point of service benefit allows members to avail of services from nonaccredited doctors and hospitals subject to the reimbursement limits on the table below: Type of Availment Rate of Reimbursement
Out Patient Consultation/Day Approved laboratory examinations as if prescribed by the HMO physician
3. *MRV-MEDICard Relative Value 4. ANNUAL EXECUTIVE CHECK-UP (AECU)
Maximum of 8 consultations based on MRV* up to P250.00 per consultation. 80% up to P2,500.00
MEDICard agrees to cover annual executive check-up at MEDICard Head Office Clinic, package includes the routine examination and the following additional tests:
6 Blood Chemistry KUB and abdominal ultrasound PLANS Plan 2500 Dreaded Disease Limit Pre-existing Conditions Coverage Emergency care in non-accredited, 80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor (vitamins & maintenance meds are excluded) May use own doctor (Reimbursement Type) including int’l. coverage / overseas & Asian Hospital Annual Out-Patient Executive CheckUp 100,000 In-patient: standard Out-patient: covered up to P 5,000 per illness per year. 75,000
1,000 per year Out-patient: max. of 5 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 1,500. MPI head office or mall satellite clinic with 8 Blood Chem (8BC) plus consultation with 2 specialists. ANNUAL 17,624 31,881 46,978 61,296 77,174 15,637
Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents)
Plan 3500 Dreaded Disease Limit 150,000
Pre-existing Conditions Coverage Emergency care in non-accredited, 80% based on MRV** up to
In-patient: standard Out-patient: covered up to P 8,000 per illness per year 100,000
OP Meds reimbursement w/ OR and prescription from MEDICard doctor 1,500 per year (vitamins & maintenance meds are excluded) May use own doctor (Reimbursement Type) including int’l. coverage / overseas & Asian Hospital Annual Out-Patient Executive Check-Up Out-patient: max. of 8 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 2,500. MPI head office or mall satellite clinic with 8 Blood Chem (8BC) plus KUB, lower abdominal ultrasound and consultation with 2 specialists. ANNUAL Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents) 20,900 37,772 52,239 65,960 81,138 16,348
Plan 5000 Dreaded Disease Limit Pre-existing Conditions Coverage Emergency care in non-accredited, 80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor (vitamins & maintenance meds are 200,000 Covered up to P 10,000 per illness per year on the 1st year (In-patient & out-patient combined) 150,000 2,000 per year
excluded) Out-patient: max. of 10 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 3,000. In-patient: 80% up to P30,000 with P 1,500 deductible based on MRV** HUMANA Executive package B ANNUAL Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents) 38,111 68,744 82,739 96,010 110,729 17,945
May use own doctor (Reimbursement Type) including int’l. coverage / overseas & Asian Hospital
Annual Out-Patient Executive CheckUp
Plan 8000 Dreaded Disease Limit Pre-existing Conditions Coverage Emergency care in non-accredited, 80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor (vitamins & maintenance meds are excluded) 300,000 Covered up to P 12,000 per illness per year on the 1st year (In-patient & out-patient combined) 200,000
3,000 per year Out-patient: max. of 15 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 5,000 In-patient: 100% up to P50,000 with P 3,000 deductible based on MRV**
May use own doctor (Reimbursement Type) including int’l. coverage / overseas & Asian Hospital
Annual Out-Patient Executive CheckUp Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents)
HUMANA Executive package of choice ANNUAL 55,786 100,555 113,914 126,580 140,630 18,448
Note :
•
Non-PhilHealth members(e.g. parents below 60 and unemployed, etc.) shall pay the corresponding portion during confinements
•
Executive check ups are for principal member plus one (1) dependent only (if dependents are enrolled)
•
•
Medical evaluation for enrollees age 41 and above is waived. For confinements and availments in Makati Medical Center which has a blanket authority policy, all disapproved charges and excess in limits shall be settled directly with the hospital upon exhaustion of limit. Failure of patient to settle the excess bill shall necessitate MEDICard to bill the member with corresponding 20% service fee and payable within ten (10) working days from receipt of billing.
•
Above rates are inclusive of VAT.
