The Union proposes that the Company

provides hospitalization and medical

coverage to all Union member based on the
card holder type HMO system. On a yearly,
basis the Company shall review the Medical
coverage plan towards improving the same,
subject to cost consideration.
The Union proposes Medicard as the
employees HMO.

Why Medicard
MediCard is a pioneer in the HMO industry
established in 1987. It is also one of the six founding
members of the Association of Health Maintenance
Organizations of the Philippines, Inc. (AHMOPI).
MediCard is the only HMO being run and operated
by doctors.
MediCardis the only HMO awarded with the ISO 9001:
2008 Certification in the Philippines and in Asia.
MediCard is the largest HMO in the Philippines in
terms of membership base totaling to more than 500,000,
a very significant factor to support claims.

Medicards hospital-based system or open-door

policy, in contrast to clinic-based and designated
hospital, enables members to avail of hospitalization and
out-patient services in any of our 1,000 accredited
hospitals/clinics backed-up by over 40,000 doctors &
specialists nationwide that is most convenient and
accessible to them. Leading the list are Asian Hospital
and Medical Center, Makati Medical Center, St. Lukes
Medical Center, The Medical City and Cardinal Santos
Medical Center.
MediCard has a team of well-trained liaison officers
who assist members during confinement and before
discharge.
MediCard hasEmergency Assistance and Response
Service (EARS) Hotlines-available 24 hrs. a day, 365
days a year.
Savings on administrative time and costs compared to
the insurance/self-administered type of medical coverage.

NO MORE TEDIOUS DOCUMENTATION

PROCEDURES. It is almost trouble-free.
Since our professional fees are based on HMO-industry
standards, it will take longer for members to maximize
the limitations of their benefits. Unlike other HMOs, our
maximum limit for the dreaded disease is on a per
illness per year basis and not on an aggregate, lifetime
or entire membership limit.
MediCard is known for the quality services we have
been extending to our clients for the past years as proven
by our renewal persistency rate of 88%. Some of our
more than 2,300 corporate clientele are 24/7 Customer
Philippines, Inc., Citibank, N.A., GMA Network Group of
Companies, Toyota Motor Phils., Phil. Daily Inquirer,
Philippine Star Daily, Landbank of the Phils., etc.

Hospitalization Confinement Benefit*

Members in need of hospitalization can always
count on the convenience and expertise of
MediCard. With its vast medical provider network,
one can feel at ease knowing that ones health is
ready to be taken cared of anytime, anywhere.

Benefit
No deposit upon admission
Room and board

Remarks
(All limits subject to PEC)
Covered
According to type of plan enrollment

Use of operating theatre and Recovery Room

within DDL

X-ray and laboratory examinations

within DDL

Services of MediCard specialists

within DDL

Surgery and anesthesia

within DDL

Administered medicines

within DDL

Dressings, sutures and plaster casts, etc.

within DDL

Fresh whole blood (including screening/ processing),

and intravenous fluids

within DDL

Human Blood Products (including screening/

processing) except gamma globulin

within DDL

ICU confinements

within DDL

Chemotherapy, Radiotherapy & Dialysis

Admission kit including wee bag
All other items directly related to the management of
the case
Visitation of MediCard liaison officer

10 sessions within DDL,whichever comes first

Covered
within DDL
Covered

B.Outpatient Care Services*

Getting your needed out-patient medical services
shouldnt be a hassle. That is why MediCard
provides its members with the complete range of
out-patient healthcare services--a one-stop shop
for quality out-patient care. With one of the most
expansive network of hospitals and clinics,
doctors and dentists, members are assured of
trouble-free access to medical services, whenever
and wherever you may need it.

