Hospital Confinement

MEMBERSHIP BENEFITS AND PRIVILEGES 1. The following no charge hospitalization (In-Patient) services will apply when MediCard physicians prescribe the hospitalization of members in any MediCard Hospitals or MediCard centers:Non-emergency confinement or surgery (elective cases) shall be subject to prior review and approval by the MediCard review board. MediCard reserves the right to direct the members to other physicians or specialist for further opinions as needed so as to protect the interest of both the member and MediCard. No deposit upon admission Room & Board according to type of enrollment Use of operating theater and Recovery Room Services of MediCard specialist like anaesthesiologists, internists, surgeons, etc. Services and medications for general/spinal anaesthesia or other forms of anaesthesia deemed necessary for a surgical procedure. Fresh whole blood transfusions and intravenous fluids X-ray and Laboratory examinations Administered medicines Dressings, plaster casts, sutures and other items directly related to the medical management of the patient ICU confinements, Chemotherapy, Radiotherapy, and Dialysis are covered subject to maximum limits and pre-existing conditions coverage Modern therapeutic modalities and interventional surgical procedures such as, but not limited to laparoscopic surgery and lithotripsy, are covered up to P20,000 each per years subject to the pre-existing conditions coverage CT Scan, MRI and ultrasound are covered up to P5,000 each per member per year subject to the pre-existing conditions coverage (inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure): The following complex diagnostic examinations and the therapeutic procedures shall be covered up to P5,000.00 each per member per year subject to the pre-existing conditions coverage (inclusive of room and board, operating room charges , professional fees and other incidental expenses relative to the procedure): Angiography (e.g. coronary, cerebral, retinal, pulmoanry, GI, etc.) Pulmonary perfusion scan Tests involving use of Nuclear Technologies (Radionuclide Ventriculography/Thallium stress testing/Radionuclide/Thyroid scan, etc.), nuclear technologies such as Pyrosphosphate Scintigraphy, Positron Emission Tomography, Radio Isotope Scanning, etc.) Electromyography, Nerve Conduction Velocity Studies 24-Hour Holter Monitoring, 2-D Echo and Doppler Treadmill Stress Test Myelogram Endoscopy including one of video Orthopedic Arthroscopy Adrecortical Function (e.g. Primary Aldosteronism, Cushings Disease) Plasma/Urinary Cortisol, Plasma Aldosterone, etc. Mammography (breast cancer) and Sonomammogram Bone densitometry scan (Dexascan) Anti-nuclear antibody (ANA), C-Reactive protein (Rheumatic and its complications), Lupus cell exam Laboratory/ancillary services for conditions whose pathogenesis or subsequent clinical improvement is not yet fully established in Medical Science New modalities and / or diagnostic and treatment procedure for conditions with established etiologies and its use...

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Out-Patient Care

MEMBERSHIP BENEFITS AND ELIGIBILITY The Following outpatient services will be provided to members in MediCard accredited hospitals or clinics: • Referral to specialists • Regular consultations and treatment (except prescribed medicines) • Eye, ear, nose and throat treatment • Treatment of minor injuries and surgeries not requiring confinement • X-ray and laboratory examinations prescribed by MediCard physician The member can go directly to the primary physician of any accredited hospital or at the head office clinic for outpatient consultations. The primary physician will request for laboratory or diagnostic examinations or refer the member to a specialist. The member may avail of services from any accredited hospital of his...

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Preventive Health Care

Preventive healthcare services are provided to members to assure that their health status is regularly and properly monitored. MEMBERSHIP BENEFITS AND PRIVILEGES The following no-charge Preventive Health Care Services will be provided to members at MediCard Head Office Clinic or at anyy designated MediCard Medical Service Units: 1. Annual Physical Examination (APE) to include:Management of Health Complete Blood Count Urinalysis (urine examination) Fecalysis (stool examination) Chest X-ray Electrocardiogram (for adults age 40 and above, or if indicated) Pap Smear (for women age 40 and above, or if indicated) 2. Management of Health 3. Routine Immunization (except cost of vaccines) 4. Counselling on health habits, diets and Family Planning 5. Record Keeping of Medical History Family and individual Clients: APE may be availed at the MediCard Lifestyle Center or at MediCard mall clinic in Festival Super Mall, Alabang, Muntinlupa City. Group and Corporate Clients: Coordinate with your company’s Human Resources/Clinic or the assigned personnel facilitating your MediCard services for your company’s group schedule. Note: APE after Semi-Annual or three quarterly payments for SME and Corporate...

