FEU - East Asia College
Mr. Mac Cabauatan
Orientation Specialist
Sales and Business Development Group I
Industry Pioneer
MediCard is a pioneer in the HMO industry, founded in 1987.
AHMOPI Founder
MediCard is one of the founding members of the AHMOPI (Association of Health
Maintenance Organizations of the Philippines, Inc.)
We are ISO Certified
MediCard is the first HMO awarded with an ISO Certification in the Asia Pacific
Region.
We are trusted by the country’s top brands
BPO
We are trusted by the country’s top brands
Media & Broadcasting
We are trusted by the country’s top brands
Food & Beverage
We are trusted by the country’s top brands
Car Manufacturing
Banks
We are trusted by the country’s top brands
Government Offices
Schools
We are trusted by the country’s top brands
We have over 28,000 doctors, specialists and 600 dentists
nationwide
We have an extensive network of accredited providers - more
than 700 hospitals and clinics nationwide
Our Clinics
The MediCard Lifestyle Center
51 Paseo De Roxas corner
Sen. Gil Puyat Avenue, Makati City
MediCard Chino Roces
GF King’s Court II Bldg.,
Don Chino Roces Avenue, Makati City
MediCard North EDSA
G/F MESU Realty Trading Corp., EDSA,
Quezon City
MediCard Ortigas
Unit 105 Parc Royale Condominium, Julia Vargas
Ave., Ortigas Center, Pasig City
MediCard Fairview
27-C Fairview Avenue, Fairview,
Quezon City
MediCard Sta. Rosa, Laguna
Tagaytay National Road, Laguna
MediCard Calamba, Laguna
2/F Star Honda Bldg., Brgy. Parian, National Highway, Calamba, Laguna
MediCard Imus, Cavite
G/F Metrobank Bldg., Anabu Kostal, Aguinaldo Highway,
Anabu ll-D, Imus, Cavite
MediCard Festival Mall
3/F Festival Supermall,
Filinvest Corporate City,
Alabang,Muntinlupa City
Emergency Assistance & Response Services or E.A.R.S.
• Call Center Department
(02) 841-8080
• Trunkline
(02) 884-9999
• Toll Free Number
1800-1888-9001
Ready to serve you 24/7
Text MediCard
• You may text in your questions and inquiries!
• Simply text REG <YOUR NAME> to be a known and registered texter of TXT
MEDICard
• Send to 0908-884-1814 for smart
subscribers or to 0917-851-2648
for globe and sun subscribers
www.medicardphils.com
Our corporate website paves the way for:
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Real-time search for accredited providers
Online membership application
Online consultation
Request for quotes
Access to health and wellness articles
Access to eMediCard
MediCard Online Settlement System or MOSS
• Paves the way for quicker access to member information, approval of outpatient
consultations and procedures; as well as real-time validity checking
• MOSS uses RF Technology, allowing radio waves to transfer data between a reader
and an electronic chip attached to the MediCard ID
MEMBERSHIP ELIGIBILITY
MEMBER TYPE
Principal Members
ELIGIBILITY
Salaried personnel at least 18 years old up to age 65
HOSPITAL-BASED COVERAGE
• Accredited Hospitals/Clinics
• Accredited Doctors/Specialists
• Accredited Dentists
3 Categories of Illnesses
Ordinary
Illnesses
Pre-Existing
Conditions
Dreaded
Diseases
Ordinary Illnesses
INFLUENZA
Acute Upper Respiratory Tract Infection
TYPHOID FEVER
(Not requiring ICU confinement)
DENGUE FEVER
(Not requiring ICU confinement)
APPENDICITIS
(Not requiring ICU confinement)
DIARRHEA
TONSILITIS
(Not requiring surgery)
URINARY TRACT INFECTION
Pre-Existing Conditions
Dreaded Diseases
Prostate Disorders
Hypertension
Hemorrhoids and Anal Fistulae
Goiter (Hypo / Hyperthyroidism)
Benign Tumors
Cataracts / Glaucoma
Uterine Myoma, Ovarian Cysts, Endometriosis
ENT conditions requiring surgery
Buergher’s Disease
Bronchial Asthma
