CareHealth Plus - Sales Counselor Veegee

04/12/2022

1. HOSPITALIZATION SERVICES AND SPECIAL PROCEDURE (HSSP)

B. Special Procedures
If Medically Necessary, we shall provide or pay the following
special procedures, including hospital confinement if required
1. X-ray
2. Ultrasound
3. Basic Mammography
4. Treadmill Test and / or 2D Echocardiography
5. CT (computed tomography) scan
6. MRI (magnetic resonance imaging)
7. Nuclear TEst
8. Hemodialysis
9. Chemotheraphy or Radiotheraphy
10. Cataract Extraction
11. Other special diagnostic or therapeutic procedures that we
deem appropriate.
9.

04/12/2022

1. HOSPITALIZATION SERVICES AND SPECIAL PROCEDURES (HSPC)

C. Emergency Care
1. We shall provide a pay for the actual charges for healthcare
services classified under Hospitalization Services and Special
Procedures (HSPC) , if emergency care is secured at our
Affiliated hospital or clinic.
2. If emergency care is secured at a non-affiliated hospital or
clinic, we shall refund Eighty (80%) of the documented actual
charges for said healthcare services based on our standard
rates.
3. If necessary, transportation or ambulance service from a non-
affiliated hospital shall be refunded provided that the transfer
is authorized by our accredited doctor and cleared by your
attending doctor.
4. It is necessary to notify Us within Forty Eight (48) hours after
the start of emergency medical condition eight directly or
through your representative, or else we shall not be liable for
any emergency care or service.

01/12/2022

2. OUT-PATIENT CARE (OPC)
a. Out-patient Services
1. Up to Fifteen (15) medical consultations per year
2. Up to Twelve (12) pre or post natal consultations per
pregnancy
3. Treatment of minor illnesses or injuries
4. Minor surgeries, i.e. those not requiring hospital
facilities
5. Eye, ear, nose and throat treatment.

28/11/2022

2. OUT-PATIENT CARE (OPC)
c. Preventive Care
1. Periodic Monitoring of health problems
2. Consultation on exercise, diet and other healthful habits
3. Counselling on family planning
4. Vaccination excluding cost of drugs or vaccine
5. Attendance at company-sponsored health seminars

28/11/2022

2. OUT-PATIENT CARE (OPC)
d. Dental Care
1. Up to Six (6) consultations per year
2. Semi-annual oral prophylaxis after at least Three (3) months
after the Effective Date
3. Tooth Extraction but excluding surgery
4. Temporary filling or recementation
5. Treatment of oral lesions, wounds and burns

28/11/2022

2. OUT-PATIENT CARE(OPC)
Other Services
1. Twenty-four (24) hour assistance by phone
2. Discounts on non-covered healthcare services at selected clinics, laboratories, drug stores or optical shops.
3. Up to Six (6) medical or dental consultations per year for One(1) pre-designated dependent qualified as such as under the SSS Law (RA 8282)

27/11/2022

OUT-PATIENT CARE (OPC)

B. Annual Physical Examination (APE) after at least Three (3)
months after the Effective Date, to include:
1. Taking of Medical history
2. Medical Examination
3. Chest X-Ray (posterior or anterior)
4. CBC (complete blood count)
5. Stool and urine examination
6. Uric acid test
7. FBS (fasting blood sugar)
8. ECG (electrocardiogram) for Thirty (30) years old & above
9. Pap smear for Thirty (30) years old and above

27/11/2022

2. Out-Patient Care (OPC)
Out-Patient benefits enenumerated below without any charges will be deducted from the Maximum Benefit Level, as follows:

a. Outpatient Services
1. Up to Fifteen (15) medical consultation per year
2. Up to Twelve (12) pre o post natal consultation per
pregnancy
3. Treatment of Minor illnesses or injuries
4. Minor surgeries, e.i. those not requiring hospital facilities
5. Eye, ear, nose and throat treatment

b. Annual Physical Examination (APE) after at least Three (3)
Months after the Effective Date to include:
1. Taking of medical history
2. Medical Examinations
3. Chest X-ray (posterior or anterior)
4. CBC (complete blood count)
5. Stool and urine examination
6. Uric Acid Test
7. FBS (fasting blood sugar)
8. ECD (electrocardiogram) for Thirty (30) yrs old and above
9. Pap smear for Thirty (30) years old and above

c. Preventive Health Care
1. Periodic monitoring of health problems
2. Consultation on exercise, diet and other healthful habits
3. Counselling on family planning
4. Vaccination but excluding cost of drugs or vaccine
5. Attendance at company-sponsored health seminars

d, Dental Care
1. Up to Six (6) consultation a year
2. Semi-Annual oral prophylaxis after at least Three (3)
months from the Effective Date
3. Tooth Extraction but excluding surgery
4. Temporary Filling or recementation
5. Treatment of oral lesions, wounds and burns

e. Other Services
1. Twenty-four (24) hour assistance by phone
2. Discounts on non-covered healthcare services at selected
clinics, laboratories, drug store or optical shops
3. Up to Six (6) medical or dental consultations per year for
Once (1) pre-designated dependent qualified as such
under the SSS Law (RA 8282)

26/11/2022

1. HEALTHCARE BENEFIT:

1. Hospitalization Services,

26/11/2022

Health Care Benifits
1. Hospitalization Services & Special Procedures
a. Hospitalization Services
1. Room and Board
2. Consultation and professional services of an affiliate doctor
or specialist
3. Laboratory tests, x-rays, and other prescribed diagnostic or
therapeutic procedures
4. Dressing, plaster cast and other medical supplies
5. Prescribed drugs and medication used in the hospital
6. Use of medical or surgical facilities and equipment,
operating and recovery room, intensive care unit, dialysis
and chemotherapy equipment
7. Administration of anesthesia or oxygen
8. Transfusion of hospital-provided whole blood or plasma

b. Special Procedures- if necessary and required during
Confinement these are included in hospital bill payment
1. X-ray
2. Ultrasound
3. Basic mammography
4. Treadmill test and/ or 2D Echocardiography
5. CT (computed tomography) scan
6. MRI (magnetic resonance imaging)
7. Nuclear Test
8. Chemotherapy or Radiotherapy
9. Hemodialysis
10. Cataract extraction
11. Other special procedure or therapeutic that we deem
appropriate.

c. Emergency Care: in event of emergency cases, health care
services the patient is entitled,
1. Actual charges of healthcare services classified under
Hospitalization Services and Special Procedures as
prescribed above, if emergency care is secured at our
affiliated hospital or clinic.
2. If Emergency Care is secured at non-affiliated hospital
or clinic , Eighty percent (80%) of documented actual
charges for said health care services based on our
standard rates.
3. If necessary, transportation or ambulance service from
a non-affiliated hospital or clinic shall be refunded
provided that the transfer is authorized by our accredited
doctor and cleared by our Attending doctor.
4. It is necessary to notify us within Forty Eight (48) hrs after
the start of the emergency medical condition either directly
or through your representative or else we shall not be
liable for any emergency care or service.
5. In any of the above circumstances , we reserve the right to
validate if the situation is as emergency or if the illness or
injury is covered under this agreement.

The charges for healthcare services under Hospitalization
Services, Special Procedures and Emergency Care described
above shall be accumulated and should be kept within the
Maximum Benefit Limit (MBL) prescribed in Art Vl hereunder.

26/11/2022

22/11/2022

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