Benefit
Regular consultations & treatment
Referral to specialists

Remarks
(All limits subject to PEC)
within DDL;
except prescribed medicines
within DDL; except prescribed medicines

Treatment of minor injuries and surgery not requiring

confinement

within DDL

X-ray and laboratory examinations

within DDL

Eye, Ear, Nose & Throat treatment

within DDL

PT / Speech Therapy
Laser treatment of Glaucoma & Retinal Detachment

Up to 10 sessions within DDL, whichever comes first

up to P20,000

Cataract Extraction (excluding cost of lens), including

phacoemulsification

within DDL

Pre & Post natal consults

Except labs

Sclerotherapy (excluding sclerosing agent)

up to P5,000

Cauterization of warts (including facial warts)

up to P1,000

Allergy Testing

up to P2,500

First dose of anti-rabies, anti-venom, anti-tetanus

Tuberculin Test (except screening)

up to P5,000 each
up to P1,000

Consultations for Chronic Dermatoses (except Psoriasis)

Covered

Consultations for Scabies

Covered

Complex Diagnostic
Procedure*
Benefit

Remarks
(All limits subject to PEC)

MRI / MRA

Up to P 5,000

CT scan

Up to P 5,000

Ultrasound

Up to P 5,000

Serum chemistry panels (eg. Chem 23, Spec M, etc.)

Up to P 5,000

Angiography (e.g. Coronary, cerebral, retinal, pulmonary,

GI, etc.)

Up to P 5,000

Pulmonary perfusion scan

Up to P 5,000

Tests involving use of Nuclear Technologies (e.g.

Radionuclide Scan/Ventriculography, Thallium stress
testing, PyrosphosphateScintigraphy, Myocardial Perfusion
Scanning, etc.)

Up to P 5,000

Electromyography, Nerve Conduction Velocity Studies

Up to P 5,000

24-Hour Holter Monitoring, 2-D Echo and Doppler

Up to P 5,000

Treadmill Stress Test

Up to P 5,000

Myelogram

Up to P 5,000

Diagnostic Endoscopy (including one of video)

Up to P 5,000

Diagnostic Arthroscopy

Up to P 5,000

Diagnostic Hysteroscopy

Up to P 5,000

Plasma/Urinary Cortisol, Plasma Aldosterone,

AdrenocorticalFunction, etc.

Up to P 5,000

Mammography and Sonomammogram

Up to P 5,000

Bone densitometry scan (Dexascan)

Up to P 5,000

Immunologic Studies: Anti-nuclear antibody (ANA), CReactive protein, Lupus cell exam

Up to P 5,000

Preventive Healthcare Services

Benefit

Annual Physical Examination (APE) to include

Remarks

Covered

Complete Blood Count

Under APE

Urinalysis

Under APE

Fecalysis (stool exam)

Under APE

Chest X-Ray

Under APE

Electrocardiogram

Under APE; For adults age 35 and above, or if prescribed

Pap Smear

Under APE; For women age 35 and above, or if prescribed

Management of Health Problems

Routine Immunization

Covered

Except administered vaccine

Counseling on Health habits, diets and Family

Planning

Covered

Record keeping of medical history

Covered

D.Emergency Care Services

In Accredited Hospitals
It may happen when you least expect it. That is why MediCard has taken steps in
providing its members not only a comprehensive emergency medical care program,
but also access to swift emergency medical help for the injured and the sick. So when
an emergency does strike, you are assured that MediCard will be there to provide you
or your loved ones prompt medical assistance.
Benefit

Remarks
(All limits subject to PEC)

Doctors services

within DDL*

Medicines used during treatment or for

immediate relief

within DDL*

Oxygen and intravenous fluids

within DDL*

Dressings, plaster casts and sutures

within DDL*

Laboratory, x-ray and other diagnostic

examinations

within DDL*; directly related to the emergency management of

the patient

In Non-Accredited Hospitals
For emergency medical services in non-participating
hospitals and clinics, members must advance payment
and later file reimbursement from MediCard.
Reimbursement shall be based on the table below
:

Benefit

Remarks

Approved Hospital Bills

80% based on MediCard Relative Value (MRV)* up to P
30,000
Doctors Professional Fees