AHMC Asian Hospital and Medical Center SLMC St. Luke's Medical Center CSMC Cardinal Santos Medical Center MMC Makati Medical Center MCGH Medical City General Hospital
**MEDICard Relative Value UNDERWRITING GUIDELINES:
•
Cut-off dates in assigning effectivity dates:
Date of Receipts Effective Date 11 to 25 every 1st of the following month 26 to 10 every 16th of the month
•
Lost ID/Contract
Any lost ID/contract must be immediately reported in writing using the Statement of Lost ID/Contract Form. The following are the rates or processing fees: Lost ID Card : P 50.00 Lost Contract : P25.00
In 1987, a group of eminent physicians from the most distinguished medical centers in the country, concerned at the ability of working people to pay for much needed quality health care, consolidated their resources together to put up MEDICard Philippines, Inc. MEDICard is a pioneer in the industry. The owners have been in the health care service for years. The country had suffered badly during the waning years of Marcos rule. Health costs were rising, but incomes were falling. Even middle income families were finding difficulty in putting money for emergencies. Thus, if sickness occurred the necessary funds were just not available to receive treatment and pay for medicines. MEDICard was born out of a desperate need. One of the founders, who was to become the first president, Dr. Nicanor D. Montoya M.D., held a very simple philosophy. It was that if a person could just put away P3.00 per day, (not a large sum, even then), he could afford hospitalization. From this premise, MEDICard was created. An organization was formed, MEDICard (Philippines) Inc., that would provide quality comprehensive health care services to a large number of Filipinos, at a cost that they could afford. Just one year later, operating from the 9th floor, Sagittarius Building, H.V. dela Costa Street, Salcedo Village, Makati City, the company commenced marketing the scheme. Recruitment of members was slow at first until it was realized that more could be reached more quickly by enlisting companies who were large employers. The advantages of this scheme to all participants were so obvious that the marketing strategy was immediately successful. The scheme was then expanded to appeal to company executives and middle managers as well as the rank and file. By 1990, the success of the scheme enforced the opening of further offices in Cagayan de Oro, Cebu and Davao City. These offices were tasked with the coordination of accredited providers and giving assistance to members. The expansion of the Company meant continual updating of systems and procedures. The founders and operating officers being mainly from the medical profession have given MEDICard a uniqueness that is difficult to be matched by other organizations that offer medical insurance. Being of the profession, more attention is given to the service than the finances. Investment is constantly being made to make quality health care services available to its
ever-growing membership throughout the country. It is the dedication to good health and services as envisioned by the founding doctors that has made MEDICard a company whose members can always rely on. Since its inception, the concept of service-oriented total health care has been the molding ideal of MEDICard. The competition is vast, and the benefits being offered by the competitors are tempting. However, MEDICard has taken the lead in providing innovative and productive ideas that cut down the cost of health maintenance without compromising its quality. And our predominantly corporate- based clientele totaling about 300,000 members from more than 1700 companies can attest to the quality of service afforded to them by our network of more than 240 hospitals and approximately 3000 doctors and dentists nationwide. MEDICard is a Health Maintenance Organization that provides a comprehensive health care program for its members. This includes emergency care, hospital confinement, preventive health care, dental care and out-patient consultation services. MEDICard is not an insurance company because unlike an insurance company where you pay your bills for reimbursement later, MEDICard guarantees all your medical expenses, including that all-important hospital deposit. Then you need not worry about money. All you need is your MEDICard ID. MEDICard will take care of everything else for you. Today, with a total of more than 448,000 members, MEDICard Philippines, Inc. is associated with over 8,000 accredited doctor, specialists and dentists, operating out of over 300 hospitals and clinics nationwide. Operating 24 hours each and every day, MEDICard Philippines, Inc. provides a quality healthcare service to all its members.
