Value Care Health Insurance

CURRENT BENEFIT COVERAGE

HEALTHCARE BENEFITS

Current Coverage

A.

OUT-PATIENT CARE

HOSPITAL BASED - ENHANCED BENEFITS

Note: All out patient may be availed only at HMO Primary Care Center and Affiliated Clinics. Consultations with specialists in affiliated hospitals are covered. 

1

Medically necessary consultations during regular clinic hours

covered

2

Pre and Post Natal consultations

covered at any affiliated clinics/hospitals

3

Treatment of minor injuries and burns

4

Eye, Ear Nose and Throat Treatments

covered

5

X-Ray, laboratory examinations, routine, diagnostic and therapeutic procedures prescribed by an affiliated physician/spe cialist

covered

6

Minor surgery not requiring confinement

covered

7

Laser Therapy excluding eye correction such as lasik, PRK and the like

covered up to MBL

8

Speech Therapy (for stroke patients only)

covered up to MBL

9

Physical Therapy/Occupational Therapy excluding subspecialties such as cardiac rehab and pulmo rehab

covered up to MBL

10

Cauterization of Warts from head to feet except genital warts and condyloma acuminatum

facial warts are covered up to PhP. 2,000; neck down up to MBL except genital warts and condyloma acuminatum

11

Allergy Testing/ allergy screening and other related examinations 

covered except cost of allergens

12

Tuberculin test prescribed by an Affiliated Physician to be availed at the HMO Primary Care Centers

covered

13

Sclerotherapy for varicose veins as prescribed by an Affiliated availed at HMO Primary Care Centers

covered up to MBL

B.

IN-PATIENT CARE

Note: All Inpatient and Emergency cases may be availed at all HMO Accredited Hospitals.

1

Professional Fees of attending doctor/s 

covered

2

X-ray, laboratory tests and other diagnostic procedures 

covered

3

Anesthesia and its administration

covered

4

Whole blood and human blood transfusions a nd IV fluids

covered

5

Oxygen and its administration

covered

6

Drugs and medicines for use in the hospital

covered

7

Sutures, dressings and plaster casts / casting materials

covered

8

Use of operating and recovery rooms 

covered

9

Use of the Intensive Care Unit (ICU) and Pre Operative Items

covered

10

Standard Nursing Services

covered

11

Admission kit including ice cap and wee bag

covered

12

Other supplies/services directly related to the medical  management of the patient

covered

13

Reconstructive Surgery due to accidental injury

covered

14

Provision in cases of room in availability

up to 48 hours

C.

Routine Check Up

1

Physical Examination

covered

2

Complete Blood Count

covered

3

Urinalysis

covered

4

Fecalysis

covered

5

Chest X-ray

covered

6

ECG

covered

7

Pap Smear

covered

8

Pre Employment Examination

if not hired, additional PhP. 450 per examinee

9

Mobile Annual Check up (at company's premises)

covered

D.

PREVENTIVE CARE

1

Periodic monitoring of health problems

covered

2

Wellness programs

covered

3

Diet counseling and exercise prescriptions

covered

4

Health habits and Family Planning counseling

covered

5

Administration of routine immunizations

6

Passive and active vaccines for treatmen t of animal bites, snake bites and tetanus 

covered up to PhP18,000 per member per year

7

Anti Flu Vaccine

covered every 1st quarter of the year

8

Anti Hepatitis Vaccine

covered-as per Company Schedule

E.

EMERGENCY CARE

1

In Accredited Hospitals

up to MBL

1.1.  Professional Fees of attending physicians

covered

1.2.  Emergency Room Fees

covered

1.3.  Medicines used for immediate relief during treatme nt

covered

1.4.  Whole blood/human blood products

covered

1.5.  Oxygen and IV fluids

covered

1.6.  X-ray, laboratory tests and other diagnostic procedures

covered

1.7 Ambulance Service (accredited to accredited)

PhP. 2,500 per conduction

2

In Non-Accredited Hospitals

100% based on Relative Unit Value up to MBL

2.1 Ambulance Service (non accredited to accredited)

PhP. 2,500 per conduction

3

Outside the Philippines

100% based on Relative Unit Value up to MBL

4

Areas w/o Accredited Hospital 

100% based on Relative Unit Value up to MBL

5

Room Upgrade in case of room unavailability

first 48 hours