Members Financial Assistance(For Employees only)

Benefit

Remarks

Natural Death

P 10,000

Accidental Death

P 20,000

Loss of both hands/both feet; Loss of

sight

P 10,000

Loss of one hand, one foot or one eye

P 5,000

Additional Benefits
Remarks
(All limits subject to PEC)

Benefit

Work-related illness/accidents (except those in exclusion)

Up to DDL for Employees only

Unprovoked Assault

Up to DDL

Congenital Illnesses

Up to P5,000 for Employees only

Slipped Disc, Scoliosis, Spondylosis, Spinal Stenosis

Up to P5,000 for Employees only

Hyperventilation syndrome

First ER availment up to P5,000 for Employees only

APE Promo

Pre-employment services

APE Package for members 35 years old and above shall include Fasting Blood Sugar (FBS) and Total
Cholesterol if availed during on-site APE conducted by Uro Industrial Clinic or at MediCard Clinics
only. This offer is valid from May 1, 2014 to April 30,2015.
P 400.00 per head for pre-employment physical examinations (paid up front) at designated
MediCard owned clinics.
If the applicant is hired and enrolled under MediCard, this will serve as his annual physical
examination and MediCard shall refund the said amount back to the company.
Free consultations at MediCard owned clinics from the following primary physicians and specialists:
1.
2.
3.
4.
5.
6.

Free consultations at MediCard owned clinics

General Surgeon
Obstetrician Gynecologist
Pediatrician
Family Medicines
General Practitioner
General Internist

Above consults will not be charged to the members Maximum Benefit Limit
Members can also avail of the free consultations even for conditions which are classified under
general exclusions or pre-existing conditions which are not covered.
On top of this, members can avail of discounts on laboratory examinations up to 20% for cases
which are not covered.
NOTE: Except for TPA
You may also want to extend the benefits of having a MediCard plan to your employees dependents.
Through RxER, MediCard's latest emergency product, they get a specialized healthcare maintenance
service that covers emergency, preventive and outpatient care for one year for P1,998.00.Best of
all, there's no age-limit, no medical exam required, and no hierarchy to be followed.
Applying is simple too. Just fill out the application form, pay for the corresponding amount and get
your card in an instant.
Salient benefits which you may avail in any of our MediCard-owned clinics include:

RxER

Unlimited check-ups with primary care physicians, Pediatricians, Medical Internists and OB
Gynecologists
Flat rate of P350.00 for specialists
One FREE Oral Prophylaxis
Dental consults with dentists
30% discount on dental procedures
30% discount on diagnostics and tests
One-time basic 5: CBC, Urinalysis, Stool Exam, Chest X-ray and Physical Exam
Emergency Care* for trauma cases in all MediCardaccredited hospitals nationwide

Other Benefits
Benefit

Remarks

24/7 Call Center Service/Access

Trunkline: 841-8080; Toll Free: 1-800-1888-9001

Text MediCard

A unique addition to complement MediCard services is an SMS service for

members to access the database of MediCards accredited network of
hospitals and doctors. Text MediCard is accessed by simply sending the
keyword MediCard to access numbers 0908-8841814 for Smart
subscribers and 0917-8512648 for Globe and Sun subscribers.

Vaccines

Access to the special discounted prices on vaccines through the MediCardGlaxoSmithKline (GSK) adult vaccination campaign(Influenza, Hepa A & B,
Typhoid, etc.).

Pre-existing Conditions Coverage

Member

Coverage

Members
Year of membership
1st year

2nd year

Amount of Coverage
Up to P 5,000 per illness per member per year
Up to P 5,000 per illness per member per year
provided that the pathogenesis or onset of such
illness, injury or adverse medical condition
started prior to or during the contestability
period; otherwise, up to DDL.

