Out-Patient Benefits

When by reason of any member’s illness or injury, not requiring hospital confinement, the following services are rendered to the member

Out-Patient Care Benefits:

  • Consultations and treatment prescribed by an affiliated physician or specialist
  • Pre and Post Natal consultations (excluding laboratory and diagnostic procedure related to pregnancy)
  • Eye, ear, nose and throat (EENT) treatment prescribe by an accredited  physician/specialist
  • Treatment for minor injuries and minor surgery except out-patient medicines
  • Dressings, conventional casts (plaster of Paris) and sutures
  • X-ray, laboratory examinations, routine diagnostic and therapeutic procedures prescribed by an accredited Physician/Specialist
  • Minor surgery not requiring confinement prescribed by an accredited Physician/Specialist
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MEDICAL PROCEDURES
The following procedures are covered as prescribed by the HC&D’s accredited physician, 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
    • Cauterization of warts up to P2,000.00 per member per year neck down only except genital warts and condyloma acuminate (OP only) 
    • Botox which is not cosmetic in nature nor for beautification purpose up to an accumulated limit of P10,000.00 per member per year (OP only)
    • Sclerotherapy for deep varicose veins (except medicines and for cosmetic purposes) to be availed through accredited vascular surgeons up to an accumulated limit of P10,000.00 per member per year (OP only)
    • Speech Therapy (for stroke patients only) up to an accumulated limit of P10,000.00 per member per year (OP only)
    • Physical Therapy and Occupational Therapy (except for scoliosis and developmental disorder) up to accumulated limit of P25,000.00 per member per year
    • Eye laser therapy only for retinal tear, retinal hole, retinal detachment and glaucoma up to an accumulated limit of P25,000.00 per member per year (except eye correction such Lasik, PRK and the like)
    • Cataract extraction shall be covered up to Plan Limit (excluding cost of lens)
    • 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