Apart from providing the most comprehensive and effective

healthcare program, it is your company’s desire to ensure that

members will have a smooth and hassle free medical
availment.

In line with this effort, we have prepared this Availment Guide

to supply information on the proper availment process and
important reminders that will assist you in availing of your
benefits.

Room & Maximum

Level
Board Benefit Limit

PRINCIPALS
Accounts Associates/
Semi-Private PHP 100,000
Support Staff
Team Leaders/ Supervisors/
Semi-Private PHP 130,000
Officers
Managers Regular Private PHP 150,000
DEPENDENTS INPATIENT BENEFITS EMERGENCY CARE (NON-ACCREDITED)
Managers/ Team Leaders/
Supervisors/ Officers/ 2. IN-PATIENT BENEFITS
Semi-Private PHP 80,000 4. In Non-Accredited Hospitals - Reimbursement subject to
Accounts Associates/ ▪ Professional Fees of attending doctor/s
Support Staff Cocolife RUV Rates
▪ X-ray, laboratory tests and other diagnostic procedures
▪ Areas w/o Accredited Hospital – up to 100% of Hospital
▪ Anesthesia and its administration
Eligible dependents per civil status: bills & Professional fees Based on the Insurer’s rates
▪ Whole blood/human blood products and intravenous fluids
Single- Parents up to 65 years old and Siblings from 15 days up to 23 incurred during the first 24hrs up to Maximum Benefit
▪ Oxygen and its administration
years old. Limit
▪ Drugs and medicines for use in the hospital
Married- Legal Spouse up to 65 years old and Children from 15 days ▪ Outside the Philippines – Up to 100% of hospital bills &
▪ Dressings, conventional casts (plaster of Paris) and sutures
old up to 23 years old Professional fees based on Insurer rates incurred during
▪ Use of operating and recovery rooms
Single Parent- Children from 15 days old up to 23 years old, Parents the first 24hrs up to Maximum Benefit Limit
▪ Use of the Intensive Care Unit (ICU)
up to 65 years old and Siblings from 15 days up to 23 years old. ▪ Standard Nursing Services
Note: with accordance to K-12 program age eligibility for dependents REQUIREMENTS:
▪ Standard Admission kit (including ice cap, wee bag, name
from 21 years old is extended up to 23 years old provided that • Official receipts of professional fees and hosp. bills
tag)
dependents are still single, unemployed and fully dependent with the • Hospital Statement of Accounts
▪ All other items directly related in the medical management
principal member and must provide a proof of enrollment and/or • Hospital Charge Slips
of the patient, as deemed medically necessary by the
Certificate of registration. • Clinical Abstracts or Medical Certificates
attending Affiliated Physician
• Police Report if treatment was for injuries sustained in an
accident
• Medical Certificate with diagnosis
OUTPATIENT BENEFITS
4. DENTAL BENEFITS (Health Partners Dental Access)

