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Health Care Service Coverage Proposal

By

GETWELL HEALTH SYSTEMS, INC.


September 13, 2018

Ms. Miriam Gonzales


Finance
PAPI Security Agency
Unit 914 EGI Taft Tower, 2339 Taft Ave., Malate, Manila

Dear Sir/Ma’am:

The delivery of economical, high quality healthcare to every human being, especially to our company
workers is a universal concern. Getwell Health Systems, a health maintenance organization (HMO),
shares this concern and has specially designed a healthcare program with the ordinary daily wage
earner in mind. This healthcare program has the following features and advantages:

1. Affordability: the monthly premium is less than a days’ salary (see attached schedule of
benefits and fees).
2. Salary deduction scheme: convenient and painless, you get full coverage after the first
monthly premium payment.
3. Open to casual and contractual employees. No P.E required.
4. Comprehensive coverage benefits: Preventive Care, Out Patient Care, Annual Physical
Exam., Emergency Care, Dental Care, Life Insurance and Accident Insurance Coverage.
5. Prompt payment of bills to accredited providers.
6. Zero or minimal out of pocket expense.
7. Open door policy: all hospitals fully accredited in case of emergencies.
8. Personalized attention and assistance from admission to discharge especially in emergency
and critical cases.
9. 24 hour coverage and hotline: 664-2580; CP Nos. 0946-1339790 ; 0932-9883252 ;
0916-2606241 ; 0917-5260465.
10. Periodic membership orientation programs & service forums.

For any clarification regarding our offer please feel free to call the undersigned or our office and we
are happy to give you the best service we can.

I am looking forward to meeting you in your most convenient time at your office to discuss the
parameter of our partnership soon. Thank you.

Very truly yours,

EDUARDO P. MICALLER
Marketing Manager
0933-8127817 Suncel
0927-1404489 Globe
Proposed Health Care Program
IN PATIENT BENEFITS
(Hospital Confinement)

A. Confinement in a GETWELL accredited Hospital

A member confined per recommendation of the GETWELL Medical Director,


Physician Coordinator or Physician on duty at our accredited hospital or
outpatient clinic may avail of the following services:

- Room & Board (depending on chosen program)


- Operating Room, Anesthesia and Recovery Room
- Professional services of specialists
- Blood transfusions and Intravenous fluids (except blood products)
- X-ray, laboratory and other, diagnostic examinations
- Administered medicines
- Dressings, plaster casts, sutures and other items related to the
management of the patient
- Other coverable hospital services, when deemed necessary by
designated attending physician.
- ICU confinement ( Intensive Care Unit )
- CT Scan & Ultrasound ( Computed Tomography )
- MRI ( Magnetic Resonance Imaging )

B. Confinement in non-accredited hospitals/clinics in emergency cases

GETWELL shall reimburse 100% of the member’s covered benefits for


confinement in a non-accredited hospital, inclusive of professional (please
refer to attached Addendum for assigned limits).

- Room and Board


- Operating Room, Anesthesia and Recovery Room
- Professional services of specialists
- Blood transfusions and Intravenous fluids (except blood products)
- X-ray, laboratory & other, diagnostic examinations
- Administered medicines
- Dressings, plaster casts, sutures & other items related to the
management of the patient
- Other hospital services, when deemed necessary by designated
attending physician.
- ICU confinement ( Intensive Care Unit )
- CT Scan & Ultrasound ( Computed Tomography )
- MRI ( Magnetic Resonance Imaging )
OUT PATIENT BENEFITS
A. Emergency Care Service
Emergency Care Service not requiring confinement shall be made available at
accredited and non- accredited hospitals / clinics ( please see attached
Addendum for its corresponding limits).
- Doctor's services
- Medicine, X-ray, laboratory examinations and blood transfusions during
the emergency.
- Oxygen and intravenous fluids
- Dressing, casts, and sutures
- Other emergency services and treatment deemed necessary by the
attending physician

B. Preventive Health Care Benefits


1. The following Health Maintenance Services shall be made available for free:
- Basic Annual Physical Examination (1 APE per year covered after
payment of twelve (12) months worth of membership fees on the dates
and venues to be designated by Getwell.)
- Immunization, except cost of medicine/vaccine
- Counseling on health habits, diet, family planning
- Recording and review of medical history
2. The following Outpatient Services shall be made available to members for free:
- Medical consultations during regular clinic hours, except prescribed
medicines.
- Emergency treatment of minor injuries or illness
- Laboratory, X-ray and other basic diagnostic examinations prescribed
by Physician on duty.
- Referral to specialists
- Eyes, Ears, Nose and Throat Treatment
C. Dental Care Services
The following Dental Care Services shall be made available at GETWELL
accredited dental clinics:
1. Oral Prophylaxis (1 Prophylaxis per year after payment of twelve (12)
months worth of membership fees).
2. Unlimited Simple tooth extractions
3. Consultation & Oral examinations
4. 2 Permanent fillings per year
5. Treatment of mouth lesions
Financial Assistance in case of member’s death

GETWELL provides financial assistance to the heir and / or assign of a member


validly enrolled in GETWELL’s Health Care Program in case of death through
natural or accidental.