Dreaded Disease
Dreaded diseases are potentially or actually life-threatening conditions or illnesses which may require prolonged or
repeated hospitalization or intensive care management. MediCard shall pay for hospitalization services up to the
maximum limit subject to the pre-existing conditions coverage.

The following are considered dreaded disease:

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.

Cerebrovascular Accident (stroke)

Central nervous system lesions (Poliomyelitis/Meningitis/Encephalitis/Neurosurgical conditions)
Cardiovascular Disease(Coronary/Valvular/Hypertensive Heart Disease/Cardiomyopathy)
Chronic Obstructive Pulmonary Disease (Chronic Bronchitis/Emphysema), Restrictive lung disease
Liver Parenchymal Disease [Cirrhosis, Hepatitis (except type A), New growth]

Chronic Kidney/Urological disease (Urolithiasis, Obstructive Uropathies, etc.)

Chronic Gastrointestinal Tract Disease requiring bowel resection and/or anastomosis
Collagen diseases (Rheumatoid Arthritis, Systemic Lupus Erythematosus)
Diabetes Mellitus and its complications
Malignancies and Blood Dyscrasias (Cancer, Leukemia, Idiopathic Thrombocytopenic Purpura)
Injuries from accidents or assaults, frustrated homicide or frustrated murder
Complications of an apparent ordinary illness including MODS and SIRS (e.g. sepsis due to pneumonia, typhoid
ileitis, cerebral malaria, etc.)
m. Single or multiple organ dysfunction and failure (MODS and MOF)
n. Conditions that may require dialysis
o. Chronic pain syndrome (greater than six weeks)
p. Any illness other than the above which would require Intensive Care Unit confinement
q. Et cetera

MediCard Accredited Hospitals in Tanauan

Membership Eligibility

Member
Type

Principal
Member

Eligibility

At least 18 years old up to age 60 and

employed by the company.

Why is it important that Glares employees be

covered with an HMO Plan
A study commissioned by the Department of Science and TechnologyNational Research Council of the Philippines (DOST-NRCP) last year
showed that business process outsourcing (BPO) workers are generally happy
with their high-paying jobs, but think of leaving them in the immediate future
due to health and social concerns.
Researchers Nimfa Ogena and Soccoro Rodriguez conducted an online
survey covering a total of 698 BPO workers from Metro Manila, Cebu, Davao
Luzon. Of the 698 respondents, 51 percent were from Metro Manila, 21 percent
from Cebu, 15 percent from Davao and 13 Luzon.
Even if theyre happy on average, there are many who are planning to leave
their jobs within the next 12 months, Ogena stated in explaining the results of
the study titled Health and Social Policy Issues of BPO Workers in the
Philippines: Is Happiness at Work Attainable?
Theyre happy but they have issues, she added.
Majority of the respondents were employed in call centers and the rest were
into non-voice services such as back office, software development,
medical transcription and engineering.

Challenges facing BPO employees in

Philippines
Hitting Business Standards
It is very common in an industry or any institution to set a
business goal. Being in line with the BPO employees
nowadays, it is your goal to meet up the requirements that
the company ask you to perform. It cant be denied that this
can add up the pressure in absorbing and adjusting the
traditional practices in a call center.

Coping with Health Issues

There are two common health conditions that normally exist when
working in a BPO industry. It would either be a hypertension which
known as High blood pressure or the hypotension that used to give you
a lower blood pressure. An agent should be wise enough in taking care
of her body, by taking vitamins and supplements.

Artilce by Armando Bartolome, ABS_CBN news Posted atDec 13 2014

What Are the Differences Between HMOs and PPOs?

health maintenance organization, orHMO, only covers subscribers'

medical expenses when they visit health providers that are part of the HMO's
network.
Preferred provider organizations, orPPOs, give their subscribers greater
freedom to visit out-of-network doctors and hospitals but are more likely to
consistently cover expenses when subscribers visit the PPO'spreferred, innetwork doctors and hospitals.
PPO networks are often much larger than HMO networks, so it is more likely
that a specialist provider a patient wants to see will be part of a PPO network.
HMO plans are generally cheaper than PPO plans.

