DATE

CORPORATE HMO PROGRAM

for
Rivera-Sarvida Construction Inc.
(COMPANY NAME)

DELIVERY SYSTEM
Hospital Based: Members can proceed directly to accredited hospitals for medical attention & treatment.
PhilHealth Integrated: The plan is integrated with the PhilHealth benefit. Members are required to file and submit duly accomplished
PhilHealth forms at the billing section of the hospital whenever applicable. Member who are not member of PhilHealth and/or not
qualified under PhilHealth provisions (i.e. foreigners, unemployed parents below 60 yrs. old, children 23 yrs. old & above) are required to
pay the PhilHealth portion whenever applicable. (confinement for not less than 24 hours, minor surgical procedures conducted at
operating room, Chemotherapy, Radiotherapy, Hemodialysis, endoscopic procedures & cataract extraction even on an OUT-PATIENT
basis).
ACCESS TO PROVIDERS NETWORK
Network Access: Option to include Major Hospitals (Makati Medical Center, St. Lukes Medical Center (QC & Global City), Cardinal
Santos Medical Center, Davao Doctors Hospital, The Medical City and Asian Hospital and Medical Center). All plans do not have access
with Fortmed Clinic & Healthway Clinics. Members under Semi-Private Plan who opt to be admitted at Makati Medical Center or any
accredited hospital that do not have a Semi-Private or Ward Accommodation shall automatically be charged of incremental costs. The
same shall apply for confinements requiring Isolation. Members can access the list of ValuCare's accredited hospitals, clinics and dental
networks through ValuCare Member's Handbook.
MEMBERSHIP ELIGIBILITY
Principal: Employee of the Client who is 18 yrs. old up to 65 yrs. old
Dependents of Married Employee: Spouse: 18 yrs. Old up to 65 / Children: 30 days old up to 23 yrs. old.
Dependents of Single/Single Parent: Children: 30 days old up to 23 yrs. Old, Parents: up to 65 yrs. old and Siblings: up to 23 yrs.
Old
PLANS & MAXIMUM BENEFIT LIMIT (MBL)
PLANS* (Room and Board Accommodation) MBL** (Maximum Benefit Limit)
LARGE PRIVATE Php200,000/illness/year
REGULAR PRIVATE Php200,000/illness/year
REGULAR PRIVATE Php150,000/illness/year
REGULAR PRIVATE Php110,000/illness/year
SEMI-PRIVATE Php90,000/illness/year
SEMI-PRIVATE Php80,000/illness/year
WARD Php70,000/illness/year
WARD Php60,000/illness/year
*Principal and Dependent can be enrolled in any preferred plan (with or without access to Major Hospitals).
*Principal and Dependent can be enrolled in any preferred plan (with or without FLU VACCINE).
**MBL is per member and inclusive of Hospital Bills, Processing Fees, and other medical-related expenses covered by the program.
BASIS OF COVERAGE
CASE/DIAGNOSIS PRINCIPAL'S COVERAGE
Pre-Existing Conditions
Covered up to MBL
(dreaded /non-dreaded illnesses)
Covered up to
Ordinary Illnesses (sudden onset)
MBL /illness/year
Sports-related Injuries* Covered up to Php10,000
Work Related Covered up to Php5,000/year (Aggregate)
Covered up to MBL
Motor Vehicular Accident (MVA)*
(subject to evaluation, Police Report & Deed of Subrogation required)
Allergy Testing/ Allergy Screening and other related examinations
Covered up to Php2,500/member/year
prescribed by an Affiliated Physician.
Tuberculin Test Covered up to Php600/member/year
Slipped Disc, Spinal Stenosis, Spondylosis
Covered up to Php5,000/year (Aggregate)
(PEC, Acquired, Congenital)
Covered up to P60,000/member/year
Scoliosis including necessary procedures, except physical therapy Shared limit for OP and IP
sessions, whether congenital, pre-existing, developmental or acquired Note: Physical Therapy sessions shall form part of the Physical
therapy/ Occupational therapy limits
Up to P60,000/member/year
Congenital Conditions except physical therapy sessions and Shared limit for OP and IP
developmental disorders. Note: Physical Therapy sessions shall form part of the Physical
therapy/ Occupational therapy limits.
Chronic Dermatoses Consultations only for OP and IP