Death Benefit
1. Natural Cause of Death please see attached Addendum
2. Accidental Cause of Death for your coverage

Added Features of the GETWELL service package

1. Open Door Membership Eligibility


- All salaried employees with ages between 18 to 60 years old, whether
permanent, regular, probationary or contractual, may qualify for
membership with GETWELL. Except when required by the GETWELL
medical staff, there is no need for medical examination for enrollment.
GETWELL, however, reserves the right to reject any membership
application for whatever reason at any time.

2. Convenient Payment Scheme


- Company-sponsored employee health care programs may be paid
quarterly, semi-annually or annually. Payment of membership fees for
plans with employee participation may be facilitated through monthly
salary deduction.
3. Open Door Policy and Prompt Reimbursement in Emergency cases
- Members needing emergency treatment, with or without confinement,
may avail of the services of the nearest available hospital or clinic,
accredited or non-accredited. For emergency cases treated without
need for confinement, GETWELL will facilitate prompt reimbursement
and or actual payment of coverable hospital bills even if the hospital is
a non-accredited.

4. Personalized 24 hours membership assistance


- Members in need of medical services may call GETWELL hotline that
are manned on a 24 hours basis. A membership or availment liaison
representative is promptly dispatched by GETWELL once we are
notified that a member needs medical attention at a hospital; the
liaison representative personally coordinates the confinement of the
member-patient from admission to discharge.
SCHEDULE OF BENEFITS AND FEES
Option 1
PACKAGE PLAN INTERNAL LIMIT 50%
Room Accommodation Category
Maximum Daily Room and Board Open
Maximum Benefit Limit Php 40,000.00 / year

I. Out-Patient Consultation / Laboratory


II. Emergency Treatment of Illness and Injury
50% of Total MBL per Semi-Annual
III. Confinement
OUTPATIENT CONSULTATION:
1. Accredited Clinic Covered
2. Non-accredited clinic in areas with provider network Covered (80%)
3. Non-accredited clinic in areas with no provider network Covered (reimbursement only)
EMERGENY TREATMENT:
1. Accredited Hospital Covered
2. Non - Accredited Hospital Covered (100%)
3. Medico Legal Cases Reimbursement only
CONFINEMENT (Hospital Bills & Professional Fees):
1. Non – emergency in areas with no provider network Covered (100%)
2. Non – accredited in areas with provider network Covered (80%)
3. Emergency confinement (nationwide) Covered (100%)
PRE-EXISTING ILLNESS:
100 - 399 Members - Covered after twelve ( 12 ) months of continuous membership
400 – up Members - Automatic coverage of Pre-Existing illness
PRESCRIBED TAKE HOME MEDICINES: Not covered
ANNUAL PHYSICAL EXAMINATION: Covered after twelve ( 12 ) months of continuous membership
DENTAL SERVICES:
1. Simple Tooth Extraction Unlimited
2. Oral Prophylaxis Once a year, covered after twelve ( 12 ) months of continuous
membership
3. Permanent Filling 2 Permanent Filling per year
FINANCIAL ASSISTANCE:
1. Natural Death Php 5,000.00
ACCIDENT INSURANCE COVERAGE (Subject to underwriting
guidelines):
1. Accidental Death Php 10,000.00
2. Dismemberment due to Accident Up to Php 20,000.00 ( as per scheduled body parts)
3. Burial Expense (accident) Php 10,000.00

PRODUCT DESCRIPTION GROSS PREMIUM


MODE OF PAYMENT MONTHLY
WARD Php 210.00
SEMI-PRIVATE Php 250.00

Conforme: __________________________ _____________________________


ANNEX C

SCHEDULE OF BENEFITS AND FEES


Option 2

PACKAGE PLAN INTERNAL LIMIT 50%


Room Accommodation Category
Maximum Daily Room and Board Open
Maximum Benefit Limit Php 60,000.00 / year
I. Out-Patient Consultation / Laboratory
II. Emergency Treatment of Illness and Injury
50% of Total MBL per Semi-Annual
III. Confinement
OUTPATIENT CONSULTATION:
1. Accredited Clinic Covered
2. Non-accredited clinic in areas with provider network Covered (80%)
3. Non-accredited clinic in areas with no provider network Covered (reimbursement only)
EMERGENY TREATMENT:
1. Accredited Hospital Covered
2. Non - Accredited Hospital Covered (100%)
3. Medico Legal Cases Reimbursement only
CONFINEMENT (Hospital Bills & Professional Fees):
1. Non – emergency in areas with no provider network Covered (100%)
2. Non – accredited in areas with provider network Covered (80%)
3. Emergency confinement (nationwide) Covered (100%)
PRE-EXISTING ILLNESS:
100 - 399 Members - Covered after twelve ( 12 ) months of continuous membership
400 – up Members - Automatic coverage of Pre-Existing illness
PRESCRIBED TAKE HOME MEDICINES: Not covered
ANNUAL PHYSICAL EXAMINATION: Covered after twelve ( 12 ) months of continuous membership
DENTAL SERVICES:
1. Simple Tooth Extraction Unlimited
2. Oral Prophylaxis Once a year, covered after twelve ( 12 ) months of continuous
membership
3. Permanent Filling 2 Permanent Filling per year
FINANCIAL ASSISTANCE:
1. Natural Death Php 10,000.00
ACCIDENT INSURANCE COVERAGE (Subject to underwriting
guidelines):
1. Accidental Death Php 10,000.00
2. Dismemberment due to Accident Up to Php 20,000.00 ( as per scheduled body parts)
3. Burial Expense (accident) Php 10,000.00

