ADDITIONAL FEATURES

PRE-EXISTING CONDITIONS
 Admission Kit is covered.
 Allergy Testing /Allergy Screening and other related examinations
prescribe by an accredited physician shall be covered up to P15,000. ValuCare shall cover up to Maximum Benefit Limit (MBL)
 Congenital Hernia is covered. of pre-existing conditions for
 Chronic Dermatoses Consultation is covered. PRINCIPALS on the start of membership.
 Provoked and unprovoked assault, including domestic violence,
whether initiated by the Member or by known or unknown third ValuCare shall cover up to Maximum Benefit Limit (MBL)
party is covered. of pre-existing conditions for
 Scabies is covered. DEPENDENTS on the start of membership.
 Valvular Diseases is covered.
 Congenital conditions (except physical Therapy sessions and
developmental disorders) are covered up to MBL.
 Anti-Rabies and Anti-Venom are covered up to P40,000 aggregate DENTAL BENEFITS
(Active and Passive Vaccine for animal bites)
 Anti-tetanus shall be covered up to MBL.
 Pre and Post Natal shall be covered up to 18 consultations, excluding
laboratory work-ups.


Unlimited dental consultations
Treatment of dental related pain except medicines
SUMMARY OF BENEFITS
 Hepatitis B except vaccines and screening is covered.  Oral Prophylaxis – Twice per contract year
 Tuberculin test except screening is covered up to P5,000.
 Sports related injuries (company and non-company sponsored) shall


Simple Tooth Extractions except surgery for impacted tooth
Gum treatment excluding medicines
Exclusively for
be covered up to MBL.
 Work related injuries or illnesses (principal members only) shall be  Recementation of loose crowns, inlays and onlays
covered up to MBL.  Dental Health Education
 Work related injuries or illnesses (dependents only) shall be covered  Minor adjustment of Dentures


up to P30,000.
Scoliosis including necessary procedures, except physical therapy
sessions, is covered up to MBL.


Temporary Fillings – unlimited, as needed
Desensitization of Hypersensitive Teeth up to 6 teeth per year
Permanent Light cure fillings up to 4 teeth per year
PRU LIFE INSURANCE
 Slipped disc, Spondylosis, Spinal Stenosis are covered up MBL.
 Hyperventilation syndrome is covered for the first ER availment up
to P15,000 (for employees only)
 Temporomandibular joint initial consultation