VALUCARE / The Program Page 1 SME PACKAGE 2022

Hepatitis B except vaccines and screening Subject to MBL if acquired for OP and IP
Room Upgrade Covered for the first 24 Hours
Covid-19 Covered subject to PhilHealth & DOH guidelines
*Items included in Standard Exclusions & Limitations are not covered unless provided by ValuCare Corporate HMO Program.
~ SUMMARY OF BENEFITS ~
PREVENTIVE HEALTH CARE
Vaccines for treatment of tetanus and animal bites Up to P40,000/member/year
(including administration fee but excluding ER Fees) Shared limit for OP and IP
Injection of vaccine (Actual cost of vaccine excluded) Covered
Initial Treatment within 24 hours from time of bite of Animal bites IP & OP subject to MBL (except cost of vaccines)

Succeeding treatment after 24 hours from time of bite of Animal bites IP & OP subject to MBL (except cost of vaccines)

Periodic monitoring & management of health problems Covered

Counseling on family planning Covered
Health education on diet & exercise Covered
Medical history record keeping Covered
Annual Physical Examination (APE) - All members are entitled to the following APE procedures per year and scheduled by ValuCare
to accredited provider.
1. Physician's Assessment Covered
2. Chest X-ray Covered
3. Complete Blood Count (CBC) Covered
4. Urinalysis (U/A) Covered
5. Stool Exam (Fecalysis) Covered
6. Electrocardiogram Covered for members 35 yrs. old & above
7. Pap smear Covered for female members 35 yrs. old & above
The APE can be availed (Annual mode: upon full payment of the membership fees / Semi-Annual: on the 6th month / Quarterly: on the 10th
month) after the effective date of the Agreement. APE shall be conducted at any ValuCare Designated Clinics for walk-in and NEW WORLD
LABORATORY, INC. for on-site availment.
For a guaranteed minimum of 60 heads for half day / 4 hours, 100 heads for 6 hours and 120 heads for whole day / 8 hours, Members who will avail
of the APE, the said benefit can be administered at the CLIENT's premises as a Mobile Service (subject to confirmed schedule).
OUT-PATIENT CARE COVERAGE
Consultation with healthcare plan coordinators/accredited physicians
during regular clinic hours (actual cost of prescribed medicines are Subject to MBL
excluded)
Pre & post natal consultation (Procedures and medications that are
Covered up to 14 consultations, subject to MBL
related to maternity are excluded)
Referrals to accredited specialists when necessary Subject to MBL
Diagnostic X-Ray, Blood extractions and other diagnostic/therapeutic
procedures prescribed by accredited physician/specialist, provided
Subject to MBL
costs of such exams & procedures are limited to specific coverage by
the program
Treatment of minor injuries such as lacerations, mild burns, sprains
Subject to MBL
and other forms of traumatic injury
Minor surgical procedures that do not require confinement, prescribed
Subject to MBL
by accredited physician/specialist
Eyes, ears, nose and throat (EENT) care and treatment prescribed by
Subject to MBL
accredited physician/specialist

Eye laser therapy only for retinal tear, retinal hole, retinal detachment
and glaucoma prescribed by an Affiliated Physician/Specialist. Eye Up to P10,000/eye/member/year
correction such as Lasik, PRK and the like are not covered.

Electrocauterization of skin lesions such as plantar warts, flat warts,

periungual warts, filiform warts and molluscum contagiosum, in any Up to P1,000/member/year
part of the body prescribed by an Affiliated Physician/Specialist.

Sclerotherapy for varicose veins (except medicines and for cosmetic

purposes) as prescribed by an Affiliated Physician, to be availed Up to P5,000/leg/member/year
through affiliated vascular surgeons.
Covered as charged up to P10,000/ member/year on reimbursement
Speech therapy for stroke patients only. basis. Note: Consultations shall be part of the limit and treated as
sessions.