Individual and Family Plan
Without AHMC, MMC, SLMC, MCGH & CSMC
PLAN 550 Limit for Dreaded Disease Principal member Only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 or more dependents P 50,000 ANNUAL P 6,767 12,267 18,082 23,900 29,715
PLAN 800 P 60,000 ANNUAL P 7,592 13,754 19,843 25,931 32,023
All Hospitals PLAN 1500 * Limit for Dreaded Disease Principal member Only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 or more dependents P 100,000 ANNUAL P 11,877 21,508 31,704 41,897 52,088 PLAN 2500 P 120,000 ANNUAL P 13,805 24,969 36,187 47,404 58,621
* Without Asian Hospital and Medical Center (AHMC) MEMBERSHIP ELIGIBILITY PRINCIPAL MEMBER Company or self-employed individual 18 years old up to age 60. DEPENDENTS For Married Principal Member 1. The legal spouse at least 18 years old up to age 60
2. Legitimate and/or legally adopted children above 90 days up to 21 years of age unmarried and unemployed and living under the same roof as the principal member For Single Principal Member 1. Parents up to age 60, unemployed and dependent upon the principal member 2. Brothers and sisters above 90 days up to 21 years of age who are not gainfully employed, unmarried and are living under the same roof as the principal member
Enrollees age 41 and above are required to undergo a medical evaluation at the MPI head office clinic, 9th floor Sagittarius Bldg., H.V. de la Costa St., Salcedo Village, Makati City with a minimal fee of P 450.00 per head. 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. For single personnel, the parents must be enrolled first followed by eldest brother/sister and so on. Note :
•
Non-PhilHealth/Medicare members (e.g. parents below 60 and unemployed, etc.) shall pay the corresponding portion during confinements
•
For confinements and availments in Makati Medical Center which has a blanket authority policy, all disapproved charges and excess in limits shall be settled directly with the hospital upon exhaustion of limit. Failure of patient to settle the excess bill shall necessitate MEDICard to bill the member with corresponding 20% service fee and payable within ten
(10) working days from receipt of billing.
•
Above rates are inclusive of 2.4% VAT, representing 12% of 20% of the total premium as proposed by AHMOPI wherein 80% is being earmarked for medical-related services.
AHMC - Asian Hospital and Medical Center, SLMC - St. Luke's Medical Center, CSMC - Cardinal Santos Medical Center, MMC Makati Medical Center, MCGH - Medical City General Hospital
VIP Program
Plan 2500 Dreaded Disease Limit Pre-existing Conditions Coverage Emergency care in non-accredited, 80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor (vitamins & maintenance meds are excluded) May use own doctor (Reimbursement Type) 100,000 In-patient: standard Out-patient: covered up to P 5,000 per illness per year. 75,000
1000 per year Out-patient: max. of 5 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 1,500. MPI head office clinic or mall satellite clinic with 8 Blood Chem (6BC) plus consultation with 2 specialists. ANNUAL 17,624
Annual Out-Patient Executive CheckUp
Principal Member only
Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents)
31,881 46,978 61,296 77,174 15,637
Plan 3500 Dreaded Disease Limit Pre-existing Conditions Coverage 150,000 In-patient: standard Out-patient: covered up to P 8,000 per illness per year
Emergency care in non-accredited, 100,000 80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor 1500 per year (vitamins & maintenance meds are excluded) May use own doctor (Reimbursement Type) Out-patient: max. of 8 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 2,500. MPI head office clinic or mall satellite clinic with 8 Blood Chem (8BC) plus KUB, lower abdominal ultrasound and consultation with 2 specialists. ANNUAL Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents) 20,900 37,772 52,239 65,960 81,138 16,348
Annual Out-Patient Executive Check-Up
Plan 5000 Dreaded Disease Limit Pre-existing Conditions Coverage Emergency care in non-accredited, 80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor (vitamins & maintenance meds are excluded) 200,000 Covered up to P 10,000 per illness per year on the 1st year (In-patient & out-patient combined) 150,000
2000 per year Out-patient: max. of 10 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 3,000. In-patient: 80% up to P30,000 with P 1,500 deductible based on MRV** HUMANA Executive package B ANNUAL
May use own doctor (Reimbursement Type)
Annual Out-Patient Executive CheckUp Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents)
38,111 68,744 82,739 96,010 110,729 17,945
Plan 8000 Dreaded Disease Limit Pre-existing Conditions Coverage Emergency care in non-accredited, 300,000 Covered up to P 12,000 per illness per year on the 1st year (In-patient & out-patient combined) 200,000
80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor (vitamins & maintenance meds are excluded) 3000 per year Out-patient: max. of 15 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 5,000 In-patient: 100% up to P50,000 with P 3,000 deductible based on MRV** HUMANA Executive package of choice ANNUAL Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents) 55,786 100,555 113,914 126,580 140,630 18,448
May use own doctor (Reimbursement Type)
Annual Out-Patient Executive CheckUp
Note :
•
Non-PhilHealth members(e.g. parents below 60 and unemployed, etc.) shall pay the corresponding portion during confinements
•
Executive check ups are for principal member plus one (1) dependent only (if dependents are enrolled)
•
•
Medical evaluation for enrollees age 41 and above is waived. For confinements and availments in Makati Medical Center which has a blanket authority policy, all disapproved charges
and excess in limits shall be settled directly with the hospital upon exhaustion of limit. Failure of patient to settle the excess bill shall necessitate MEDICard to bill the member with corresponding 20% service fee and payable within ten (10) working days from receipt of billing. • Above rates are inclusive of VAT.
