PTA STANDARD OF HEALTHCARE BENEFITS FOR C.Y. 2008

 
1.Type of Plan/Premium Rate
Ward
Semi Private
Private
   Dreaded Disease Limits
   For Principal Enrollees
   For Immediate Dependents
   For Extended Dependents
   For Retirees    
P 70,000.00
P120,000.00
P 150,000.00

2. Processing Fee is waived
    As a HMO standard, pre-existing diseases are waived for corporate accounts

3. Membership Eligibility – Age limit for employees/dependents, no hierarchy condition

  1. Principal
    1. 18 years old up to 65 years old employed by PTA
    2. Retirees – up to age 70
  2. Dependent of married principals
    1. spouse up to age 65
    2. legitimate/legally adopted children 5 days old and above, single
  3. Dependent of single principals
    1. parents up to 65 years old, unemployed/dependent on principal member
    2. brothers & sisters 15 days old up to 21 years of age, single who are unemployed
  4. Extended Dependents

            a,   parents & parents-in-law up to 65 years old

  1. brothers & sisters 15 days old up to 21 years, single and unemployed
  2. married brothers & sisters
  3. married children and their family members

4. Coverage of Congenital Defects/illnesses up to the maximum benefit limit per year for Principal Members and up to P70,000 for Immediate dependents only

5. Room Accommodation/Emergency Room Upgrade – no additional cost within 72 hours in case of non-availability or preferred room plan except Suite room

6. ICU Confinement – covered as charged up to dreaded disease limit (DDL)

7. Emergency Treatment – Administration of Immunization except cost of vaccine is covered - To include first Anti rabies, Anti Venom and Anti Tetanus.

8. Special Diagnostic Procedures
Up to maximum benefit limit – Angiography, Angioplasty, Open Heart Surgery, Thalium Scintigraphy, Chemotherapy, Radiotherapy, Cobalt Therapy, CT Scan, Lithotripsy, Laparoscopy, Laparoscopic Cholecystectomy, Dialysis, Hysteroscopic Myoma Resection, Laser Therapy (LT) for Glaucoma, LT for Retinal Detachment, Mammogram, Treadmill, 2D Echo, MRI, Ultrasound Test, Nuclear/Radioactive Isotope Scan, Diagnostic Study of Sleep Apnea

9. Preferred Accredited Hospital
Chinese General Hospital, Hospital de San Juan De Dios, Makati Medical Center, Manila Doctors Hospital, Medical Center Manila, Medical City, National Kidney Institute, Phil. Heart Center, Santo Tomas University Hospital, St. Luke’s Medical Center, first 2 big hospitals in each city throughout the country

10. Consultations – Any accredited hospital

11. Annual Physical Examination - Mobile Clinic for APE within office premises.
     To include:
 
    Complete Blood count – (Complete Blood Chemistry for Private Plan Holders)
     Urinalysis
     Fecalysis
     Chest X-ray
     Eye Refraction
     ECG-Adults 35 yrs. & above or if prescribed
     Pap Smear – Women age 35 yrs. & above, or if prescribed.
   
12. Out patient Physical Therapy – Covered up to maximum benefit limit (MBL)

13. Dental Benefits – To include annual prophylaxis, consultations/oral examination, simple tooth extractions, temporary fillings, permanent amalgam fillings

14. Accreditation of 2 PTA physicians as coordinators for referrals to accredited hospitals and doctors

15. Liaison officer of HMO that will coordinate with PTA account

16. A.H.M.O.P.I. member/Financial Standing of the Company

17. Other benefits not mentioned should be within standard HMO services