Varicose Veins
Tuberculosis
Arthritis
Chronic Cholecystitis / Cholelithiasis
Migraine Headache
Acquired Hernias
Gastritis / Duodenal or Gastric Ulcers
Dreaded Diseases
Cerebrovascular Accident (Stroke)
Respiratory / Renal or any form of Multiorgan failure
Cancers (of any form)
Collagen Vascular Disease
Cardiovascular Disease (Coronary, Valvular, Hypertensive Heart
Disease)
Malignancies and Blood Dyscrasias (Cancer, Leukemia)
Chronic Obstructive Pulmonary Disease (Chronic Bronchitis /
Emphysema)
Any illness that may require an ICU confinement
Liver Parenchymal Disease (Cirrhosis, Hepatitis except Type A,
New Growth)
Complications or morbities that may arise from a previous surgical
procedure
Diabetes Mellitus and its complications
Any complication related to above mentioned illness
Coverage of Illnesses
Member
Coverage
Principal Members
Up to Dreaded Disease Limit (DDL)
per illness per member per year
Hospitalization Care
Services
Emergency Care Services
Outpatient Care Services
Preventive Healthcare
Services
Member’s Financial
Assistance (MFA)
Dental Care Services
Hospitalization Care
Services
Emergency Care Services
Outpatient Care Services
Preventive Healthcare
Services
Members Financial
Assistance (MFA)
Dental Care Services
Hospitalization Care Services
Hospital Confinement Benefits
Benefit
No deposit upon admission
Room and board
Remarks
Covered
Covered according to type of plan enrollment
X-ray and laboratory examinations
Covered
Services of MEDICard specialists like Anesthesiologists, Internists, Surgeons,
etc.
Covered
Administered medicines
Covered
Surgery, Anesthesia, Dressings, Sutures and Plaster Casts, etc.
Covered
Fresh Whole Blood and Intravenous Fluids
Covered
Use of Operating Room, Recovery Room and ICU
Covered
Admission Kit including wee bag
Covered
Hospitalization Care Services
Hospital Confinement Benefits
Benefit
Remarks
Human Blood Products and its processing / screening (except gamma globulin)
Up to DDL
Chemotherapy, Radiotherapy, and Dialysis / Brachytherapy
Up to DDL
Work-related illnesses / accidents (except those in exclusions)
Up to DDL
Unprovoked Assault
Up to DDL
Congenital / Hereditary Illnesses
Up to DDL
Slipped Disc, Scoliosis, Spondylosis, Spinal Stenosis
Up to DDL
Hyperventilation syndrome (First ER availment only)
Up to P5,000
Hospitalization Care Services
Hospital Confinement Benefits
Benefit
Remarks
Epilepsy, Seizure disorder / Parkinson’s disease, dementia, Alzheimer’s disease / Guillain-Barre syndrome,
multiple sclerosis, demyelinating disease, Myasthenia gravis, and other autoimmune neurologic diseases
Up to P5,000
Open heart surgery (except the cost of pacemaker)
Up to DDL
Organ Transplant (except the cost of organ & donor’s expense)
Up to DDL
Polysomnogram / sleep study
Up to P5,000
Hepatitis B (Excluding Hepa B screening & vaccines)
Up to DDL
All other items directly related to the management of the case
Up to DDL
Hospitalization Care Services
Complex Diagnostic Procedures
Benefit
Remarks
MRI/MRA, CT Scan & Ultrasound
Up to DDL
Serum Chemistry Panels (eg. Chem23, Spec M etc)
Up to DDL
Angiography, Pulmonary Perfusion Scan
Up to DDL
Test involve use of nuclear technologies
Up to DDL
Electromyography, Nerve Conduction Velocity Studies
Up to DDL
24-Hour Holter Monitoring, 2-D Echo and Doppler
Up to DDL
Treadmill Stress Test, Myelogram
Up to DDL
Hospitalization Care Services
Complex Diagnostic Procedures
Benefit
Remarks
Diagnostic Endoscopy (including one video)
Up to DDL
Diagnostic Arthroscopy, Diagnostic Hysterscopy
Up to DDL
Plasma/ Urinary Cortisol, Plasma Aldosterone, Adrenocortical Function etc.