PRODUCT DESCRIPTION GROSS PREMIUM


MODE OF PAYMENT MONTHLY
WARD Php 250.00
SEMI-PRIVATE Php 300.00

Conforme: __________________________ _____________________________


ANNEX C

SCHEDULE OF BENEFITS AND FEES


Option 3
PACKAGE PLAN AGGREGATE LIMIT 100%
Room Accommodation Category
Maximum Daily Room and Board Open
Maximum Benefit Limit Php 40,000.00 / year

I. Out-Patient Consultation / Laboratory


II. Emergency Treatment of Illness and Injury
100% of Total MBL
III. Confinement
OUTPATIENT CONSULTATION:
1. Accredited Clinic Covered
2. Non-accredited clinic in areas with provider network Covered (80%)
3. Non-accredited clinic in areas with no provider network Covered (reimbursement only)
EMERGENY TREATMENT:
1. Accredited Hospital Covered
2. Non - Accredited Hospital Covered (100%)
3. Medico Legal Cases Reimbursement only
CONFINEMENT (Hospital Bills & Professional Fees):
1. Non – emergency in areas with no provider network Covered (100%)
2. Non – accredited in areas with provider network Covered (80%)
3. Emergency confinement (nationwide) Covered (100%)
PRE-EXISTING ILLNESS:
100 - 399 Members - Covered after twelve ( 12 ) months of continuous membership
400 – up Members - Automatic coverage of Pre-Existing illness
PRESCRIBED TAKE HOME MEDICINES: Not covered
ANNUAL PHYSICAL EXAMINATION: Covered after twelve ( 12 ) months of continuous membership
DENTAL SERVICES:
1. Simple Tooth Extraction Unlimited
2. Oral Prophylaxis Once a year, covered after twelve ( 12 ) months of continuous
membership
3. Permanent Filling 2 Permanent Filling per year
FINANCIAL ASSISTANCE:
1. Natural Death Php 5,000.00
ACCIDENT INSURANCE COVERAGE (Subject to underwriting
guidelines):
1. Accidental Death Php 10,000.00
2. Dismemberment due to Accident Up to Php 20,000.00 ( as per scheduled body parts)
3. Burial Expense (accident) Php 10,000.00

PRODUCT DESCRIPTION GROSS PREMIUM


MODE OF PAYMENT MONTHLY
WARD Php 320.00
SEMI-PRIVATE Php 380.00

Conforme: __________________________ _____________________________


ANNEX C

SCHEDULE OF BENEFITS AND FEES


Option 4

PACKAGE PLAN AGGREGATE LIMIT 100%


Room Accommodation Category
Maximum Daily Room and Board Open
Maximum Benefit Limit Php 60,000.00 / year
I. Out-Patient Consultation / Laboratory
II. Emergency Treatment of Illness and Injury
100% of Total MBL
III. Confinement
OUTPATIENT CONSULTATION:
1. Accredited Clinic Covered
2. Non-accredited clinic in areas with provider network Covered (80%)
3. Non-accredited clinic in areas with no provider network Covered (reimbursement only)
EMERGENY TREATMENT:
1. Accredited Hospital Covered
2. Non - Accredited Hospital Covered (100%)
3. Medico Legal Cases Reimbursement only
CONFINEMENT (Hospital Bills & Professional Fees):
1. Non – emergency in areas with no provider network Covered (100%)
2. Non – accredited in areas with provider network Covered (80%)
3. Emergency confinement (nationwide) Covered (100%)
PRE-EXISTING ILLNESS:
100 - 399 Members - Covered after twelve ( 12 ) months of continuous membership
400 – up Members - Automatic coverage of Pre-Existing illness
PRESCRIBED TAKE HOME MEDICINES: Not covered
ANNUAL PHYSICAL EXAMINATION: Covered after twelve ( 12 ) months of continuous membership
DENTAL SERVICES:
1. Simple Tooth Extraction Unlimited
2. Oral Prophylaxis Once a year, covered after twelve ( 12 ) months of continuous
membership
3. Permanent Filling 2 Permanent Filling per year
FINANCIAL ASSISTANCE:
1. Natural Death Php 10,000.00
ACCIDENT INSURANCE COVERAGE (Subject to underwriting
guidelines):
1. Accidental Death Php 10,000.00
2. Dismemberment due to Accident Up to Php 20,000.00 ( as per scheduled body parts)
3. Burial Expense (accident) Php 10,000.00

PRODUCT DESCRIPTION GROSS PREMIUM


MODE OF PAYMENT MONTHLY
WARD Php 380.00
SEMI-PRIVATE Php 450.00

Conforme: __________________________ _____________________________