ValuCare cardholders have the option to choose the hospital and doctor from the pool of accredited providers. They can also seek the assistance of our medical coordinators if they do not have a particular preference in any of our accredited hospitals and clinics.
AFTER SALES SERVICE
A team of Client Service Staff Specialists is on hand to assist the planholders.
MEDICAL SERVICE GROUP
A team of Medical Liaison Officers is tasked to ensure the proper delivery of medical services. This team is trained to make immediate decisions to ensure a friendly, convenient and hassle-free service. In making sure that members are well-attended to during their confinement, hospital visits are made within 24 hours of admission.
ValuCare has one of the most comprehensive provider networks in the HMO industry. Its more than 1,300 accredited hospitals and clinics, 990 dental clinics, and 19,000+ medical specialists are all equipped to render medical services to all plan holders nationwide. The continuous expansion and regulation of this network is assured by the ValuCare Provider Relations team, making sure that access to healthcare is made available to all members anywhere they are.
The versatile Customer Service Associates of the ValuCare Customer Care Department attends to availment-related concerns thru its trunk line, mobile phones, toll-free and direct land line numbers – 24/7. More than these head office hot line numbers, each roving Liaison Officer transacts and assists members using the ValuCare mobile apps and iView system which enable field LOs to promptly decide on urgent cases and assist members – wherever they are.
The ValuCare Alarm System is decentralized; each Center (VC-Meralco Avenue, VC-Makati, VC-PCS North Edsa/QC, VC-The Medical City, VC-St. Lukes Medical Center QC, including all the VC corporate clinics and provincial offices) is equipped with a local approval system designed for the convenience of members in the area.
The team is responsible for the monitoring, measurement and preparation of reports relevant to the efficiency of strategic utilization management programs implemented by key departments.
Essential elements include the timely preparation of utilization reviews and the precise valuation of medical requirements tailor-fitted to client requirements.
Eligible individual with no dependents and not enrolled within a group or corporate account.
Minimum of 3 members, with at least one (1) adult as principal member.
A group of individuals working in the same company / organization
-at least 20 regular employees
-100% of regular employees
An illness or injury is considered to be in existence prior to the effective date of the planholder coverage in any of the following cases:
1. When any professional advice or treatment has been obtained for such illness or injury prior to the said effective date of coverage;
2. Such illness or injury is evident to the planholder before the effective date of his/her membership;
3. The natural history of such illness or injury can be clinically determined to have started prior to the effective date of coverage.
Applicant is required to accomplish an application form which shall be subjected to evaluation based on ValuCare Underwriting's PEC waiver guidelines. ValuCare shall cover pre-existing conditions only after the first 12 months of membership, as provided below, upon approval of application, unless the condition falls under the provision on exclusions and limitations as stated in this Agreement:
2nd year – 50% of MCB (aggregate limit)
3rd year – 100% of MCB (per illness per year)
However, for kidney and gall stones medical cases, coverage shall be up to 75% of MCB (aggregate limit); No coverage for dreaded diseases and conditions except for cases acquired during the effectivity of membership.
4th and succeeding years – covered up to 100% of MCB (per illness per year) for all medical cases.
The following conditions, but not limited to, when occurring during the first year of coverage after the effective date, are considered pre-existing: (a) Acquired hernias; (b) Benign new growths or tumors (like sebaceous cysts, lipoma, epidermal inclusion cysts etc.); (c) Bronchial Asthma; (d) Buergher's disease; (e) Chronic ENT conditions requiring surgery (Nasal Polyposis, Chronic Otitis Media, Vocal Fold Polyp/Nodules); (f) Eye disorders like cataracts and glaucoma; (g) Fatty liver; (h) Gallbladder diseases like cholecystitis, cholelithiasis; (i) Gastric & duodenal ulcers; (j) Gynecological conditions (endometriosis, myoma, ovarian cysts); (k) Hemorrhoids and anal fistula; (l) Hypertension, atherosclerosis, dyslipidemia; (m) Neurological disorders like Paralysis; (n) Osteoarthritis, gout, hyperuricemia; (o) Peptic Ulcer Disease; (p) Primary Koch's Infection/Tuberculosis; (q) Prostate diseases like benign prostatic hypertrophy; (r) Thyroid disease (Nodular Nontoxic Goiter, Hypothyroidism, Hyperthyroidism); (s) Varicose veins; (t) Any dreaded diseases, if present upon enrollment.
The following diseases, but not limited to, are considered dreaded: (a) Cerebrovascular Accident (stroke); (b) Central Nervous System lesions (Poliomyelitis/ Meningitis/ Encephalitis/ neurosurgical conditions); (c) Cardiovascular Disease (Coronary/ Valvular/ Hypertensive Heart Disease/ Cardiomyopathy); (d) Chronic Obstructive.
Pulmonary Disease (Chronic Bronchitis/ Emphysema), Restrictive Lung Disease; (e) Liver Parenchymal Disease (Cirrhosis, Hepatitis (except Type A), New Growth); (f) Chronic Kidney/Urological disease (Urolithiasis, Obstructive uropathies, etc.); (g) Chronic Gastrointestinal Tract Disease requiring bowel resection and/or anastomosis; (h) Collagen diseases; (i) Diabetes Mellitus and its complications; (j) Malignancies and Blood dyscrasias (Cancer, Leukemias, Idiopathic Thrombocytopenic Purpura); (k) Injuries from accidents or assaults, frustrated homicide or frustrated murder; subject to police report; (l) complications of an apparent ordinary illness including MODS and SIRS (e.g. sepsis due to pneumonia, typhoid ileitis, cerebral malaria, etc.); (m) Single or multiple organ dysfunction and failure (MODS and MOF); (n) Conditions that may require dialysis; (o) Chronic pain syndrome (greater than six weeks); (p) Any illness other than the above which would require Intensive Care Unit confinement.
• Dental Benefits
• Financial Assistance (for principals)
• Special Modalities