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Emergency Care

In the event of any life threatening condition caused by any illness or injury, MediCard shall provide its members the following emergency care services: MEMBERSHIP BENEFITS AND PRIVILEGES When the member is under Emergency Case and ends up at the emergency room of MediCard Accredited Hospitals or MediCard centers, the following are provided free of charge: Doctor’s services Medicines used during treatment or for immediate relief Oxygen and intravenous fluids Dressings, casts, and sutures Laboratory, X-ray and other diagnostic examinations directly related to the emergency management of the patient. EMERGENCY CARE IN NON-MEDICARD Accredited Hospitals For emergency medical services in non-MediCard accredited medical facilities, members must first settle all payments and later file reimbursement from MediCard. MediCard shall reimburse eighty percent (80%) of the total bills, inclusive of professional fees, based on what would have cost had the service been rendered in an accredited hospital through the services of an accredited doctor, but not to exceed the amount of ₱5,000. MediCard shall reimburse members for the medical services in non-accredited hospitals when it is verified that MediCard facilities were not used because to have done so would entail a delay resulting in death, serious disability or significant jeopardy to the member’s condition or the choice of hospital was beyond the control of the member or the member’s family. In filing reimbursement for emergency medical services availed in non-participating hospitals, members must submit to MediCard Claims and Reimbursement Section the following documents within (30) calendar days from discharge: a. Duly filled-out claim form b. Official receipt (original) c. Itemized statement of account d. Charge slips/itemized breakdown of charges e. Professional fee receipts (original) f. Medical certificate/clinical abstract g. Hospital report/surgical report (for any procedure done) h. Incident report i. Police reports, if due to accident or medico-legal case j. Photocopy of MediCard ID k. Prescription of attending physician for medicines purchased 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 (80%) of the total hospital bills inclusive of professional fees and base on relative values for MediCard accredited hospitals, but not to exceed the amount of P5,000.00. MediCard shall pay the said amount when it is verified that MediCard facilities were not used because to have done so would...

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Members Financial Assistance

Aside from the healthcare benefits, the principal member is entitled to a life indemnity program providing his heirs with financial assistance in the event of death or injuries through natural causes or accidental means. The indemnities are subject to the following schedule: SCHEDULE OF MEMBERS’ FINANCIAL ASSISTANCE Natural Death P   10,000.00 Accidental Means P   20,000.00 Loss of both hands P   10,000.00 Loss of both feet P   10,000.00 Loss of sight (both eyes) P   10,000.00 Loss of one hand and one foot P   10,000.00 Loss of one hand and sight of one eye P   10,000.00 Loss of one foot and sight of one eye P   10,000.00 Loss of one hand or one foot P    5,000.00 Loss of sight of one eye P    5,000.00   MFA is extended on the condition that the death or injury results from causes that are covered and are not under the exclusions or uncovered pre-existing conditions. Also, total annual premium for the agreement year should have been paid at the time of availment. Otherwise, all remaing unpaid annual premiums will be deducted from the amount of assistance. In filing for MFA, the survived members must submit to MediCard Claims and Reimbursement section the following documents within sixty (60) days from the occurance of death or accident: a. MediCard membership card b. Affidavit of next of kin or marriage agreement c. Death Certificate (original copy) d. Atending Physician’s Statement (duly notarized) e. Certificate of employment of principal member f. Police Report (in case of an...

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Dental Care

MEMBERSHIP BENEFITS AND PRIVILEGES Members may avail of the following dental care services from any of the accredited dental clinics: Once a year oral prophylaxis (after having paid the annual premium) Consultations and oral examinations Simple tooth extractions, except surgery for impacted tooth Temporary fillings Gum treatment and adjustment of dentures Recementation of loose jackets, crowns in-lays and on-lays Treatment of mouth lesions, wounds and burns Dental care services availment procedures: 1. Call dentist to set up appointment (refer to list of dentists provided) 2. Visit dentist and present MediCard ID to avail of service 3. Sign all related documents and forms after treatment/procedure was...

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