DELIVERY SYSTEM
HOSPITAL BASED: Planholders can proceed directly to an accredited hospital.
NETWORK ACCESS: Planholders can directly access the list of ValuCare accredited hospitals, coordinators and affiliate/accredited clinics.
PHILHEALTH INTEGRATED: The plan is integrated with the PhilHealth benefits;
Planholders are required to file and submit duly accomplished PhilHealth forms at the billing section of the hospital. Planholders who are not members of PhilHealth and/or not qualified under PhilHealth provisions (i.e. foreigners, unemployed parents below sixty (60) yrs. old, children twenty-one (21) yrs. old, etc.) are required to pay the PhilHealth portion whenever necessary (i.e. confinement for not less than 24 hours, minor surgical procedures and chemotherapy, radiotherapy, hemodialysis, endoscopic procedures, and cataract extraction even on an OUT-PATIENT basis).
MEMBERSHIP ELIGIBLITY
PRINCIPAL MEMBER: from 18 yrs. old to below 60 yrs. old
DEPENDENTS:
If Married:
1st Priority - Legal Spouse from 18 yrs. old to below 60 yrs. old
2nd Priority - Children from 90 days old to below 21 yrs. old, (from eldest to youngest, single & unemployed)
If Single:
1st Priority - Father, below 60 years old 2nd Priority - Mother, below 60 years old 3rd Priority - Siblings, 90 days to below 21 years old, (from eldest to youngest, single & unemployed)
SERVICE AND BENEFITS PACKAGE
A. OUT-PATIENT SERVICES
Any number of necessary consultations and treatments during regular clinic hours (excluding the prescribed medications);
Referrals to accredited specialists;
X-ray, laboratory examinations and diagnostic procedures required and prescribed by the Primary/Accredited Physician;
Ten (10) pre or post-natal consultations with ValuCare accredited obstetricians.
B. PREVENTIVE CARE SERVICES
Immunizations, excluding the cost of the vaccines;
Medical management of health problems;
Family planning consultations, health education & counseling on diets or exercise;
Annual Physical Examination (A.P.E.):
- Physical examination/physician's assessment;
- Chest X-ray;
- Complete Blood Count (CBC);
- Urinalysis;
- Stool analysis (fecalysis);
- Electrocardiogram (ECG) for all members at age 35 yrs. old & above; and
- Pap smear for female members at age 35 yrs. old & above.
C. IN-PATIENT SERVICES
Room & board accommodation based on the planholder's designated plan at any ValuCare accredited hospital;
Use of operating room and recovery room;
Professional fees for accredited:
-Medical Coordinators;
-Medical Specialists;
-Surgeons;
-Anesthesiologists
Medicines and injectables including prescribed drugs purchased outside the hospital when these are not available in the hospital pharmacy at the time of confinement. When purchased by the member, the cost thereof shall be reimbursed to him by ValuCare following the procedures for claims reimbursement;
Blood transfusions (including human blood products) except gamma globulin;
Intravenous (IV) fluids; X-ray, laboratory examinations, and diagnostic tests ordered by ValuCare attending physicians;
Dressings, casts, and sutures;
Standard nursing services;
Inhalation therapy;
Oxygen and its administration;
ICU/CCU or its equivalent confinement, when required;
All other items directly related to the medical management of the patient.
D. EMERGENCY CARE SERVICES
In ValuCare accredited hospitals:
Doctor and hospital services;
Medicines used for immediate relief and during treatment;
Oxygen, intravenous fluids, whole blood and human blood products;
Dressing, casts, and sutures; and,
X-ray, laboratory and diagnostic examinations, and other medical services related to the emergency treatment of the patient.
In non-accredited hospitals, ValuCare shall reimburse the following based on the limits stated below, up to Php15,000 per emergency case but not to exceed planholder's Maximum Coverage Benefit (MCB):
100% of the physician's professional fees, based on what it would have cost ValuCare had the treatment been done in an accredited hospital; and,
80% on applicable hospital bill.