AHMC Asian Hospital and Medical Center SLMC St. Luke's Medical Center CSMC Cardinal Santos Medical Center MMC Makati Medical Center MCGH Medical City General Hospital **MEDICard Relative Value
Individual and Family Program
MEMBERSHIP ELIGIBILITY Principal Member: Any person at least 18 years old and up to 60 years old. Qualified Dependent Member:
1. For Married Principal Members
The legal spouse up to 60 years old Legitimate and/or legally adopted children 90 days and up to 21 years of age who are not gainfully employed and living under the same roof as the principal member.
2. For Single Principal Members
Parents up to age 60, unemployed and dependent on the principal
member. Brothers and sisters 90 days old and up to age 21 who are not gainfully employed and are living under the same roof as the principal member. Note: 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 principal member. For single, the parents must be enrolled first followed by the eldest brother/sister and so on. Deadline for enrollment of dependents:
•
For dependents who meet the eligibility requirements within the agreement period -30 days form the date dependent become eligible for membership. (copy of birth certificate or marriage contract must be submitted)
•
Any additional dependents other than the above can be enrolled upon the renewal of agreement.
•
After the lapse of the period specified above, MEDICard will no longer receive, evaluate and accept any designation or application to be a qualified dependent from any PRINCIPAL MEMBER.
Underwriting cut-off dates in assigning effectivity date: Date of Receipt of Application/Endorsement 11th to 25th of the month 26th to 10th of the month Effectivity Date 1st of the following month 16th of the same month
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 preexisting condition/ dreaded disease limits will be computed on a prorated basis (i.e. If age of eligibility is up to 60 years old, only who are 60 years and 6 months old and younger will be accepted for membership).
Renewing members who will become age eligible 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 conditions/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 that member remains eligible/12) x PEC/DD limit = Pro-rated Limit In relation to his dependents, the MEMBER shall be known as the PRINCIPAL and he shall be deemed to have undertaken to comply with all the requirements and obligations of individual regular membership under this MMA on behalf of said dependent/s, particularly the payment of all the required fees, dues and charges.
Group and Corporate Program
MEMBERSHIP ELIGIBILITY Group Program With 5 to 10 principal members of legal age, 18 up to 60 years old. Corporate Program With at least 11 principal members of legal age, 18 up to 60 years old. Request for a Quotation Click here to request for a quote for Group and Corporate Programs. Kindly specify the number of members to be included in the program.
VIP Program
EMERGENCY CARE IN NON- ACCREDITED HOSPITAL When a member is in immediate danger of losing a limb, eye or other parts of the body or is in severe pain that requires immediate relief and enters a
non MEDICARD accredited hospital for treatment, MEDICARD agrees to reimburse only eighty percent (80%) of the total hospital bills inclusive of professional fees and based on relative values for MEDICARD accredited hospitals, but not to exceed the amount of P60,000.00. OTHER BENEFITS
1. Prescribed out-patient medicine reimbursement shall be covered up to
P1,000.00 per member per year excluding vitamins and maintenance medicines provided official receipt and prescription from MEDICard physician must be submitted.