HMO Versus PPO

It is important to know the difference between HMO and PPO.

HMO is an organization of healthcare providers (e.g. doctors and

hospitals) that have contracted with an insurance company to offer
their services at a fixed price.
HMO plans are normally quite restrictive and with lots of rules. You
will be asked to select a primary care physician, who handles all
aspects of your healthcare.
PPOs also have contractual relationships with insurance companies.
Difference is that they are more loosely organized and are not as
restrictive as HMOs.
With a PPO, you can choose to see whichever doctor you like, but if
the doctor is not in the network, you will have to pay more out-ofpocket. You dont need a referral to see a specialist
PPOs are a popular choice for sole proprietors or owners of very small
companies, since they require employees to pay a larger percentage
of their own health care costs..

HMO vs PPO Table

https://www.humana.com/individual-and-family/products-and-services/medical-plans/hmo-vs-ppo

Typical costs of medical care

Kidney problems Medical costs in the Philippines for treating kidney
problems is extremely expensive. According to the national kidney and
transport institute, kidney diseases are the 7thbiggest cause of death in the
Philippines. Dialysis which is usually a required treatment for kidney problems
can cost 3000 4000 pesos per session and can be required 3 times per
week for years. This means someone undergoing dialysis could be spending
over 40,000 pesos per month just on the dialysis procedure. This type of
medical cost is just too high for many Filipinos. The actual kidney operation
can cost from 1 2 millions pesos.
Heart disease 5 out of 10 Filipinos according to the NSA die from
cardiovascular causes and up to 21% of the deaths in a particular year are
caused by heart disease. Its a serious problem, even more so when you
consider the average cost of heart surgeries and treatments range from
200,000 pesos to 1.5 million pesos for your total medical bill.
Cancer the most common cancer in the Philippines is breast cancer with 15
Filipinos a day who die from the disease. Treatment costs can vary depending
Aileen Ng for Money Monster health Insurance
on the cancer and stage but can often cost more than 2 million pesos once
you include the expensive medicines and doctors fees. This puts tremendous
stress on families who will suffer both emotionally, seeing their loved ones

Health problems and stress in Information Technology and Business

Process Outsourcing employees

In an article by the US National Library of Medicine National Institute

of Health. it discussed the health problems that employees in IT and BPO
industries are prone to.
"wherein sleep disorders were observed among 83% as compared with
industry average (IT enabled Services) of 39.5%.(11) Burn out stress
syndrome which included chronic fatigue, insomnia, and altered biological
rhythm was also commonly observed among them."
A detailed questionnaire of around 1000 IT and BPO employees including
their personal details, stress score by Holmes and Rahe to assess the level of
stress and master health checkup profile were taken and the results were
analysed. Around 56% had musculoskeletal symptoms. 22% had newly
diagnosed hypertension,10% had diabetes, 36% had dyslipidemia, 54% had
depression, anxiety and insomnia, 40% had obesity. The stress score was
higher in employees who developed diabetes, hypertension and depression.
Early diagnosis of stress induced health problems can be made out by stress
scores, intense lifestyle modification, diet advice along with psychological
counselling would reduce the incidence of health problems in IT sector and

In an Original Research conducted by Divya. P, MPT

Physiotherapist,of the Department of Respiratory Medicine,
M. S. Ramaiah Medical College,
Bangalore, Karnataka, India in his Paper entitled Cardiovascular
Response to Verbal Communication A Study in Business Process
Outsourcing Employees
Divya tested 150 BPO employees before and after their shift.
Outcome Measurements:
The cardiovascular parameters such as Heart rate,blood pressure
and rate of perceived exertion were measured before and after
shifts. The heart rate and blood pressure were measured using
Digital electronic monitor and rate of perceived exertion was
measured Borg rating of perceived exertion scale