1. OUT-PATIENT BENEFITS / SERVICES By Appointment:

• Medically necessary consultations during regular clinic ▪ Oral Consultation I Examination
hours ▪ Oral Prophylaxis - Covered twice a year
• Pre and Post Natal consultations excluding lab & ▪ Simple Tooth Extraction
diagnostics ▪ Temporary Filling
• Treatment for minor injuries such as lacerations, mild ▪ Simple Repair and Adjustment of Dentures
burns & sprains ▪ Recementation of Jacket Crowns, Bridges, Inlay and Onlay
• Eye, ear, nose and throat (EENT) treatment ▪ Palliative Treatment of Simple Mouth Sores and Blisters
• X-Ray, lab examinations, routine, diagnostic and ▪ Desensitization of Hypersensitive Teeth - Up to two (2)
therapeutic procedures Teeth/year
• Minor surgery not requiring confinement ▪ Permanent Fillings (Light Cure Fillings) - Up to two (2)
• Electro cauterization of skin lesions such as plantar warts, Teeth/year
flat warts, periungual warts, filiform warts and molluscum ▪ Gum Treatment for Cases Like Inflammation or Bleeding
contagiosum, in any part of the body - Neck down: up to ▪ Emergency Out-Patient Dental Treatment
MBL; Facial warts: up to Php 2,000 ▪ Oral Incision and drainage
• Allergy Testing/ allergy screening and other related ▪ Temporo Mandibular Joint Consultation (TMJ)
examinations - Covered up to Php 2,500 ▪ Restorative and Prosthodontics treatment planning
• Tuberculin test - Covered up to Php 1,000 ▪ Dental nutrition and dietary counseling
• Sclerotherapy for varicose veins (except medicines and for ▪ Dental health education
cosmetic purposed) - Covered up to Php 10,000 per leg
EMERGENCY CARE (ACCREDITED) ▪ Dental X-ray - Reimbursable up to Php1,000/member/year
3. EMERGENCY CARE SERVICES IN ACCREDITED NETWORKS *DEEP SCALING or HEAVY PROPHYLAXIS is not covered.
▪ Doctor’s services (This procedure requires additional fees depending on the
▪ Emergency Room Fees dentist)
▪ Medicines used for immediate relief during treatment
▪ Whole blood/human blood products
▪ Oxygen and IV fluids
▪ X-ray, laboratory tests and other diagnostic procedures
 ▪ Scoliosis including necessary procedures, except physical
therapy sessions, whether congenital, pre-existing,
developmental or acquired - Up to MBL member/year
(shared limit for IP and OP)
Note: Physical Therapy sessions shall form part of the
HEALTHCARE PROGRAM
▪
Physical therapy/ Occupational therapy limits
Congenital Conditions except physical therapy sessions and
developmental disorders - Up to MBL member/year
SUMMARY
(shared limit for IP and OP)
Note: Physical Therapy sessions shall form part of the and AVAILMENT GUIDE
Physical therapy/ Occupational therapy limits
▪ Chronic Dermatoses - Consultations only
▪ Hepatitis B except vaccines and screening
▪ Administration of immunization except of cost of vaccines
▪ Hyperventilation - Covered first for ER cases up to 50% of Exclusive for
MBL/member/year
▪ Sleep Study and Sleep Apnea - Covered up to
P65,000/member/year
▪ AIDS secondary to blood transfusion or accidental needle
injection
5. ANNUAL PHYSICAL EXAMINATION - PRINCIPALS ONLY
▪ Routine Check Up
▪ Physical Examination and History Taking
▪ Complete Blood Count COST OF ID’s
▪ Urinalysis ▪ For Lost ID’s: Php 200.00
▪ Fecalysis ▪ For Replacement of ID’s: Php 50.00 April 01, 2020 – March 31, 2021
▪ Chest X-ray (Replacement ID will be released five to seven (5 - 7)
▪ Electrocardiogram (ECG) - Covered for 35 years old and up working days upon receipt of payment)
▪ Pap smear - Covered for 35 years old and up
▪ Blood Typing 9. FAQ’s
▪ Eye Refraction
▪ Blood Chemistry (FBS, Total Cholesterol, Triglycerides, How do I know if a certain diagnostic procedure requested by
HDL, LDL and Uric Acid) an accredited doctor is covered under my program?
* Covered for Managers For inquiries on your benefit coverage, you can call or email our
* Only FBS and Total Cholesterol are covered for Team 24/7customer care email cncariaga@cocolife.com. Our Call Center
Leaders/ Supervisors/ Officers/ Accounts Associates/ Specialist will ask for your medical details to assess the coverage of
Support Staff. your availment based on your Cocolife program. FOR ASSISTANCE & INQUIRIES
Note: To be scheduled by HR What do you mean by confinement of hospitalization? COCOLIFE DEDICATED HOTLINE
A person is said to be confined or hospitalized if he is admitted in a NUMBER:
hospital as a registered bed patient for at least twelve (12) hours. (0917) 822-2945
6. FINANCIAL ASSISTANCE (for principals only)
Death due to Natural Cause Php 100,000
What do you mean by latest modality?
Death due to Accident Php 100,000
A medical procedure is defined as: 24/7 MEDICAL HELPLINE
1. Available only to one or two tertiary medical care facilities TRUNK LINE 02 812-9090
7. SPECIAL PROVISIONS
2. Requires specialized skills from specialized personnel and:
PRE-EXISTING MEDICAL CONDITIONS
3. Is sanctioned and recognized as a significant medical update and MOBILE NUMBERS (0917) 536-0962
▪ Pre-existing Medical Conditions are covered. (0917) 824 3942
part of the standard clinical practice guidelines by the corresponding
MATERNITY BENEFIT
clinical and academic society or association responsible for certifying (0917) 886 4799
▪ Covered Members - Female Employees (Married)
practicing specialist physicians. (0922) 892-8828
▪ Cocolife shall cover the hospital bills and professional fees
incurred by covered Member for maternity (0922) 838 4176
services/procedures, up to the following limit:
Are your hotlines available even during midnight?
0917 802 6146
o Normal Spontaneous Vaginal Delivery -
Our call center operates 24/7 and is manned by our Call Center
P5,000/member/year
Specialists who are highly trained to assist you in any of your medical COCOLIFE TEXT MESSAGING FACILITY
o Caesarian - P5,000/member/year
concerns.
o Dilation and Curettage (D&C) -
P5,000/member/year 0917 622 COCO
10. Provider Access
Maternity Complications other than the above
o
mentioned - P5,000/member/year
(2626)
In Patient: All accredited hospitals and clinics. No access in In which our valued clients can utilize if in any event that
▪ Type of Availment - Reimbursement basis based on actual
St. Luke’s Medical Center – BGC.
amount and subject to above mentioned limits if availed hospitals/clinics are experiencing difficulties in reaching
outside the network
Out Patient: All accredited hospitals and clinics. No access in our Helpline, we encourage to send an SMS for a more
▪ PhiiHealth benefits - Require to File and On top of
St. Luke’s Medical Center – BGC. efficient coordination and faster reply.
Maternity Limit
No access in Asian Hospital & Medical Center, Cardinal Santos Medical
Center, Makati Medical Center, St. Luke’s Medical Center – Quezon
8. CONDITIONS WITH SPECIFIC LIMITATIONS
City and The Medical City except for OP-Emergency cases and ER
▪ Initial Treatment within 24 hours from time of bite of Arranged by:
leading to confinement.
Animal bites (under ER and OP only)
▪ Succeeding treatment after 24 hours from time of bite of
Animal bites
11. GENERAL EXCLUSION CONDITIONS: Please refer to Cocolife’s
▪ Vaccines for treatment of tetanus and animal bites
Guidebook.
(including administration fee but excluding ER Fees)