ZIGZAG MEDIA INC.

Transcription

HEALTHCARE BENEFIT ORIENTATIONZIGZAGMEDIA INC.Period of CoverageNovember 14, 2016 to November 13, 2017

CORPORATE PROFILEEstablished in 19951,000,000 Members NationwideExtensive Network Accreditation Approximately 1,300 hospitals, clinics & diagnostic centers Over 18,000 reputable physicians and specialists More than 880 dentistsStrong Manpower Complement and Infrastructure 24/7 Customer Service Assistance Patient Relations Officers Over 1,500 Strong Workforce 4 Regional Offices (Cebu, Bacolod, Davao, Calamba) 14 Satellite Offices (CDO, Angeles, Legaspi, Dumaguete,Iloilo, Zamboanga, General Santos, Kidapawan, Roxas,Ormoc, Tacloban, Tagbilaran, Tagum, Bukidnon)Beyond 90% Client Retention Rate

DIVERSE CLIENTELE

DIVERSE CLIENTELE

ELIGIBLE MEMBERS1. PRINCIPALS Permanent Employeesup to age 65 years old2. DEPENDENTS Eligible dependents ofpermanent employees,provided hierarchyis followed

ELIGIBLE DEPENDENTSHIERARCHY RULE:For Single Principal Members1. Mother or Father– not over 65 years old2. Siblings (Eldest to Youngest)– 30 days - 21 years old– Unmarried– Unemployed

ELIGIBLE DEPENDENTSHIERARCHY RULE:For Single Parent Principal Members1. Children (Eldest to Youngest)– Biological / Legitimate / Legally adopted– 30 days – 21 years old– Unmarried– Unemployed2. Mother or Father– not over 65 years old3. Siblings (Eldest to Youngest)– 30 days - 21 years old– Unmarried– Unemployed

ELIGIBLE DEPENDENTSHIERARCHY RULE:For Married Principal Members1. Legal spouse– not over 65 years old2. Children (Eldest to Youngest)– Biological / Legitimate / Legally adopted– 30 days – 21 years old– Unmarried– Unemployed

ENROLMENT GUIDELINESEnrollment period – 30 days window Dependents – 30 days from effective date of coverageNo additional dependents except for: Newly born baby – 30 days from date of birth Spouse of newly wed employees – 30 days from date of marriage Dependent of a new employee – 30 days from effective date ofPrincipal member

BENEFITS ROOM & BOARD AND MBLPRE EXISTING CONDITIONSPREVENTIVE CAREOUT PATIENT CAREIN PATIENT CAREEMERGENCY CAREDENTAL CARE

ROOM & BOARD/MAXIMUM BENEFIT LIMITRoom andBoardMaximum BenefitLimit / MBL(Regardless of the price)(Per type of illness)SEMI PRIVATE100,000SMALL PRIVATE100,000REGULAR PRIVATE150,000PhilHealth Required

MAXIMUM BENEFIT LIMITDependents Enrolled after SixMonths from effective date ofcoverage shall be on Pro-ratedbasis.

PRE-EXISTING CONDITION ingNewDependents DependentsPhp 5,00080% RULENOTE: If the 80% rule is not met, pre-existing conditions or dreaded diseases shall not be covered onthe first twelve (12) months of healthcare coverage.What are PRE-EXISTING CONDITIONS? Conditions existing prior to effective date of coverage Professional advice sought for such illness prior to effective date Illness or injury evident to member Nature of disease or illness can be clinically determined to havestarted prior to coverage whether the member is aware or not The following are examples of PEC: Hypertension, goiter, asthma, TB,gall or kidney stones, diabetes, tumors, myoma, arthritis, scoliosis,hernia, prostate disorders etc.

PREVENTIVE CARE ANNUAL PHYSICAL EXAMINATION(APE) Basic 5 Pap smear and ECG for 35 years old and above To be scheduled by your HR / in coordination withIntellicare For ALL Employees Routine Immunization (except cost of vaccines)

OUT PATIENT CARE Medical Consultations with Intellicare affiliated doctors Referral to Intellicare accredited specialists Treatment of minor injuries such as lacerations, mild burns, sprainsand the like Laboratory, x-ray, and other diagnostic proceduresprescribed by an Intellicare accredited physician Minor surgery not requiring confinement Pre- and post-natal consultations with anyIntellicare affiliated OB-GYN up to 14 consultations/year. Speech / Physical Therapy up to 12 sessions per year.

