SERVICES:

IN PATIENT: Confinement and Bone Implant

OUT PATIENT: Laboratory (bloodchem only) ,
Diagnostic Procedure, Medicines (specified), medical devices
(specified)
SERVICES: in patient
1. CONFINEMENT ASSISTANCE-
Requirements:
a.   Copy of Unified Intake Sheet (UIS)
b.  Original Statement of Account (SOA)
c. Original or Certified True Copy of the
Clinical or Medical Abstract or Discharge Summary
 If the Clinical/Medical Abstract is not yet available, a medical certificate or
certificate of confinement may be accepted. However, the abstract must
be submitted for the processing of payment.
d. Copy of Valid ID of the patient and his representative
f. Certificate of Eligibility
SERVICES: out patient
1. Cancer Treatment-
Chemo Drugs and Radiation Therapy
Requirements:
a.   a.   Copy of Unified Intake Sheet (UIS)
b.  Original or Certified True Copy of the Clinical or Medical
Abstract or Discharge Summary
c. Original Medical Prescription
d.   Copy of Valid ID of the patient and his representative
e. Original or Certified True Copy of the Treatment Protocol
f. Copy of Certification on the number of sessions availed
from the Philhealth (radiation therapy)
g. Official Price Quotation
i. Certificate of Eligibility
SERVICES: out patient
1. Treatment for End Stage Renal Disease
Hemodialysis and Erythropoietin Injection
Requirements:
a.   Copy of Unified Intake Sheet (UIS)
b. Original or Certified True Copy of the Clinical or Medical
Abstract or Discharge Summary
c. Original Medical Prescription
d.   Copy of Valid ID of the patient and his representative
e. Copy of Certification on the number of sessions availed
from the Philhealth
f. Price Quotation
g. Certificate of Eligibility
SERVICES: out patient
Requirements:
1. Medicines a.   Copy of Unified Intake Sheet
a. Hemophilia (UIS)
b.  Anti-rejection (post- transplant) b. Original Medical Prescription
c.  Rheumatoid Arthritis c. Official Price Quotation
d.  Anti-Lupus d. Original or Certified True Copy of
e. Immunocompromised (IVIg) the Clinical or Medical Abstract or
f.  Psoriasis Discharge Summary
g.  Orphan Disease e. Copy of Valid ID of the patient
h.  Idiopathicthrombocytopenic Purpura and his representative
(ITP) f. Original or Certified True Copy of
i.  Thalassemia the Treatment Protocol
j. Neuro-psychiatric medicine g. Original Statement of Account
(SOA)
SERVICES: out patient
Requirements:
1. Laboratory and Diagnostic
procedure a.   Copy of Unified Intake Sheet
(UIS)

a. Blood chem, b.    Original or Certified True Copy

of the Clinical or Medical Abstract or
b. CT Scan, Discharge Summary / Medical
Certificate
c. MRI,
d. 2d echo, c. Price Quotation
d.   Copy of Valid ID of the patient
e. mammogram, and his representative
f. Xray, e. Statement of Account (SOA)
g. UTZ
SERVICES: out patient
1. Implant-
Bone and Cochlear
Requirements:
a.  Copy of Unified Intake Sheet (UIS)
b.   Price Quotation
c.    Original or Certified True Copy of the Clinical or Medical
Abstract or Discharge Summary
d.   Copy of Valid ID of the patient and his representative
e. Police Report
f. Request for the Implant
g. Original Statement of Account (SOA)
h. Acknowledgement Receipt
SERVICES: out patient Requirements:

1. Medical devices a.  Copy of Unified Intake Sheet (UIS)

a.Pacemaker
b. Official Price Quotation
b.Septal occlude c. Original or Certified True Copy of
c.PCI devices (stent, the Clinical or Medical Abstract or
Discharge Summary
balloon catheter, etc.) d. Copy of Valid ID of the patient and
his representative
d.Valves ( MVR/
e. Original Statement of Account
AVR/MAVR) (SOA)-
f. Acknowledgement Receipt
Exemptions: limitations of the program
1. Room and board
2. Professional fees
3. Maternity cases except when
there is complication as
validated by CAD medical
officer.
4. Medical treatment or
intervention for substance
abuse
5. Reimbursement of payment
made by patients
1. Vehicular accident when
suspect are identified
2. Patients admitted in suite,
presidential and executive
rooms
3. Applications filed beyond 7
days upon the death of the
patient
4. Complication as a result of
cosmetic surgery
Validity of Other
Guarantee policies
letter : 4. Patients discharged with
1. 30 days from the date of issuance promissory Note may apply for
assistance within 60 calendar days
In cases of implant and medical
from the date of discharge.
devices, validity of GL may go
beyond 30 days but not more than 5. All completed requirements shall
60 days based on the schedule of be submitted within 15 days upon
surgery release of the GL.
2. The GL is non transferable and
cannot be converted to cash
3. All expired or unutilized GLs
within the prescribed period shall be
deemed automatically cancelled.
Other
concerns: