Insurance Philippines

Description

Caritas Heath Shield Inc. is a HMO member and Ayala owned established in 1995, providing a health care for filipino families today and tomorrow.

The company is continuing effort to assure the best health care services,we have deemed it appropriate to provide our members the very same medical benefits we promise.

GOLD PLAN

Membership Privileges (Out Patient Benefits) Upon effectivity of his Membership, the member may avail of the following health services

a. Out patient Services

• up to twelve(12)consultation per year
• up to ten (10) pre/post natal consultation per pregnancy
• Treatment of minor injury or illness
• Minor surgery(not requiring hospital facilities)
• Eye, Ear, Nose and throat treatment

b. Annual Physical Examination (after at least six (6) months from the date of effectivity of this agreement to include

• Taking Medical History
• Medical Examination
• Chest x-ray (PA)
• Complete blood count
• Fasting blood sugar
• Urine and stool examination
• Electrocardiogram (for 35 years old and above)
• Pap smear (for 35 years old and above)

c. Preventive Health Care

• periodic monitoring of health problems
• consultation on diet, exercise, and other healthful habits
• counselling on family planning
• Immunization, exluding cost of drugs or vaccine
• Enrollment on company-sponsored health seminar

d. Dental Care

• up to four (4) consultation per year
• Annual oral prophylaxis (after at least three (3) months from the date of effectivity of this agreement)
• Tooth extraction, excluding surgery for impaction
• Temporary filling or recementation
• Treatment of oral pain, lesions, wounds and burns

e. Other Services

• 24 hour telephone assistance
• Discountson non covered health services at selected hospital clinic,laboratories, drug store or optical shops
• Up to four (4) consultation per year for one pre-designated dependent, who is qualified as such under the SSS law(RA8282)  

MEDICAL EXPENSE BENEFITS (In patient Benefits & special procedures)

1. HOSPITALIZATION BENEFITS

• Room and Board as specified Art.IV No.1
• Services of an accredited physician or specialist
• Laboratory test, xrays and other indicated diagnostics
• Use of Surgical or medical equipment and facilities, namely operating and recovery room, intensive care unit, dialysis and chemotherapy equipment.
• Administration of anesthesia and/or oxygen
• transfusion of hospital-provided whole blood or plasma
• Dressing, plaster cast and other medical supplies
• Prescribed drugs and other  medication used in the hospital

2. Emergency Care

• Accredited hospital: Actual cost
• Non- Accredited hospital:80% based on Caritas Standard Rates
• Ambulance service from a non accredited to an accredited hospital shall be reimbursed.

3. Special Diagnostic and Laboratory Procedures

• X-ray
• Ct Scan
• Basic mammography
• 2D Echocardiography with Doppler
• Treadmill Test
• Ultrasound
• Magnetic Resonance Imaging (MRI)
• EMG
• Nuclear Test
• Other procedures deemed appropriate by CARITAS

INSURANCE BENEFITS

TERM LIFE INSURANCE- if the member dies before exceeding the age of 70 years and before the start of the expanded period of coverage, his beneficiary shall be entitled to an amount equal the initial Expanded Benefit limit upon approval of the claim by insurance company

ACCIDENTAL DEATH INSURANCE- if the member dies before his 65th birthday and before the start of the expanded period of coverage as a result of an injury sustained in accident, his beneficiary shall be entitled to an additional amount equal to initial expanded limit. Example (100,000 insured amount x 2 as additional amount  = 200,000php)

WAIVER OF INSTALLMENT DUE TO DISABILITY- if the member is totally disabled during the paying period and before his 60th birthday, CARITAS shall waive the payment of each installment.

* ALL CLAIMS UNDER THE ABOVE INSURANCE COVERAGES SHALL BE SUBJECT TO 1 YEAR CONSTESTABILITY.

RIGHTS OF A MEMBER:

• Member shall be allowed to transfer his caritas health card plan at anytime, however new applicant is subject to acceptance by Caritas.
• Member shall be allowed to terminate caritas health card plan at anytime. he shall be entitled to termination value as follows:

             Payments on contract price (pocp)                                Termination Value

              Less than 20%                                                            None

              20%-40%                                                                  10% of pocp

              40%-60%                                                                  20% of pocp

              60%-80%                                                                  30% of pocp

              80%-100%                                                                40% of pocp

Note:

if this agreement is terminated after full payment of contract price but before the start of expanded period of coverage, the MEMBER shall be entitled to 50% of the contract price.

if this Agreement is terminated during the expanded period of coverage, the MEMBER shall be entitled to 70% of the available expanded benefit limit.

For more information Feel Free to contact this number 09273211998.

Tags

CARITAS Health Insurance, Caritas Heath Shield Inc., health insurance philippines