VALUCARE / The Program Page 2 SME PACKAGE 2022

 IN-PATIENT CARE COVERAGE
Room & board accommodation based on member's plan Subject to MBL
Professional fees of accredited physicians/specialists (attending
physicians, surgeons, anesthesiologists, cardiopulmonary clearance
Subject to MBL
before surgery and cardiac monitoring during surgery) according to
ValuCare's Schedule of Rates
Medicine for in-patient use (including reimbursement of prescribed
medicines purchased outside the hospital when these are not
Subject to MBL
available in the hospital's pharmacy at the time of confinement), take-
home medicine not covered
Blood transfusion (packed RBC, fresh frozen plasma, platelet
pharesis, platelet concentrate), blood typing and crossmatching, Subject to MBL
infusion of intravenous fluids (gamma globulin not covered)
Diagnostic X-ray, Laboratory examinations and diagnostic/therapeutic
Subject to MBL
procedures related to case/confinement

Use of operating room, recovery room, Intensive Care Unit (ICU),

Subject to MBL
Coronary Care Unit (CCU, Neurocritical Care Unit (NCCU) as required

Standard nursing services Subject to MBL

Inhalation and nebulization therapy
Oxygen and the materials needed to facilitate its administration
Anesthesia & materials needed to facilitate its administration
Dressings, sutures & conventional casts (Plaster of Paris, etc.)
Standard admission kit, including ice cap and wee bag
All other items directly related to the medical management of the
patient, as deemed medically necessary by the attending accredited
physician
EMERGENCY CARE COVERAGE
Doctors and hospital services
Medicine used for immediate relief and treatment if symptoms
Oxygen and the materials needed to facilitate its administration, Blood
transfusion (packed RBC, fresh frozen plasma, platelet pharesis,
platelet concentrate), blood typing and crossmatching, infusion of
intravenous fluids (gamma globulin not covered)
Dressings, sutures & conventional casts (Plaster of Paris)
Diagnostic X-ray, Laboratory examinations and diagnostic/therapeutic
procedures related to case/confinement
Emergency care services in non-accredited hospital
Emergency care services outside the Philippines
Emergency care services in areas without accredited hospitals or
medical facilities
MEDICAL PROCEDURES /MODALITIES
ROUTINE PROCEDURES (whether In-Patient or Out-Patient)
Blood Chemistry (Fasting Blood Sugar, Lipid Profile, SGOT, SGPT,
BUN, creatinine)
Chest X-Ray (PA, Lateral, Apicolordotic, Thoracic Cage)
Complete Blood Count
Stool Exam (Fecalysis)
Urinalysis
DIAGNOSTIC PROCEDURES
12-Lead Electrocardiogram (ECG)
4D Ultrasound except for maternity-related cases
24-Hour Holter Monitoring
2D Echocardiography with Doppler Studies
Adrenocortical Function Test
All diagnostic / therapeutic procedures medically necessary for
treatment
Alpha Globin/ Globulin Genotyping
Acoustic Radiation Force
Anchored Periplasmic Expression (APEx)-2 Hyrbid
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
Reimbursable up to Php30,000
(80% of applicable hospital bills & 100% of professional fees based on
ValuCare rates) incurred during the first 24 hours of treatment
Reimbursable up to Php30,000
(80% of applicable hospital bills & 100% of professional fees based on
ValuCare rates) incurred during the first 24 hours of treatment
Reimbursable up to MBL
(100% of applicable hospital bills & professional fees based on
member's program and ValuCare's Schedule of Rates)
Covered 100% as charged, subject to MBL
Covered 100% as charged, subject to MBL
Covered 100% as charged, subject to MBL
Covered 100% as charged, subject to MBL
Covered 100% as charged, subject to MBL
Covered 100% as charged, subject to MBL
Covered up to P5,000/member/year Shared limit for OP and IP
Covered 100% as charged, subject to MBL
Covered 100% as charged, subject to MBL
Covered 100% as charged, subject to MBL
100% of Actual Cost subject to MBL
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP

VALUCARE / The Program Page 3 SME PACKAGE 2022

Antivascular Endothelial Growth Factor (VEGF) drugs (Avastin,
Lucentis, Macugen) for Retinopathy, Macular Degeneration and other Covered up to 100% of MBL/member/year Shared limit of IP & OP
Optha indications
Arthrocentesis OP: Up to six (6) sessions subject to MBL IP: Up to MBL
Audiogram & Tympanogram Covered 100% as charged, subject to MBL
BCR-ABL by Quantitative Real-time Polymerase Chain Reaction (QRT-
Covered up to 100% of MBL/member/year Shared limit of IP & OP
PCR, RT-PCR)
Beta Globin/ Globulin Genotyping Covered up to 100% of MBL/member/year Shared limit of IP & OP
Capsule Endoscopy Covered up to 100% of MBL/member/year Shared limit of IP & OP
Coblation Procedures Covered up to 100% of MBL/member/year Shared limit of IP & OP
Continuous Renal Replacement Therapy (CRRT) Covered up to 100% of MBL/member/year Shared limit of IP & OP
Contrast Enhanced Ultrasound Covered up to 100% of MBL/member/year Shared limit of IP & OP
Contrast Enhanced Fluorodeoxyglucose FDG PET Scan Covered up to 100% of MBL/member/year Shared limit of IP & OP
Ductoscopy (Breast) Covered up to 100% of MBL/member/year Shared limit of IP & OP
Duolink In-Situ Fluoresence Hybridization (DISH) Covered up to 100% of MBL/member/year Shared limit of IP & OP
Endoscopic Ultrasound Covered up to 100% of MBL/member/year Shared limit of IP & OP
Endovenous Laser Treatment Covered up to 100% of MBL/member/year Shared limit of IP & OP
Endovenous Laser Ablation Covered up to 100% of MBL/member/year Shared limit of IP & OP
Enhanced Fluorescent Protein Voltage Sensor (VPSP2.1) Covered up to 100% of MBL/member/year Shared limit of IP & OP
Enhanced Luciferase Complementation Covered up to 100% of MBL/member/year Shared limit of IP & OP
Enzymed-linked Immunosorbent Spot (ELLISPOT) Assay Covered up to 100% of MBL/member/year Shared limit of IP & OP
Epidermal Growth Factor Receptor (EGFR) Mutation Assay / Test Covered up to 100% of MBL/member/year Shared limit of IP & OP
ESAT-6 and CFP-10 Antigens Covered up to 100% of MBL/member/year Shared limit of IP & OP
Fluorescence In-Situ Hybridization (FISH) Covered up to 100% of MBL/member/year Shared limit of IP & OP
Gastric Electrical Stimulation Technology Covered up to 100% of MBL/member/year Shared limit of IP & OP
Image-guided Surgery / Radiotherapy Covered up to 100% of MBL/member/year Shared limit of IP & OP
Infrared Coagulation Hemorrhoidectomy Covered up to 100% of MBL/member/year Shared limit of IP & OP
Infrared Thermography Covered up to 100% of MBL/member/year Shared limit of IP & OP
Intravenous Ultrasound Covered up to 100% of MBL/member/year Shared limit of IP & OP
JAK-2 Mutation Covered up to 100% of MBL/member/year Shared limit of IP & OP
Karyotyping Covered up to 100% of MBL/member/year Shared limit of IP & OP
KRAS Testing Covered up to 100% of MBL/member/year Shared limit of IP & OP
Magnetic Resonance Spectroscopy Covered up to 100% of MBL/member/year Shared limit of IP & OP
Mammotome or Vacuum Assisted Breast Biopsy Covered up to 100% of MBL/member/year Shared limit of IP & OP
Monoclonal Antibody Therapy for Autoimmune conditions and
Rheumatological Diseases
(Note: Certain Monoclonal Antibodies have immunosuppressive
properties and this led to their therapeutic application (monoclonal Covered up to 100% of MBL/member/year Shared limit of IP & OP
antibody therapy) in autoimmune conditions and rheumatologic
diseases, such as SLE, ankylosing spondylosis, rheumatoid arthritis,
etc.)
Multiphoton imaging Covered up to 100% of MBL/member/year Shared limit of IP & OP
Multislice / multidetector/ spiral / multirow CT Covered up to 100% of MBL/member/year Shared limit of IP & OP
Neutral Commet Assay Covered up to 100% of MBL/member/year Shared limit of IP & OP
Optical Glutamate Sensor Covered up to 100% of MBL/member/year Shared limit of IP & OP
Parkinson's Profile Covered up to 100% of MBL/member/year Shared limit of IP & OP
Percutaneous Discectomy CT Guided Intradiscal Electrothermal
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Ablation Technic (IDET)
Peritonial Dialysis Adequacy Test Covered up to 100% of MBL/member/year Shared limit of IP & OP
Peritoneal Equilibrium Test Covered up to 100% of MBL/member/year Shared limit of IP & OP
phaA and phaB genes test Covered up to 100% of MBL/member/year Shared limit of IP & OP
Pharmacoscintigraphy Covered up to 100% of MBL/member/year Shared limit of IP & OP
Philadelphia chromosome Covered up to 100% of MBL/member/year Shared limit of IP & OP
Photodynamic Glutamate Sensor Covered up to 100% of MBL/member/year Shared limit of IP & OP
Platelet Aggregation Test Covered up to 100% of MBL/member/year Shared limit of IP & OP
Polymerase Chain Reaction (PCR) for katG and rpoB Covered up to 100% of MBL/member/year Shared limit of IP & OP
Polymerase Chain Reaction Single Strand Confirmation Polymorphism
Covered up to 100% of MBL/member/year Shared limit of IP & OP
(PCR-SCCP)
QuantiFERON Tuberculosis (QFTB) Covered up to 100% of MBL/member/year Shared limit of IP & OP
Radiofrequency Ablation (RFA) and other RF procedures Covered up to 100% of MBL/member/year Shared limit of IP & OP
Renal Denervation Covered up to 100% of MBL/member/year Shared limit of IP & OP