NOTE: Always make an appointment with the accredited dentist to be

CORPORATION OF U.K.
 Medicolegal Cases is covered up to maximum benefit limit.
 Organ transplant (excluding cost of organ and donor’s expense) is assured of accommodation
covered up to MBL.
 Sophisticated/New modalities is covered up to P30,000. PREVENTIVE HEALTH CARE SERVICES April 1, 2022 to March 31, 2023
 Autoimmune Disease is covered up to P30,000.
 Covid Home Care is covered.  Health education and counseling diets or exercise
 Covid-19 is covered subject to Philhealth and DOH guidelines.  Health habits and family planning counseling
 Mental Health Consultation is covered under the condition that  Wellness Program once per contract year
consultations must pass through ValuCare’s teleconsult. If a specialist  Annual Physical Examination (APE) for principal and dependent No. 33, Meralco Avenue, Brgy. San Antonio, Pasig City
*can be availed as early as October 2022 Trunk Lines: 8702-3310 & 5317-4388 Fax: 8687-9453 & 56;
is needed, ValuCare will refer the member to its accredited
 Physical examination 24-hour hotlines: 8702-3310;
psychiatrist.
(0917)886-2892; (0917)793-2273; (0925)610-0301
 Teleconsult is covered thru Konsulta MD.  Stool examination (Fecalysis)
Toll free: 1-800-1-888-7345 & 1-800-1-888-1568
 Motor vehicular Accidents is covered.  Urine examination (Urinalysis) Help Desk: (02) 8702.3402 & (02) 8702.3401
*VC shall cover Motor Vehicular Accident cases upon submission of  Complete Blood Count (CBC) Website: www.valuecarehealth.com
the necessary documents (i.e. Police Report, Medical Certificate, OR,  Eye and Optemetric Refraction
etc.,). In case where patient submits a police report at any time
 Electrocardiogram for members 30yrs.old and
during the entire confinement and before this charge, (and
accomplishes the deed of subrogation if a third party is involved) and
above
is found to be not at fault after evaluation, VC agree to issue a letter  Pap Smear for female members 30yrs.old and
of authority to cover confinement based on the limit of benefits. above
 REQUIREMENTS:
OUT-PATIENT HEALTH CARE SERVICES PROCEDURES FOR IN-PATIENT AVAILMENT  Duly filled up Reimbursement Form
 Statement of Account from hospital (Summary & Itemized)
 Medically necessary consultations, including pre and post-natal with medicare deduction and individual charge slips
consultations during regular clinic hours, except prescribed  Official Receipt/s of laboratory/diagnostic charges with
medicines. Proceed to request
Admitting Section ValuCare Upon discharge:
 Eye, ear, nose and throat (EENT) treatment prescribed by an *file PHIC  Official Receipt/s in payment of hospital bill
of ValuCare liaison officer
Affiliated Physician/Specialist. accredited will issue LOA *settle charges  Official Receipt/s in payment of Professional Fee(s)
 Treatment for minor injuries such as lacerations, mild burns, hospital and after proper not covered by  Official Receipt/s and prescription/s for medicines and
sprains and the like. secure admitting verification VC supplies bought outside the hospital during confinement
 X–Ray, laboratory examinations, routine, diagnostic and orders
 Clinical Abstract/ Medical Certificate
therapeutic procedures prescribed by an affiliated  If necessary: Operative Record (for surgical cases), Police
physician/specialist, provided however that the cost of Report (medico-legal cases)
diagnostic and therapeutic procedures covered shall be limited EMERGENCY HEALTH CARE SERVICES  Authorization to Deposit
to the amount set forth below.
 Pre & Post-natal consultations covered up to 18 consultations NOTE: All reimbursement is subject for evaluation prior to
 In Areas with Accredited Hospital: For reimbursement, 100% of the
 Referral to specialist. approval.
cost of health services availed based on the Plan holder’s plan up to
PROCEDURES FOR OUT-PATIENT AVAILMENT The plan is integrated with Philhealth benefit. Plan holders are
MBL
required to file Philhealth (Medicare) prior to discharge from the
 Official Business Trip: For reimbursement, 100% of the cost of
Proceed to Valucare hospital for the following:
Present VC card to health services availed based on the Plan holder’s plan up to MBL
accredited hospital /  Admissions not less than 24 hours;
Plan coordinator  In Areas with no Accredited Hospital: For reimbursement, 100% of
clinic  Out-patient OR procedures;
the cost of health services availed based on the Plan holder’s plan
 Endoscopic procedures;
up to MBL.
Secure Request Form  Cataract Extraction;
from the Plan Patient will be  Chemotherapy
Coordinator for AMBULANCE SERVICES (For reimbursement)
referred to a  Radiotherapy;
laboratory procedures specialist when  Dialysis;
necessary  Ambulance Service thru reimbursement (hospital to hospital
 Lithotripsy
transfer) shall be covered up to Php 5,000 per conduction.
NOTE: Please keep the acknowledgement receipt for
PROCEDURES FOR EMERGENCY AVAILMENT future reference.

IN-PATIENT HEALTH CARE SERVICES Proceed to ER of

ER
FOR NON- FINANCIAL ASSISTANCE
ValuCare ADMISSION:
personnel
Room and Board according to the member’s room and board accommodation accredited *check charge ValuCare shall provide cash assistance (for Life and Accidental Death &
will render
 Use of operating and recovery rooms hospital and slips
immediate Disablement) to all Principal members, based on the following schedule:
 Professional fees in accordance with ValuCare Schedule of Rates present your VC *settle charges
care
 Drugs and Medicines for use in the hospital card not covered a. Group Yearly Renewable Term Life Insurance (Basic Life) P 100,000
 Whole blood and human blood products transfusions and intravenous b. Accidental Death and Dismemberment Benefits P 100,000
fluids c. Dismemberment, as per schedule of indemnities, stated below:
 X-Ray, laboratory examinations, and diagnostic tests
 Dressing, casts (except fiberglass supplies) and sutures
FILING OF REIMBURSEMENT NATURE AMOUNT
 Anesthesia and its administration Loss of Life 100 % of the insurance amount
NOTE: Filing of reimbursement claims should be made within thirty
 Standard Nursing Services Loss of entire sight of both eyes 100 % of the insurance amount
(30) calendar days after availment date (within Metro Manila Area) or Loss of both hands and feet 100 % of the insurance amount
 Standard Admission Kit within sixty (60) calendar days after availment date(outside Metro Loss of one hand & one foot 100 % of the insurance amount
 Use of Intensive Care Unit (ICU/CCU) Manila Area) Loss of either hand or foot and sight
 All other items directly related in the medical management of the
of one eye 100 % of the insurance amount
patient, as deemed medically necessary by the attending Affiliated Loss of either hand or foot or
Physician sight of one eye 50 % of the insurance amount
  Polysomnograms (Sleep Recording) PROCEDURES/DIAGNOSTIC EXAMINATIONS BASED TO STIPULATED
BENEFITS  Pulmonary Function Tests LIMIT BELOW:
 Cardiac Stress Tests (Thallium and Dipyridamole Stress
Test) 4D Ultrasound except for
up to Php10,000, subject to MBL
PROCEDURES/DIAGNOSTIC EXAMINATIONS COVERED UP TO  Radionuclide Ventriculography maternity-related cases
MBL  Surface Electromyography (SEMG) up to six (6 sessions) subject to MBL
 12-Lead Echocardiography (ECG)  Radioisotope Scans and function Studies: Arthrocentesis for OP; up to MCB for IP
 24 Hour Electroencephalogram (EEG) Monitoring a. Cardiac Botox which is not cosmetic in
 24 Hour Holter Monitor b. Gastrointestinal nature nor for beautification up to Php10,000, subject to MBL
 2D Echo w/ Doppler c. Liver purpose
 Adrenocortical Function d. Parathyroid Bone, Pulmonary (Perfusion/Ventilation Cryosurgery up to P 10,000, subject to MBL
 Anti-Nuclear Antibody, C-Reactive Protein (Rheumatic Lung Scan) CT Pulmonary Angiography up to Php10,000, subject to MBL
e. Renal Electrocauterization of Warts
conditions & its complications), Lupus Cell Exam
f. Thyroid Scans Face P5,000 per contract year at P1,000
 Arterial Blood Gas
g. Total Body Scans Neck Down per session
 Arthroscopic Procedures, Orthopedic Arthroscopy
 Audiograms and Tympanograms  Thallium Scintigraphy Except Genital
 Treadmill Stress Test (TMST) Endovenous Laser Therapy (except Covered up to Php10,000, subject
