SSC - Valucare Summary of Benefits

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Valucare Summary of Benefits

Unit 607-613, East Tower, Philippine Stock Exchange
Center (PSEC), Exchange Road, Ortigas Center, Pasig City
' 702-3388 7 Fax: 637-9456
Out-Patient Monitoring (Office Hours): ' 702-3310
In-Patient Monitoring (Office Hours): ' 702-3310
24 Hour Emergency Hotlines: 0917-8862892 / 0917-7932273
E-mail: wecare@valucare.com.ph

Summary of Benefits for SSC Employees

Quick Links
Membership Eligibility
Room and Board Limit
Benefit Limit
Out-Patient Benefits
In-Patient Benefits
Emergency Care Services
Annual Physical Examination
Special Concessions/Endorsements
Other Benefits Endorsement
Dental Benefits

Item	Valucare Benefits
Membership Eligibility: * Principal * Dependents - Married - Single Employee	18 to 70 years old 18 to 70 years old Children 15 days up to 21 years old Children who are at least 15 days up to 21 years old
Room and Board Limit: * Employees * Dependents	Semi-Private Semi-Private
Benefit Limit: * Employees * Dependents	Maximum Coverage Benefit (MCB) Php 80,000 Php 80,000
Philhealth Benefits (Medicare): A. Out-Patient Benefits * Consultation * Eye, Ear, Nose and Throat * Minor Surgery * X-ray and Laboratory Procedures * Dressings, Conventional Casts and Sutures * Speech Therapy * Physical Therapy * Cauterization of warts * Sclerotherapy for varicose veins * Pre- and Post-natal consultations * Allergy Testing/Allergy Screening and other related examinations * Out-patient Routine Procedures * Out-patient Diagnostic Procedures	Integrated covered covered covered covered covered covered for stroke patients only up to 12 sessions/member/year as charged subject to MCB Facial warts - Php 1,500/year Neck down except genital area - Php 1,000/session covered up to Php 5,000/leg/member/year once every month and 3 times on the 9th month of pregnancy covered up to Php 2,500/member/year only when prescribed and not to be done during Annual Physical Examination (APE) covered 100% of the actual cost covered 100% of the actual cost
B. In-Patient Benefits * Room and board limit * Professional fees * Standard nursing services * Anesthesia and administration * Drugs and medication * Oxygen and its administration * Dressings, plaster casts * Lab tests, x-ray and other diagnostic procedures * Whole blood and human blood & IV fluids * ICU confinement * CT scans and ultrasound (except for maternity cases) * Admission kit * Others	covered covered covered covered covered covered covered covered covered covered covered covered other supplies/services directly related to the medical management of the patient
C. Emergency Care Services * Emergency treatment in accredited hospitals * Emergency treatment in non-accredited hospitals * Emergency treatment outside the Philippines or Areas without accredited hospital * Ambulance Service (reimbursement basis) * Anti-Tetanus, Anti-Rabies and Anti- Venom * Room upgrading	covered reimbursable up to 100% of the actual cost of hospital bills and professional fees incurred within 24 hours of treatment up to MCB covered up to Php 30,000 (reimbursement basis) within Metro Manila - unlimited Province to Manila - Php 3,000 Anti-tetanus - MCB Anti-rabies and Anti-venom - Php 10,000 for both covered for 48 hours for emergency case only (except Suite Room)
D. Annual Physical Examination * Complete Blood Count * Physical Examination * Urinalysis * Fecalysis * Chest X-ray * Fasting Blood Sugar * Cholesterol * Electrocardiogram * Papsmear	covered covered covered covered covered covered for employees only covered for employees only covered for members age 35 and above or as indicated covered for members age 35 and above or as indicated
E. Special Concessions / Endorsements * Open Heart Surgery * Angiography/Angiogram * Organ Transplant * Transurethral Microwave Therapy of Prostate * Percutaneous Ultrasonic Nepholithotomy * Sclerotherapy (for varicose veins) * Lithotripsy * Laparoscopy * Hysteroscopic Myoma Resection * Hysteroscopically guided dilation and curretage * Dialysis * Chemotherapy / Radiotherapy * Gamma Knife Surgery * Cryosurgery * Arthroscopic Procedures, Orthopedic Anthroscopy * Stereotactic Brain Biopsy * Eye Laser therapy for retinal detachment and glaucoma only, excluding eye correction such as lasik, PRK and the like * Myelogram * 2D echo with doppler * Electromyography * Treadmill Stress Test * Mammography/Sonomammogram * Videogastroscopy * Bone Densitometry Scan * Nuclear * Tuberculin Test * Speech Therapy (for stroke patient only) * Adrenocortical Function * Anti-nuclear Antibody (ANA) C-reactive protein (rheumatic and its complications, lupus cell exam) * Brachytherapy * Herniography (acquired cases only) * Inhalation Therapy * Ultrasound guided procedures * Other special machine guided procedures * Others	covered up to Maximum Benefit Limit (MBL) covered up to 100% of actual cost subject to MCB/member/year covered up to MBL covered up to Php 25,000/member/year covered 100% of actual cost up to MBL/member/year covered up to Php 5,000/leg/member/year covered 100% of actual cost up to MBL/member/year covered 100% of actual cost up to MBL/member/year covered 100% of actual cost up to MBL/member/year covered 100% of actual cost up to MBL/member/year as charged subject to MCB covered up to actual cost up to 12 sessions subject to MBL covered up to actual cost up to 12 sessions subject to MBL covered up to actual cost up to 12 sessions subject to MBL covered up to actual cost up to 12 sessions subject to MBL covered up to actual cost up to 12 sessions subject to MBL as charged subject to MCB covered covered covered covered covered covered 100% of actual cost up to MBL/member/year covered covered Php 600/member/year (only when prescribed) 12 sessions on reimbursement basis (per contract) as charged subject to MCB as charged subject to MCB as charged subject to MCB as charged subject to MCB as charged subject to MCB as charged subject to MCB as charged subject to MCB as charged subject to MCB
F. Other Benefits Endorsement * Pre-existing illness coverage * Dreaded Disease * Congenital Illnesses * Work related conditions * Scoliosis * Motor vehicle liability * Financial assistance * Provoked and unprovoked assault * Sports related injuries * Sports related injuries (company sponsored events)	Employees: Current and newly enrolled - MCB Dependents: Currently enrolled - MCB Newly Enrolled: covered after 1 year of continuous membership upon approval of application all members are covered up to 100% of MBL all members - covered up to Php 20,000 covered up to MBL covered up to Php 20,000 including necessary procedure covered Natural Death - Php 10,000 Accidental Death - Php 20,000 Dismemberment - Php 10,000 covered up to MBL covered up to Php 10,000 covered up to MCB
G. Proposed Upgrade in the Benefits * Pre-existing illness coverage	covered - 100% of hospital bills and professional fees based on Valucare rates (reimbursement basis)
H. Dental Benefits * Consultation * Oral Prophylaxis * Simple tooth extraction * Temporary filling * Simple adjustment of dentures * Emergency dental treatment * Desensitization of hypersensitive teeth * Recementation of jacket, crowns, inlays and onlays * Restorative and prosthodontic treatment planning List of Accredited Dentists	unlimited twice a year covered unlimited covered covered covered up to 2 teeth covered covered
Personalized Access to Laboratory Services (PALS) Program members can have their blood examination done in school.

Posted June 2008

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ST. SCHOLASTICA'S COLLEGE

2560 Leon Guinto Street, Malate, Manila, Philippines :: (632) 524-7686

For inquiry, comments and suggestions, please send e-mail to sscinfo@ssc.edu.ph