VALUCARE / The Program Page 4 SME PACKAGE 2022

Reverse Transcription Polymerase Chain Reaction (RT-PCR)
Robotic Surgery / Robotically assisted Surgery
Single Incision Laparoscopy Surgery (SILS)
Spinal Angiogram
Stereotactic Radiation Therapy/ Stereotactic Radiosurgery
Supramagnetic Ion Oxide (SPIO)- enhanced MRI
Transarterial Hemorrhoidal Dearterialization (THD)
Terahertz Imaging
Three-Dimensional Conformal Radiotherapy (3DCRT)
Thyroplasty
Tomotherapy
Tractography
Ultrafast Electron Beam Computed Tomography
Ultroid Hemorrhoid Management
Vulcan EAS (Electro Thermal Arthroscopy System)
Bone Scan
Bone Mineralodensity Studies
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered up to 100% of MBL/member/year Shared limit of IP & OP
Covered 100% as charged, subject to MBL
Covered 100% as charged, subject to MBL

Botox which is not cosmetic in nature nor for beautification purpose Covered up to P5,000/member/year Shared limit for OP and IP

Brainstem Auditory Evoked Response (BAER) Covered 100% as charged, subject to MBL

Continuous Positive Airway Pressure (CPAP) titration for sleep study Up to P60,000/member/year (shared limit for OP and IP)