 Bone Densitometry Scan (Dexascan)
 Angiography (gastrointestinal, brain, retinal and peripheral for cosmetic purposes) to MBL
 Bone Mineral Density Studies
vascular) Esophageal Manometry up to Php20,000, subject to MBL
 Computed Tomography (CT) Scan
 Angioplasty /Coronary Angiogram and/or /Coronary Artery Intensified Modulated
 Diagnostic Radiographs: Bypass Graft Radiotherapy
up to Php20,000, subject to MBL
a. Biliary tract: Cholecystogran and Cholangiogram  Cataract Surgery (excluding cost of lens) Laboratory / ancillary services for
b. Chest, ribs, sternum and clavicle  Conventional Hemorrhoidectomy conditions whose pathogenesis or
c. Digestive: Plain film of the abdomen. Barium Enema, Maximum limit of P25,000 per
 Electromyography, Nerve Conduction Velocity Studies subsequent clinical improvement
contract year
Upper Gastrointestinal (GI) Series, Lower GI Series,Small  Eye Laser Therapy (for Cataract extraction, Retinal is not yet fully established in
Bowel Series Detachment & Glaucoma) except for correction of error of Medical Science
d. Face (including sinuses), head and Neck refraction such as myopia, astigmatism & hyperopia Covered up to Php20,000, subject
Laser / Coblation Tonsillectomy
e. Urinary: Kidney, ureter and Bladder (KUB) Pyelograms  Hysteroscopic Myoma Resection to MBL
and Crystograms  Hysteroscopically-guided D&C Mammotome up to Php20,000, subject to MBL
f. X-ray of the extermities and pelvis  Laparoscopy Stapled Hemorrhoidectomy up to Php20,000, subject to MBL
g. X-ray of the spine (cervical, thoracic, lumbo sacral)  Lithotripsy Positron Emission Tomography
up to Php50,000, subject to MBL
 Diagnostic Ultrasounds:  Percutaneous Ultrasonic Nephrolithotomy (PET) Scan
a. 2D-Echo with Doppler  Stereotactic Brain Biopsy Photodynamic Therapy up to Php10,000, subject to MBL
b. Abdomen  Scalpel Hemorrhoidectomy Sclerotherapy up to P 10,000 per contract year
c. Duplex Scan  Serum Chemistry panels (eg. Chem 23, Spec M, etc.) Stereotactic Brain Surgery up to 50% of MBL
 Transurethral Microwave Therapy of Prostate Continuous Positive Airway
d. Digestive and Urinary Systems Up to Php 60,000 shared limit for
 Dialysis Pressure (CPAP) tiltration for sleep
e. Ultrasound of the Lungs OP and IP
 Intravenous Chemotherapy study
 Electroencephalogram (EEG) Monitoring
 Inhalation Therapy Up to six (6) sessions subject to
 Electronyelography and Nerve Conduction Studies Phlebotomy
 Therapeutic Radiology MCB for OP; Up to MBL for IP
 Endoscopic Procedures a. Brachytherapy Physical Therapy/Occupational Shared limit of up to fifteen (15)
 Fluorescein Angiography b. Cobalt therapy excluding sub-specialities sessions/member/year subject to
 Impedance Plethysmography c. Linear Accelerator Therapy such as cardiac rehabilitation, MBL for OP; Up to MBL or IP. *Note:
 Magnetic Resonance Angiography (MRA) d. Radioactive Cesium pulmonary rehabilitation and the Therapy of one (1) body area shall
 Magnetic Resonance Imaging (MRI) e. Radioactive Iodine like. be considered as one (1) session.
 Mammogram & Sonomammogram  Speech Therapy (for stroke patients only) Thoracentesis
Up to ten (10) sessions subject to
 Myelogram  Gamma Knife Surgery MBL for OP; Up to MBL for IP
 Nuclear Radioactive Isotope Scan  Genetic Studies
 Pap Smear  Oral Chemotherapy
 Plasma Urinary Cortisol, Plasma Aldosterone