2. POINT OF SERVICE PROGRAM
Point of service benefit allows members to avail of services from nonaccredited doctors and hospitals subject to the reimbursement limits on the table below: Type of Availment Rate of Reimbursement
Out Patient Consultation/Day Approved laboratory examinations as if prescribed by the HMO physician
3. *MRV-MEDICard Relative Value 4. ANNUAL EXECUTIVE CHECK-UP (AECU)
Maximum of 8 consultations based on MRV* up to P250.00 per consultation. 80% up to P2,500.00
MEDICard agrees to cover annual executive check-up at MEDICard Head Office Clinic, package includes the routine examination and the following additional tests:
6 Blood Chemistry KUB and abdominal ultrasound PLANS Plan 2500 Dreaded Disease Limit Pre-existing Conditions Coverage Emergency care in non-accredited, 80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor (vitamins & maintenance meds are excluded) May use own doctor (Reimbursement Type) including int’l. coverage / overseas & Asian Hospital Annual Out-Patient Executive CheckUp 100,000 In-patient: standard Out-patient: covered up to P 5,000 per illness per year. 75,000
1,000 per year Out-patient: max. of 5 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 1,500. MPI head office or mall satellite clinic with 8 Blood Chem (8BC) plus consultation with 2 specialists. ANNUAL 17,624 31,881 46,978 61,296 77,174 15,637
Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents)
Plan 3500 Dreaded Disease Limit 150,000
Pre-existing Conditions Coverage Emergency care in non-accredited, 80% based on MRV** up to
In-patient: standard Out-patient: covered up to P 8,000 per illness per year 100,000
OP Meds reimbursement w/ OR and prescription from MEDICard doctor 1,500 per year (vitamins & maintenance meds are excluded) May use own doctor (Reimbursement Type) including int’l. coverage / overseas & Asian Hospital Annual Out-Patient Executive Check-Up Out-patient: max. of 8 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 2,500. MPI head office or mall satellite clinic with 8 Blood Chem (8BC) plus KUB, lower abdominal ultrasound and consultation with 2 specialists. ANNUAL Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents) 20,900 37,772 52,239 65,960 81,138 16,348
Plan 5000 Dreaded Disease Limit Pre-existing Conditions Coverage Emergency care in non-accredited, 80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor (vitamins & maintenance meds are 200,000 Covered up to P 10,000 per illness per year on the 1st year (In-patient & out-patient combined) 150,000 2,000 per year
excluded) Out-patient: max. of 10 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 3,000. In-patient: 80% up to P30,000 with P 1,500 deductible based on MRV** HUMANA Executive package B ANNUAL Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents) 38,111 68,744 82,739 96,010 110,729 17,945
May use own doctor (Reimbursement Type) including int’l. coverage / overseas & Asian Hospital
Annual Out-Patient Executive CheckUp
Plan 8000 Dreaded Disease Limit Pre-existing Conditions Coverage Emergency care in non-accredited, 80% based on MRV** up to OP Meds reimbursement w/ OR and prescription from MEDICard doctor (vitamins & maintenance meds are excluded) 300,000 Covered up to P 12,000 per illness per year on the 1st year (In-patient & out-patient combined) 200,000
3,000 per year Out-patient: max. of 15 consults, up to P 250 per consultation. Laboratory exams are covered 80% up to P 5,000 In-patient: 100% up to P50,000 with P 3,000 deductible based on MRV**
May use own doctor (Reimbursement Type) including int’l. coverage / overseas & Asian Hospital
Annual Out-Patient Executive CheckUp Principal Member only Principal + 1 dependent Principal + 2 dependents Principal + 3 dependents Principal + 4 dependents In excess of 4 dependents (per dependents)
HUMANA Executive package of choice ANNUAL 55,786 100,555 113,914 126,580 140,630 18,448
Note :
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Non-PhilHealth members(e.g. parents below 60 and unemployed, etc.) shall pay the corresponding portion during confinements
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Executive check ups are for principal member plus one (1) dependent only (if dependents are enrolled)
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Medical evaluation for enrollees age 41 and above is waived. For confinements and availments in Makati Medical Center which has a blanket authority policy, all disapproved charges and excess in limits shall be settled directly with the hospital upon exhaustion of limit. Failure of patient to settle the excess bill shall necessitate MEDICard to bill the member with corresponding 20% service fee and payable within ten (10) working days from receipt of billing.
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Above rates are inclusive of VAT.
AHMC Asian Hospital and Medical Center SLMC St. Luke's Medical Center CSMC Cardinal Santos Medical Center MMC Makati Medical Center MCGH Medical City General Hospital
**MEDICard Relative Value UNDERWRITING GUIDELINES:
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Cut-off dates in assigning effectivity dates:
Date of Receipts Effective Date 11 to 25 every 1st of the following month 26 to 10 every 16th of the month
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Lost ID/Contract
Any lost ID/contract must be immediately reported in writing using the Statement of Lost ID/Contract Form. The following are the rates or processing fees: Lost ID Card : P 50.00 Lost Contract : P25.00