Computed Tomography Scans (except Spiral Computed Tomography

Covered 100% as charged, subject to MBL
Scan with 3D Reconstruction)
CT Pulmonary Angiography Covered up to P5,000/member/year Shared limit for OP and IP
CT Stonogram Covered Php30,000, subject to MBL
Electroencephalogram (EEG) Monitoring Covered 100% as charged, subject to MBL
Electromyography (EMG), Nerve Conduction Velocity Studies Covered 100% as charged, subject to MBL
Endoscopic procedures, which include nasal endoscopy,
esophagogastroscopy, proctosigmoidoscopy and colonoscopy Covered 100% as charged, subject to MBL
(Laparoscopic PCNL not covered)
Esophageal Manometry Covered up to P5,000/member/year Shared limit for OP and IP
Intensified Modulated Radiotheraphy Covered up to P5,000/member/year Shared limit for OP and IP
Laryngeal Stroboscopy Covered 100% as charged, subject to MBL
Lung function studies Covered 100% as charged, subject to MBL
M-Mode Echocardiography Covered 100% as charged, subject to MBL
Magnetic Resonance Imaging (MRI) including Magnetic Resonance
Covered Php5,000, subject to MBL
Spectroscopy (MRS)
Mammography & Sonomammography Covered 100% as charged, subject to MBL
Mammotome Covered up to P5,000/member/year Shared limit for OP and IP
Myelogram Covered 100% as charged, subject to MBL
Nuclear Radioactive Isotope Scan (NRIS) Covered Php10,000, subject to MBL
Organ Transplant (excluding donor's expenses and cost of organ) Covered 100% as charged, subject to MBL
Photodynamic Therapy Covered up to P5,000/member/year Shared limit for OP and IP
Plasma Urinary Cortisol, Plasma Aldosterone Covered 100% as charged, subject to MBL
Positron Emission Tomography (PET) Scan Covered up to P5,000/member/year Shared limit for OP and IP
Pulmonary Perfusion Scan Covered 100% as charged, subject to MBL
Sleep Study (for Obstructive Sleep Apnea Syndrome) Covered up to Php5,000, subject to MBL
Treadmill Stress Test Covered 100% as charged, subject to MBL
Ultrasound (Maternity-related ultrasound procedures not covered) Covered 100% as charged, subject to MBL
Ultrasound-guided Procedures Covered Php10,000, subject to MBL
Other Special machine-guided procedures (CT-guided biopsy,
Covered Php10,000, subject to MBL
drainage of fluids, etc)
All other sophisticated diagnostic modalities with or without Covered up to Php5,000,
comparable conventional or traditional equivalent or counterparts subject to MBL
THERAPEUTIC PROCEDURES
Angiography including Magnetic Resonance Angiogram Covered up to Php10,000, subject to MBL
Angioplasty Covered up to 50% of MBL
Arthroscopic Procedures Covered up to Php40,000, subject to MBL
Brachytherapy Covered up to Php30,000, subject to MBL

VALUCARE / The Program Page 5 SME PACKAGE 2022

Cataract Surgery (excluding cost of lens) Covered 100% as charged, subject to MBL
Non-oral chemotherapy (for cancer treatment only) Up to MBL shared limit for OP and IP
Chemotherapy (oral form) Up to P60,000/member/year shared limit for OP and IP
Cryosurgery Covered up to Php1,000/area, subject to MBL
Dialysis Up to MBL shared limit for OP and IP
Herniorrhaphy (acquired cases) Covered 100% as charged, subject to MBL
Hysteroscopic Procedures (Hysteroscopy Guided D&C, Hysteroscopic
Covered up to Php20,000, subject to MBL
Myemectomy & the like)
Inhalation and nebulization therapy Covered 100% as charged, subject to MBL
Laparoscopic Procedure (Lap Cholecystectomy, Lap Adrenalectomy,
Covered up to Php40,000, subject to MBL
Pelvic Laparoscopy & the like)
Lithotripsy (ESWL) Covered up to Php35,000, subject to MBL
Open Heart Surgery Covered up to 50% of MBL
Orthopedic Surgery (Cost of implant or prosthesis not covered) Covered 100% as charged, subject to MBL
Percutaneous Adrenalectomy Covered up to Php20,000, subject to MBL
Percutaneous Ultrasonic Nephrolithotomy Covered up to Php35,000, subject to MBL
OP: Shared limit of up to twelve (12) sessions/member/year subject to
Physical therapy / Occupational therapy excluding subspecialties such MBL
as cardiac rehabilitation, pulmonary rehabilitation and the like. IP: Up to MBL Note: Therapy of one (1) body area shall be considered
as one (1) session
Prostate Surgery, which include transurethral resection of the prostate Covered 100% as charged, subject to MBL

