(NAR) VOL.8 NO. 1 / JANUARY-MARCH 1997
This insurance scheme is in addition to other schemes the employer should provide under the employment contract and existing laws.
Particular Benefit I. Room and Board not exceeding 45 days for each member and another 45 days to be shared by his dependents From To 1. Primary Care Hospitals P55/day P85/day 2. Secondary Care Hospitals 100/day 150/day 3. Tertiary Care Hospitals 145/day 220/day II. Medical Expense benefit per single period confinement 1.For ordinary cases a. Drugs and Medicines Primary 595 895 Secondary 790 1,185 Tertiary 1,015 1,525 b. X-ray/Lab/Others Primary 150 225 Secondary 360 540 Tertiary 635 955 2. Intensive Cases a. Drugs and Medicines Primary 1,350 2,025 Secondary 1,620 2,430 Tertiary 2,915 4,375 b. X-ray/Lab/Others Primary 325 490 Secondary 630 1,245 Tertiary 1,280 1,890 3. Catastrophic Casesa. Drugs and Medicines
Secondary 3,650 5,475 Tertiary 4,170 6,255 b. X-ray/Lab/Others Secondary 1,620 2,430 Tertiary 3,845 5,770 III.. Medical/Dental Practitioner's Fee per day for 1. General Practitioner 55 85 2. Specialist 80 120 The Practitioner's Fee per single period of confinement shall not exceed: 1. For Ordinary Cases a. General Practitioner 300 450 b. Specialist 450 675 2. For Intensive/Catastrophic Cases a. General Practitioner 450 675 b. Specialist 750 1,125IV. Surgeon's Fee shall be in accordance with the Relative Value Scheme not to exceed P10,620.00
V. Anesthesiologist's Fee (30% of Surgeon's Fee) not to exceed P3,190.00.
VI.. Operation Room Fee for Surgical Procedure under the following brackets of Relative Unit Value (RUV):
1. RUV of 5.0 and below Primary 170 255 Secondary 295 445 Tertiary 470 705 2. RUV of 5.1 to 10 units Secondary 505 760 Tertiary 600 900 3. RUV of above 10 units Secondary 960 1,440 Tertiary 1,550 2,325 VII.. Fee for Surgical Family Planning Procedures (for members and spouses only): Vasectomy 400 600 Tubal Ligation 500 750