EXCLUSIONS AND LIMITATIONS
No health care benefits shall be paid for the following:
a) Service from Non-VALUCARE Accredited Physician and / or Non-VALUCARE
Accredited Hospitals and other health/medical providers, including adverse
medical conditions arising from treatment of the same except those
stipulated under the provisions on emergency care services.
b) Custodial, Domicilliary, Convalescent; Intermediary Care;
c) Diagnostic work-ups, treatment and operations, to treat congenital
deformities and abnormalities (e.g., herniorrhaphy to treat indirect inguinal
hernia);
d) Diagnostic examinations and treatments for cosmetic purposes, and / or
treatment of illnesses resulting from cosmetic procedures, except
reconstructive surgery necessary to treat a functional defect resulting from
an accident injury;
e) Weight reduction programs, surgical operation or procedure for treatment
of obesity, including but not limited to gastric stapling;
f) Maternity care and other conditions resulting from and related to
pregnancy;
g) Physical Examinations and Psychological testing necessary for employment,
school, insurance or licensing purposes;
h) Experimental medical procedures or alternative medicines, such as but not
limited to acupuncture, acupressure reflexology and chiropractics;
i) Services to diagnose, work up, treat and / or reverse infertility or fertility,
virility / potency (erectile dysfunction);
j) Organ transplantation and related laboratory examination, and it's
complications;
k) Purchase or lease of medical equipment, oxygen and oxygen dispensing
equipment except during covered in-patient care;
l) Corrective appliances, artificial aids, surgically implanted internal and
external prosthetic devices;
m) Speech Therapy for congenital and developmental disorders;
n) Psychiatric and / or psychological illnesses and conditions including neurotic
and psychotic behavior disorders; Anxiety disorders;
o) Prescribed out-patient or take home medicines;
p) Treatment of injuries or illness resulting from war, or any combat related
activities while in Military service; injuries resulting from riots, strikes, and
other civil disturbances; injuries or illnesses resulting from attempted suicide
or self-destruction, regardless of whether Planholder was sane or insane;
diagnostic examinations and treatment of infectious disease declared as
epidemic by the Department of Health of the Philippines and/or World Health
Organization;
q) Treatment of illnesses and injuries attributable to the Planholder's own
misconduct, domestic violence, assault, gross negligence, alcoholic
intoxication, illegal drug use, intemperate or chronic use of drugs or alcoholic
liquor (e.g., hepatic cirrhosis secondary to alcoholism), vicious or immoral
habits (e.g., sexually transmitted diseases like AIDS, gonorrhea and syphilis,
condylomata, herpes and their attendant complications), participation in the
commission of a crime whether consummated or not, violation of a law of
ordinance, and unnecessary exposure to any imminent danger or hazard to hh) Collagen diseases, including Systemic Lupus Erythematosus, Sclerederma,
health; dermatomyositis, polymyositis.
r) Dental cases and illnesses, Including its complications; oral surgery for
purposes of beautification;
s) Treatment of injuries or illnesses caused by directly or indirectly by TIPS ON HOW TO MANAGE WELL YOUR MBL:
 Use the VC Network of Providers
participation in any hazardous sport or activity which includes, but is not
 Be an active participant in the management
limited to BASE jumping, bungee jumping, gliding, hang gliding, high wire, ski of your illness
jumping, skydiving, sky surfing, ballooning and sky flying; land sports  Use Diagnostic facilities with relatively lower
including martial arts (judo, karate, taekwando), gymnastics, boxingm rates
wrestling, horseback riding, polo, paintball, mountain or indoor climbing,  Use of the VC primary care clinics for
motor sports (car racing, motorbike racing), adventure racing, aggresive inline common ordinary illness
skating, BMX, extreme motocross, extreme skiing, freestyle skiing, land and  Attend and participate in the wellness
ice yachting, mountain biking, mountain boarding, outdoor climbing, caving programs/lectures conducted at your
or spelunking, sandboarding, skateboarding, speed biking, speed skiing, company.
scootering and street luge; water sports including barefoot water skiing, cliff
diving, free-diving, jet skiing, open water swimming, powerboat racing, round
the world yacht racing, scuba diving, snorkeling, speed sailing, surfing QR CODE FOR ACCREDITED PROVIDERS
wakeboarding, whiterwater kayaking, windsurfing; among others.
t) Treatment of injuries sustained in a motor vehicle accident if the Planholder
or his guardian fails or refuses to execute the Deed of Subrogation specified in
Article 6.3;
u) Corrective eye surgery for error of refraction such as myopia, astigmatism
and hyperopia;
v) Allergy testing, desensitization treatment and related materials
w) Professional fees of medico-legal officers;
x) Congenital and genetic disorders, developmental disorders, sleep and
eating disorders; and metabolic conditions like but not limited to Crigler-
Naijar syndrome, cystinosis, diabetes insipidus, Fabry, fatty acid metabolism
disorders, galactosemia, Gaucher glucose 6-phosphate dehydrogenase
(G6PD), Hurler-Scheie, Hunter hypophosphatemia, lactic acidosis,
mucopolysaccharidosis, Niemann-Pick, organic acidemias, purine
phenylketonuria (PKU), Pompe, porphyria, pseudo-Hurler, pyruvate
dehydrogenase deficiency.
y) Hazardous job-related illnesses and injuries (e.g. highway construction and
jobs that involve driving, due to the heavy machinery involved, miners;
roofers, structural metal workers, military service members, especially during
times of combat, and especially those that serve on in near the from lines).
z) Slipped disc, spondylosis, scoliosis, spinal stenosis; neurological diseases like
multiple sclerosis, demyelinating disease, Guillain-Barre syndrome, Parkinsons
disease, Alzheimers disease, myasthenia gravis, epilepsy, congenital eizure,
disorders; autoimmune disorders.
aa) Dermatological care for aesthetic purposes such as but not limited to
electrocautery, laser treatment or chemical treatment for skin tags,
xanthelasma, milia, keloids, scars, etc.; Psoriasis and vitiligo;
bb)Circumcision, except to correct phimosis;
cc) Gamma globulins, immunoglobulins (e.g., rabies immunoglobulin)
interferon and hormonal therapy;
dd) Screening tests;
ee) Vaccines except anti-tetanus, anti-rabies, and anti-venom;
ff) Dietary / nutrition supplementation, including but not limited to enteral
and parenteral nutritional, vitamins, minerals, amino acids;
gg) Molecular genetic / chromosomal diagnostic examinations.