Up to DDL
Mammography and Sonomammogram
Up to DDL
Bone Densitometry Scan (Dexoscan)
Up to DDL
Immunologic Studies: Anti-nuclear antibody (ANA), C-Reactive Protein, Lupus Cell Exam
Up to DDL
Genetic Studies
Up to DDL
Hospitalization Care Services
Modern Therapeutic Procedures
Benefit
Remarks
Laparoscopic procedures
Up to DDL
Lithotripsy / ESWL
Up to DDL
Hysteroscopic procedures / Transurethral microwave therapy (TUMT) of the prostate
Up to DDL
Stereotactic Brain Biopsy / Gamma Knife Surgery
Up to DDL
Percutaneous Ultrasonic Nephrolithotomy
Up to DDL
Arthroscopically-guided procedures
Up to DDL
MRI / CT Scan / Ultrasound guided procedures
Up to DDL
Endoscopically-guided excisions / treatments / procedures
Up to DDL
Hospitalization Care Services
New Diagnostic & Therapeutic Modalities
Benefit
Remarks
Positron Emission Tomography (PET) Scan
Up to P5,000
Laser/Coblation Tonsilectomy
Up to P5,000
Endovenous Laser Therapy (Except for Cosmetic purposes)
Up to P5,000
Stapled / Scalpel Hemmorhoidectomy
Up to DDL
Photodynamic Therapy
Up to P5,000
Intensified Modulated Radiotherapy (IMRT)
Up to P5,000
Cryosurgery
Up to DDL
Hospitalization Care Services
New Diagnostic & Therapeutic Modalities
Benefit
Remarks
New diagnostic & treatment procedures for conditions with established etiologies and its use is only
as alternative to the conventional methods
Up to P5,000
Laboratory / ancillary services for conditions whose pathogenesis or subsequent clinical
improvement is not yet fully established in Medical Science
Up to P5,000
Mammotome
Up to DDL
3D & 4D Ultrasound (except Maternity Cases)
Up to P5,000
Robotic Surgery
Up to P5,000
Hospitalization Procedures
1.
2.
3.
If the specialist doctor decides that you need
to be confined in the hospital, the
MEDICard Coordinator will issue an
Admitting Order to be presented at the
hospital’s Admitting Section together with
your MediCard ID.
You will be admitted to the hospital room
accommodation specified in your healthcare
package or room plan.
You will be visited by MediCard Liaison
Officer during confinement to inform and
clarify about your healthcare package.
PHILHEALTH
•
The hospitalization benefits due under the Philhealth program are assigned to and integrated with the
MEDICard program
•
Whenever applicable, members are required to accomplish all necessary documentation supporting Philhealth
claims prior to discharge
•
Non-filling of Philhealth coverage will result to the member paying for the Philhealth portion
Note: Non-Philhealth members (i.e. unemployed parents below 60 years old, etc.) must pay the corresponding Philhealth portion during confinements
and out-patient surgical procedures (i.e. out-patient cataract extraction)
Additional Benefits:
Access to Lifeline Arrows, a company which has now evolved as the Philippines’ Rescue
911 within its coverage area (16-911)
Ambulance Services (Land Transport) are covered up to P3,000 per member per year
on a Reimbursement Basis
In cases of non-availability of room according to plan during emergency cases, member
may avail of the next higher room available except Large Suite Room within the first 2
days, provided a certification from the hospital admitting section must be secured before
the date of discharge to that effect
Hospitalization Care
Services
Emergency Care Services
Outpatient Care Services
Preventive Healthcare
Services
Members Financial
Assistance (MFA)
Dental Care Services
Outpatient Care Services
Applies to any condition which is not emergency in nature and does not require
hospital confinement
Benefit
Regular consultations & treatment
Referral to specialists
Remarks
Covered
Covered; except prescribed medicines
Treatment of minor injuries and surgery not requiring confinement
Covered
X-ray and laboratory examinations
Covered
Eye, Ear, Nose & Throat treatment
Covered
Consultations for Psoriasis & Vitiligo
Covered
Consultations for Chronic Dermatoses
Covered
Consultations for Scabies
Covered in MPI Clinics
Outpatient Care Services
Applies to any condition which is not emergency in nature and does not require
hospital confinement
Benefit
Remarks
Physical and Speech Therapy / Occupational Therapy
Up to DDL
Cardiac / Pulmonary Rehab
Up to DDL
Laser Treatment for Glaucoma and Retinal Detachment
Up to DDL
Cataract Extraction (except the cost of lens)
Up to DDL
Prenatal and Postnatal Consultations
Covered in any accredited hospitals and clinics excluding laboratory
exams
Sclerotherapy (except sclerosing agent)
Up to P5,000
Allergy Testing / Skin Testing, Patch Test
Up to DDL
Tuberculin Test (except screening)
Up to DDL
Doses of anti-rabies, anti-tetanus and anti-venom
Cauterization of warts including facial warts
Up to P18,000 each
Up to P1,000
Out-Patient Procedures
1.
Visit the MEDICard Coordinator during
clinic hours only in any accredited hospital
and present your MEDICard ID.
2.
3.
The MEDICard Coordinator may refer you
to a specialist and will issue the referral
form or should you need to undergo
laboratory or diagnostic procedures, the
coordinator will issue the examination
request form for you to present.
Proceed to the specialist’s clinic or the
laboratory/diagnostic department and show
your MEDICard ID and the referral
form/examination request form.
Hospitalization Care
Services
Emergency Care Services
Outpatient Care Services
Preventive Healthcare
Services
Members Financial
Assistance (MFA)
Dental Care Services
Emergency Care Services
Applies to any life-threatening condition caused by an illness or injury
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Doctor’s services
Medicines used during treatment or for immediate relief
Oxygen and intravenous fluids
Dressings, plaster casts & sutures
X-ray, laboratory tests & other diagnostic examinations directly related to the emergency
management of the patient
Emergency Procedures
1.
2.
3.
Present your card at the emergency room of
any accredited hospital
Should you need hospitalization due to your
particular emergency case, always remember
to be admitted under the service of the
Primary Physician in that particular
hospital.
Have the ER staff notify MediCard
immediately of your admission.
Emergency Care Services
Reimbursement Benefits
Hospital
Rate of Reimbursement
In non-accredited hospitals
Reimbursement of 100% based on MediCard Relative Value up to DDL
In areas without accredited hospitals
Reimbursement of 100% based on MediCard Relative Value up to DDL
In foreign countries
Reimbursement of 100% based on MediCard Relative Value up to DDL, in
Philippine Currency
Medicard Relative Value - Schedule of charges as agreed between the Association of Health Maintenance Organizations in the Philippines and various
recognized Medical Societies using the Philippine College of Surgeons (PCS) Book.
Emergency Care Services
Reimbursement Requirements:
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•
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Duly filled-out claim form
Official Receipt - Original
Itemized statement of account
Charge slips/itemized breakdown of charges
Professional fee receipt-original
Medical certificate / clinical abstract
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Hospital report / surgical report (for any procedure
done)
Incident report
Police reports, if due to accident or medico-legal case
Prescription of attending physician for medicines
purchased during confinement
Filing should be done within 30 days from the date of discharge
Processing of checks is 15 working days upon submission of complete documents
Hospitalization Care
Services
Emergency Care Services
Outpatient Care Services
Preventive Healthcare
Services
Members Financial
Assistance (MFA)
Dental Care Services
Preventive Healthcare Services
Annual Physical Examinations (APE)
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Complete Blood Count
Urinalysis (urine exam)
Fecalysis (stool exam)
Chest X-ray
Eye Refraction
Electrocardiogram (35 years old & above, or if
prescribed)
Pap smear (for women 35 years old & above, or
if prescribed)
Fasting Blood Sugar
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Management of Health Problems
Routine Immunization
Counseling on health habits, diets and family
planning
Record keeping of medical history
Wellness lectures @ 1hour per session
APE to be availed at MEDICard-owned Clinics, At the company premises through Mobile Clinic (for at least 50
persons) or at any designated MEDICard accredited clinic (for provincial area) only.
Hospitalization Care
Services
Emergency Care Services
Outpatient Care Services
Preventive Healthcare
Services
Members Financial
Assistance (MFA)
Dental Care Services
MFA for Principal Members
The indemnities are subject to the ff:
(for Principal Members only)
Natural Death
P50,000
Accidental Death
P50,000
Loss of both hands or both feet or both sight
P50,000
Loss of one hand or one foot or one eye
P25,000
Loss of both thumbs & index finger
P5,000
Note: provided that the death / injury results from causes that are covered and are not under the exclusions
Hospitalization Care
Services
Emergency Care Services
Outpatient Care Services
Preventive Healthcare
Services
Members Financial
Assistance (MFA)
Dental Care Services
Dental Care Services
Dental Care Benefits
Benefit
Oral Prophylaxis
Remarks
Covered TWICE a year
Consultations and Oral Examinations
Covered
Simple Tooth Extractions
Covered
Temporary Fillings
Covered
Permanent Amalgam and / or Light Cure Fillings
Up to 2 surfaces per member per year
Desensitization of Hypersensitive Teeth
Up to 2 teeth
Emergency out-patient dental treatment
In accredited dental clinics
Dental Care Services
Dental Care Benefits
Benefit
Remarks
Temporomandibular Joint (TMJ) consultations
Covered
Pre and post-natal dental consultations
Covered
Restorative and Prosthodontic consultations
Covered
Dental Nutrition & Dietary Counseling
Covered
Dental Health Education
Covered
Gum treatment and adjustment of dentures
Covered
Recementation of loose jackets, crowns, in-lays and on-lays
Covered
Treatment of mouth lesions, wounds and burns
Covered
Exclusions
&
Limitations
Exclusions:
Hospitalization
• Hospitalization and services a member receives from a non-accredited physician and/or from a non-accredited hospital except during
emergency case.