OUT PATIENT AVAILMENTLetter of Eligibility/LOAIF DECLINED, attending medicalstaff will all I telli are’sCustomer Service for assistance.File PhilHealthfor requiredprocedures

OPTIONS FOR OUT PATIENT

OUT PATIENT CARE PARTNERSAventus Makati ClinicClinic Hours: Monday-Saturday / 8am to 5pm6th floor Filomena Bldg.,104 Amorsolo St., Legaspi Village, Makati CityTel # 751-3108/ 869-3289 / 519-6787 / 817-1464 / 869-1993Aventus Alabang ClinicClinic Hours: Monday-Saturday / 8am to 6pm2nd Floor Sycamore ARC 1Building, Buencamino St.,Alabang-Zapote Road, Alabang, Muntinlupa CityTel # 556-3596 / 556-3598 / 556-3594Aventus Ortigas Clinic***Clinic Hours: Monday-Saturday / 8am to 5pmGround Floor, AIC Realty Corporate Center,Sapphire St., Ortigas CenterTel # 584-1013 /584-2430 /570-9967(NOTE: Bring 2 valid IDs for the building and clinic, slippers and shorts are not allowed)Aventus Cebu ClinicClinic Hours: Monday-Saturday / 8am to 5pmUnit 203 2/F TGU Tower I.T. ParkAsiatolon, Apas, Cebu CityTel # (032) 268-8072 / 479-9261; Fax # (032) 236-2585

OUT PATIENT CARE PARTNERSAventus Calamba ClinicClinic Hours: Monday-Saturday / 8am to 5pmUnit 201-203 SQA Corporate Center, Barangay 1National Highway Crossing, Calamba, LagunaTel # (049) 306-0397 / (049) 508-1806Aventus Sta. Rosa ClinicClinic Hours: Monday-Saturday / 7am to 4pm2nd Floor Carvajal Building 2 National Highway, Balibago, Sta. Rosa, LagunaTel # (049) 302-5046Manila Line: Tel # 520-8522Aventus U.N. Avenue Clinic***Clinic Hours: Monday-Saturday / 8am to 5pm5/F Times Plaza Bldg., U.N. Ave. corner Taft Ave., Ermita, ManilaTel # 353-6807 / 518-0056(NOTE: Bring 2 valid IDs for the building and clinic, slippers and shorts are not allowed)Aventus PCS ClinicClinic Hours: Monday-Saturday / 7am 5pm2nd Floor Philippine College of Surgeon Bldg.,992 North Edsa, Quezon CityTel. # 352-4675 to 77

IN PATIENT CARE Room & Board Accommodation within the limits of the PLAN Professional fees of attending Intellicare affiliated physicians Diagnostic procedures referred by the attending Intellicareaffiliated physicians / specialists. Administered Medicines either orally or intravenously Transfusion of blood and intravenous fluids Anesthesia and its administration

IN PATIENT CARE Standard nursing care services, standard admissionkit,sutures, dressings, plaster casts, and other items directlyrelated to the medical management of the patient Use of Intensive Care Unit Use of Operating Room & Recovery Room facilities Assistance in administrative requirementsthrough the Intellicare’s Patient Relation Officers Ambulance Service (hospital to hospital & point of incidentto hospital) to be covered thru reimbursement upto Php 3,000/conduction/member/year

IN PATIENT AVAILMENTSecure anadmitting orderfrom anIntellicareaccrediteddoctor.Proceed to the admittingsection and have your cardSWIPED for validation ofmembership eligibility.If approved, In-patient LOEwill be printed.(Sign the LOE).Present theadmitting orderand LOE. (Foremergency cases,confinements willbe directly facilitatedby the ER staff).IF DECLINED, staff willall I telli are’s Custo erService for assistance.Sign the Referral ControlSheet (RCS) 3 to be issuedy I telli are’s Patie tRelation Officer (PRO).Settle anymiscellaneous/additionalcharges upon discharge.(Please double check orvalidate items charged ifcorrect.)Occupy allowedroom.File yourPhilhealthbefore hospitaldischarge.InformIntellicare officeregardingadmissionwithin 24hours.

ACCESS TO IN PATIENT CAREQ: If the room that I am entitled to is fully occupied, could Ioccupy higher room categories?(Involuntary Room Upgrading)––If entitled Room is not available, member may occupy(1)One category higher (except suite room) and pay onlyfor the ROOM AND BOARD DIFFERENCE, Intellicare willcover the incremental charges.If within confinement the entitled room becomes availablemember should transfer automatically to their allowedroom category. Otherwise, pay all incremental charges.

ACCESS TO IN PATIENT CAREQ: If I want to stay in a more expensive room, and am willing topay for the accommodation, may I do so?(Voluntary Room Upgrading)––Yes. However, keep in mind that staying in a moreexpensive room also makes the other services (i.e.,medicines, professional fee, etc.) more expensive.You will be charged for the excess over yourentitlement and should pay the excess upon discharge(approximately 30% of your total hospital bill, excessroom & board and doctor’s fee). All excess bills shall becollected from you before discharge.

