In-Patient Benefits

In case a Member suffers an ailment which requires hospital admission, he/she shall be entitled to the hospitalization benefits listed below.

In-Patient Care Benefits:

  • Room and Board Accommodation
  • Professional fees of attending physician/specialist
  • Standard Nursing Services
  • Use of operating room and recovery room, Intensive Care Unit (ICU), isolation room (if prescribed by the attending Affiliated Physician)
  • Medicines for in-patient use (prescribed by the attending physician)
  • Blood products, transfusions and intravenous fluids, including blood screening and cross matching if the member/ patient is the recipient (excluding expenses for donor screening services)
  • X-Ray, laboratory examinations, routine diagnostic and therapeutic procedures incidental to confinement
  • Dressings, conventional casts (plaster of Paris) and sutures
  • Anesthesia and its administration
  • Oxygen and its administration
  • Standard Admission kit
  • All other items directly related in the medical management of the patient, as deemed medically necessary by the Attending Affiliated Physician
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MEDICAL PROCEDURES
The following procedures are covered subject to the limit of the plan and the pre-existing conditions (PEC) if applicable:

  1. Routine Procedures
    • Complete Blood Count
    • Blood Chemistries
    • X-ray
    • Fecalysis
    • Urinalysis

  2. Immunologic and Special Laboratory Examinations
    • 24-hour protein determination
    • ANA (Anti-Nuclear Antibody) Profile
    • Glycosylated Hemoglobin
    • Hepatitis Profile
    • Prostate Specific Antigen (PSA)
    • SLE Test, FAT Widal Test, ASO Titer, Serum Ig-Ci, Alpha-Feto Protein, ESR
    • Thyroid Profile
    • TORCH Profile, e.g., Anti-Toxoplasma Gondi (IgM), Anti-Cytomegalo-Virus (Total Ig), Anti Rubella
    • Troponin
    • Urine/blood culture & sensitivity test
    • Allergy testing /allergy Screening and other related examinations
    • Tuberculin test

  3. Special Diagnostic Procedures
    • 3D Imaging
    • Breast Scintigraphy
    • Computed Tomography (CT) Scan / Computed Axial Tomography Scan(CAT) (All types)
    • Echocardiography (all types)
    • Electroencephalography
    • Electromyelography with Nerve Conduction Tests
    • Fluorescein Angiography or Angioscopy of Eye Total
    • Mammography and Sonomammogram
    • Stress Testing (All types)
    • Nuclear Imaging
    • Total Body Scan, Bone Scan, Renal Scan, Pulmonary Scan, Thallium Scan, Thyroid Scan, Parathyroid Scan
    • Ultrasonography (Chest, Abdominal, Thyroid, Renal, Breast, Pelvic or Trans-vaginal)
    • Magnetic Resonance Imaging (MRI) shall be covered up to P10,000

  4. Treatments
    • Physical Therapy and Occupational Therapy (except for scoliosis and developmental disorder) up to P25,000.00 per member per year
    • Lithotripsy  up to an accumulated limit of P35,000.00 per member per year
    • Dialysis
    • Radiotherapy
    • Chemotherapy

  5. Other Procedures
    • 1st  dose of anti-rabies, anti-venom and anti-tetanus vaccines up to P18,000.00
    • Other forms of Nuclear Medicine covered up to P35,000.00 per member per year
    • Laparoscopic Procedures covered up to P35,000.00 per member per year
    • Endoscopic Procedures
    • Arthroscopic Procedures
    • Other medically necessary diagnostic or therapeutic procedures not mentioned above and those for which there are no comparable, conventional or traditional counterparts are covered up to P10,000.00 per procedure per member per year

OTHER BENEFITS:

  • Involuntary room upgrade to the next higher room category (except for Suite room) is allowed in case of non-availability of member’s assigned room within the first 24 hours. After twenty-four (24) hours, the MEMBER must transfer to his/her designated room category, otherwise incremental charges shall be billed to the MEMBER from day one (1) confinement.
  • Motor Vehicle Accidents (subject to the exclusions and limitations clause) covered as charged subject to Plan Limits
  • Unprovoked Assault, including domestic violence, whether initiated by the Member or by a known or unknown third party - covered as charged subject to Plan Limits