Protein Electrophoresis Covered 100% as charged, subject to MBL

Therapeutic Radiology:
a. Brachytherapy Up to MBL shared limit for OP and IP
b. Cobalt Up to MBL shared limit for OP and IP
c. Linear Accelerator Therapy Up to MBL shared limit for OP and IP
d. Radioactive Cesium Up to MBL shared limit for OP and IP
e. Radioactive Iodine Up to MBL shared limit for OP and IP
Radiotherapy Covered up to 6 sessions, subject to MBL
Stapled Hemorrhoidectomy Covered up to P5,000/member/year Shared limit for OP and IP
Stereotactic Brain Surgery Covered up to 100% of MBL/member/year Shared limit of IP & OP
Trans-urethral Microwave Therapy (TUMT) Covered up to P25,000/member/year Shared limit for OP and IP
All new & sophisticated modalities of treatment with or without
comparable conventional or traditional Covered up to Php5,000, subject to MBL
equivalent or counterparts
The above limits are subject to MBL, pre-existing provisons, Exclusions & Limitations, and antecedent expenses. The limit for procedures that may
require confinement shall be inclusive of room & board, operating room charges, professional fees, and other incidental expenses relative to the
procedures.
OTHER BENEFITS
Ambulance Service: ValuCare shall reimburse the cost of Ambulance Service by land based on the limits stipulated below per
conduction:
Accredited to Accredited Metro Manila Unlimited
Accredited to Accredited Province to Manila Php3,000/conduction
Non-Accredited to Accredited Metro Manila Unlimited
Non-Accredited to Accredited Province to Manila Php3,000/conduction
Wellness programs (seminars/lectures) Covered (once per contract year)
DENTAL BENEFITS
Any number of consultations with an accredited dentist Covered
Treatment of dental related pain excluding cost of prescribed
Covered
medicines
Simple Oral Prophylaxis once a year Covered
Simple tooth extractions, except surgery for impactions Covered
Gum treatment excluding the cost of prescribed medicines Covered
Recementation of jacket crown, inlays & onlays Covered
Treatment of lesions, wounds & burns Covered
Temporary fillings Covered
Annual dental examination Covered
Adjustment of dentures Covered
Relief and/or prescription for acute dental pain Covered
Emergency desensitization of hypersensitive teeth Covered
Orthodontic consultation Covered
Aesthetic dental consultation Covered
Note: Above dental services can be availed with prior appointment with the accredited dentist. Medicines prescribed by the dentist are
not covered and for the acount of the Member.

VALUCARE / The Program Page 6 SME PACKAGE 2022

 FINANCIAL ASSISTANCE (for employees only)
SCHEDULE OF BENEFITS AMOUNT OF COVERAGE
GROUP YEARLY RENEWABLE TERM LIFE INSURANCE (BASIC LIFE) Php 100,000
ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS (AD&D) Php 100,000
Loss of Life 100%
Loss of entire sight of both eyes 100%
Loss of both hands and feet 100%
Loss of one hand and one foot 100%
Loss of either hand or foot and sight of one eye 100%
Loss of either hand or foot or sight of one eye 100%
However, should the Planholder failed to settle any of its financial obligation prior to the date of ocurrence, the same shall be deducted
from the financial assistance.
SPECIAL FEATURES
SCHEDULE OF REFUND FOR ANNUAL and SEMI-ANNUAL PAYMENT
If a Member's coverage is terminated or cancelled, the unused pro rata Membership Fee paid shall be refunded to the member only if no
availment has been made by the Member prior to the termination or cancellation. Refund is available only if the Member has fully paid its
annual or semi-annual Membership Fees.
Percent (%) of refund from the Membership Fees
If the Agreement / Membership has been in force for:
ANNUAL SEMI-ANNUAL
Less than one (1) month 80% 40%
At least one (1) month but less than three (3) months 70% 35%
At least three (3) months but less than six (6) months 40% 20%
Six (6) months or more No Refund No Refund
There shall be no refund of Membership Fees in the event that:
a. Membership Fee is payable on a quarterly or monthly mode;
b. Remaining coverage of the member is six (6) months or less;
c. The Member has availed of any benefits under this Agreement. If the Membership Fees are unpaid prior to the cancellation or
termination of Membership, MEMBER shall settle pro rata Membership Fee, inclusive of penalty charges if applicable.
d. Delay in the payment of membership Fees

Note: Processing fee shall not be refunded. Fees paid for processing of applications are non-refundable. Applicable processing of
refund is after ninety (90) days from termination date of Member / Agreement to determine any incurred but not yet reported utilization.

PERSONALIZED ACCESS TO LABORATORY SERVICES (PALS)* - Allows members to undergo prescribed simple laboratory test (i.e.
Fasting Blood Sugar) to be done at the office or even at home upon coordination with ValuCare.
*Initially available in Metro Manila area only.

VALUCARE / The Program Page 7 SME PACKAGE 2022