EMERGENCY CAREEMERGENCY CASES are life-threatening situations requiringurgent medical or surgical care e.g. heart attack, stroke, poisoning,loss of consciousness or respiration and alsForeign Territories forER ConfinementCovered up to MBLCovered thrureimbursement up toPhp 30,000Covered thrureimbursement up toPhp 30,000Hospital Bills – 100%Intellicare’s RVSHospital Bills – 80%Intellicare’s RVSHospital Bills – 80%Intellicare’s RVSProfessional Fees –% Intellicare’s RVSProfessional Fees – 80%Intellicare’s RVSProfessional Fees – 80%Intellicare’s RVS*Relative Value Scale (RVS) – rates supposedly paid by HMOs to accreditedHospitals

REIMBURSEMENT1.Secure Intellicare reimbursement form from www.intellicare.com.phand fill out completely.2.Complete the following documents and attach to the ReimbursementForm:OUT PATIENTIN PATIENT Original Official Receipt (with TIN) Statement of Account from theHospital Medical Certificate Laboratory result (if w/ diagnosticprocedure) Original Official Receipt (with TIN) Statement of Account from theHospital Medical Certificate Laboratory result (if w/ diagnosticprocedure) Operative record with histopath (ifwith operation Police report & Medico-legalReport (if required)NOTE: Submit to Intellicare not more than 30 days from expiration of treatment Intellicare will process the request within 20 working days upon receipt of completedocuments

OTHER BENEFITS Anti-rabies, anti-venom and anti-tetanus vaccines shall be covered up toPhp20,000.00 each per member per year Cauterization of warts (from neck down except genital warts) shall becovered up to Php1,000.00 per member per year to be done at anyAventus Clinics only provided that an accredited physician recommends itand only for cases that affect the physiological functions of the member(not for cosmetic/aesthetic purposes). Sclerotherapy shall be covered up to Php5,000.00 per leg per member peryear provided that it is medically necessary and recommended by anaffiliated vascular surgeon (not for aesthetic purposes). Congenital illnesses/ Conditions shall be covered up to PEC limit not toexceed Php20,000.00 per principal member per year Tuberculin Test shall be covered up to Php600.00 per member per year ifthe member shows symptoms of Tuberculosis and if prescribed byaccredited physician.

OTHER BENEFITS Scoliosis, slipped disc, spondylosis and spinal stenosis shall be covered upto PEC limit per year Allergy Testing shall be covered up to the maximum benefit limit permember per year if prescribed by Accredited Physician except for AllergyScreening which shall be covered up to Php5,000.00 per member per yearif prescribed by Accredited Physician Work-related illnesses/ injuries shall be covered up to the maximumbenefit limit per year subject to the exclusions and limitations of thecontract Eye laser treatment for retinal hole, retinal detachment and glaucoma(excluding eye correction such as lasik, PRK and the like) shall be coveredup to PEC limit per year Cataract surgery excluding cost of lens shall be covered up to PEC limitper year

OTHER BENEFITS Unprovoked murder & assault shall be covered up to the maximumbenefit limit per year subject to the exclusions and limitations ofthe contract and a police report must be submitted to Intellicare forevaluation Vehicular accidents shall be covered up to the maximum benefitlimit per year subject to the exclusions and limitations of thecontract and a Police report MUST be submitted to Intellicare forevaluation. Chronic dermatoses and scabies shall be covered for consultationsonly Sports related injuries that are acquired during companysponsored events EXCEPT for hazardous sports shall be coveredup to Php10,000.00 per member per year subject to the exclusionsand limitations of the contract.

DENTAL BENEFITS Dental ExaminationTwice a year oral prophylaxisSimple tooth extractionTemporary fillingsPermanent light cure filling - up to two (2) teeth peryearDesensitization of Hypersensitive teeth - up to two(2) teeth per yearRecementation of jackets, crown, inlays and onlaysTreatment of minor gum problems, mouth lesions,wounds, and burnsOrthodontic consultations (braces and malpositionof teeth)Temporo mandibular joint consultation (clicking ofjaws)Pre-natal check of teeth and gumsEmergency dental treatment for the relief of painDental health education

DENTAL AVAILMENTCheck listof Intellicareaccrediteddentists (youmay refer to yourguidebook or Intellicare websiteor call Intellicare CustomerService for assistance).Call the dentistto confirmscheduleand inquire if byappointment or walk-inpatients areaccommodated.Proceed to the dentalclinic on the day of yourdental availment andpresent Intellicare cardfor validation.Sign Referral ControlSheet (RCS) 5 availableat the dental clinic.Avail entitleddental benefit.

FINANCIAL ASSISTANCE(FOR ENROLLED PRINCIPAL MEMBERS ONLY) Natural Death- Php 25,000.00 Death due to Accident- Php 50,000.00 Loss of both hands- Php 10,000.00 Loss of both feet- Php 10,000.00 Loss of sight (both eyes)- Php 10,000.00 Loss of one hand and one foot- Php 10,000.00 Loss of one hand and sight on one eye- Php 10,000.00 Loss of one foot and sight on one eye- Php 10,000.00 Loss of one hand or one foot or sight on one eye- Php 5,000.00

GENERAL EXCLUSIONSAND LIMITATIONS Out-of-Network services Miscellaneous hospital charges Health check ups (Pre-e

Clinic Hours: Monday-Saturday / 8am to 5pm 5/F Times Plaza Bldg., U.N. Ave. corner Taft Ave., Ermita, Manila Tel # 353-6807 / 518-0056 (NOTE: Bring 2 valid IDs for the building and clinic, slippers and shorts are not allowed) Aventus PCS Clinic Clinic Hours: Monday-Saturday / 7am 5pm 2nd Floor Philippine College of Surgeon Bldg.,