• Miscellaneous hospital charges such as but not limited to:
• Special or private nursing services
• Supplemental foods and medicines like vitamins and minerals
• Non-medical personal appliances (e.g. t.v., computer, refrigerator)
• Telephone charges
• Health check ups such as but not limited to:
• Pre-employment check-ups for other companies
• Annual check-ups for government requirements
• Physical exams for insurance purposes or travel abroad
• Hospitalization and treatment outside the Philippines except in emergency cases only
Exclusions:
Others
• Reconstructive surgery (e.g. liposuction, nose job, bust lift, etc.) – except to treat a functional defect directly caused by an accident or
illness herein
• Cosmetic alterations for aesthetic purposes / Dermatological care for aesthetic purposes such as chemical treatment for skin tags,
xanthelasma, milia, keloids, scars, etc.
• Reproductive disorders (e.g. infertility, reversal of fertility, impotence, erectile dysfunction), artificial insemination, sex change
• Experimental medical procedures such as acupuncture, acupressure, reflexology, iridology, chelation therapy, cell implant therapy and
chiropractics
• Vaccines / Shots:
• For active and passive immunization
• Steroid injections
Exclusions:
Others
• Psychiatric and psychological illnesses and any accidents arising from these conditions:
• Substance addiction or reaction to use of prohibited drugs
• Alcoholism, alcohol intake
• Anxiety reaction, neurotic and psychiatric behavior disorders
• Neuro-developmental disorders which may result to mental retardation and other conditions which may require specialized speech/physical and
other related therapies:
• ADHD
• Autism
• Down Syndrome
Exclusions:
Others
• Sexually-transmitted diseases, AIDS, Hepatitis B, Condyloma, Gonorrhea, Syphilis, Herpes and their attendant complications
• Laboratory exams for screening sexually related illnesses and injuries
• Corrective laser eye surgery (e.g. for error of refraction - myopia, hypermyopia)
• Orthodontics, Prosthetics, take-home medical appliances and other durable medical equipment such as but not limited to:
• Intra-ocular lens
• Pacemaker, special braces, stents
• Wheelchairs, crutches, walkers
• Special Confinements such as but not limited to:
• Recuperation in sanitariums or convalescent home
• Rehabilitation including medicines
• Custodial, domiciliary care
Exclusions:
Others
EXTERNAL FORCES / ACTIVITIES
• Exposure to imminent danger or health hazards such as:
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Serving in military, navy, air force of any country or international authority
War-like or combat operations, government declared acts of rebellion, terrorism
Active participation in strikes, riots, demonstrations and labor disputes
Provoked criminal acts
Violation of a law / ordinance
Commission of a crime (whether consummated or not)
Setting off / Handling pyrotechnic materials
Attempted suicide, self-inflicted injuries
• Sports-related injuries such as:
• Participating in extreme or dangerous sports/hazardous activities (e.g. skydiving, motor sports, judo, karate, taekwondo,
boxing, wrestling, bungee jumping, scuba diving, snorkeling, horseback riding, polo, hunting, etc.)
Exclusions:
Others
• Maternity care and other conditions as a result of pregnancy unless specifically provided
• Ultrasound
• Laboratory examinations related to maternity
• Maternity Complications
• Circumcision
• Oral surgery for purposes of beautification, temporomandibular joint disease (TMJ) surgery done by dental practitioner
• Professional fees of medico-legal officers
• Diagnosis of unknown etiology or the absence of any organic dysfunction
Corporate
Engagement
Summary
Hotels & Spas
Hotels & Spas
Restaurants
Beauty & Fitness / Optical
Medical Services / Stores
Enjoy a healthy life… with peace of
mind.
