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CORP ACCOUNTS WITH SPECIAL INSTRUCTIONS

General Rule:

  • For LOA request of laboratories and procedures the member is required to send us a copy of the doctor's request with the exact amount of each procedure before we can issue a LOA.
  • All approval requests with amount of Php5,000 and above is required to be encoded in Polaris CBMS. 
  • All approval requests with amount of Php15,000 and above is required to seek approval first of the Polaris team before we can issue LOA.
  • OPD-OR availment are deductible in outpatient limit.

Admission Requirements:

  • Admission report or Admission order
  • Laboratory results if available

Inpatient Discharge Requirements:

  • Medical abstract or Medical certificate with the attending physician's signature
  • Summary of Account (SOA)
  • Itemized charges
  • Laboratory results
  • OR-tech (if applicable)
  • PF should be indicated in the SOA
  • Discharge Schedule: Monday to Friday up to 6pm only; Saturday up to 2pm only; Sunday no discharge allowed

Click here to download the computation sheet of Polaris.

For Discharge Approval:


Please send only one email at a time, ensuring it contains all the necessary details and attachments.

Ensure that all attachments are labeled clearly.

The following documents are required for approval:

   - Medical Certificate/Abstract/Discharge Note (must include the final diagnosis and the doctor’s signature. For the Discharge Order, the disposition of the patient upon discharge must be included)

   - Statement of Account (SOA)

   - Approval Template

   - Additional documents as requested (e.g., Patient data, laboratory results, etc. As per the approver’s instructions, Medical Officers may send the Medical Certificate/Abstract, SOA, and Approval Template initially for computation.)

Send the approval to the following email addresses:

   - coo@polaris-finance.com; support@polaris-finance.com; info@polaris-finance.com; insurance@polaris-finance.com; operation@polaris-finance.com; xguirao@polaris-finance.com; helpline@polaris-finance.com


For OPD-OR Approval:


Approval is required for amounts of 15,000 and above.

Please send only one email at a time with complete details and an attachment.

Ensure that the attachment is labeled appropriately.

The following document is required for approval:

   - Doctor’s request (must include the final diagnosis and the doctor’s signature)

Send the approval to the following email addresses:

   - coo@polaris-finance.com

   - support@polaris-finance.com

   - info@polaris-finance.com

   - insurance@polaris-finance.com

   - operation@polaris-finance.com

   - xguirao@polaris-finance.com

   - helpline@polaris-finance.com

   - tpa@polaris-finance.com

   - gm@polaris-finance.com

CHRONIC DERMATOSES - COVERED (POLARIS FINANCIAL-PIONEER MARINE HELLAS S.A)

DETAILS TO ASK TO THE PROVIDER DURING LOA REQUEST


Please provide the following details:


1. Last consultation (date)

2. Name of doctor on last consult

3. Medications

4. Itemized price of lab tests

5. Copy of doctor's request

RULES AND GUIDELINES IN LOA APPROVAL


1. Request for coverage must come from accredited physician with valid loa for consult (members cannot request for procedures on their own)

Do not approve requests for lab/diagnostic procedures without this or from non-accredited doctors

2. No approval for non-accredited but accepting physicians

3. No requests for approval for loa ordered for laboratory/diagnostic procedures withour prior consultation with the accredited physician

4. If md is accredited but the patient did not pass thru our process (ie loa facilitated consult) and paid the pf, then did not pass thru our system and there should be no approval for the request for lab or diagnostic

5. No approval for previous requests for lab/dianostic procedures from md when the patient was still with another hmo (requested when the member was still with former hmo)

6. Re-assess request that were ordered more than 2 months ago (request must be current)


ADDITIONAL REQUIREMENT:

Request a copy of the doctor's request and the exact amount or each procedure.


REQUEST APPROVAL FORMAT


Member's Name:

Age:

Gender:

Company Name:

Facility:

Requesting Doctor's Name:

Doctor's Specialization:


Date of Consultation with the Requesting Doctor:


Prior Consult Chief Complaint:


Diagnosis:


Note: If it is an existing Chronic Disease/PEC, since when that member was diagnosed with this and what were his/her medications:


Requested Tests:


Incurred Utilization:

PEC limit/MBL per illness:

Plan Category:

ROOM AND BOARD UPGRADE PROVISION

Request Certificate of isolation and/or certificate of room non-availability for the application of room waiving.

PROVISION ON INCREMENTAL CHARGES


(Rate of room occupied – room and board plan benefit) x (no. of days confined)

Plus 25% of net hospital bills if upgrading one (1) level: Ward to Semi-Private

Plus 35% of the net hospital bills two (2) levels: Ward to Private


(Not applicable for Suite room upgrade)

HC&D ADMISSION REPORT TEMPLATE

PROVIDED LIST OF PEC:

Tumor/Cyst of Internal Organs
Hemorrhoids/Anal Fistula
Diseased tonsils and sinus conditions requiring surgery
Cataract/Glaucoma
Pathological Abnormalities of nasal septum or turbinates
Goiter and other thyroid disorders
Hernia/Benign Prostatic Hypertrophy
Endometriosis
Asthma/Chronic Obstructive Lung disease
Epilepsy
Spinal column abnormalities
Tuberculosis
Cholecystitis
Gastric or Duodenal ulcer
Hallux valgus
Hypertension and other Cardiovascular diseases
Calculi of the urinary system
Tumors/Cyst on skin, muscular tissue, bone or any form of blood dyscracias
Diabetes Mellitus
Cerebrovascular Accident/Transient Ischemic Attack
ENT conditions requiring surgery
migraine
cirrhosis of the liver / fatty liver
cholelithiasis

"covered naman natin ang autoimmune. wala naman po sa exclusion natin yun as long as covered ang PEC." - Rowena Hernandez


All availment amounting Php10,000 and above need to have approval from paramount before issuing loa (please email to paramount for documentation).


ROOM AND BOARD UPGRADE PROVISION


Request Certificate of isolation and/or certificate of room non-availability for the application of room waiving.


PROVISION ON INCREMENTAL CHARGES


35% incremental charges


INPATIENT PF COMPUTATION


PF counting is the same with room and board counting   (start counting the day after admission).


Computation Sheet needs to be accomplished and send to Paramount team upon request of approval in their end.

Click here to download the computation sheet.


Email Address of the Paramount approvers:

catalina.pamiroyan@paramount.com.ph

naome.lucernas@paramount.com.ph


ACCIDENT AVAILMENT REQUIREMENTS


Upon admission to ER, required to send incident report (IR), POLICE REPORT, OR-CR, DRIVER'S LICENSE

If the patient cannot provide all the requirements, he/she needs to send us a copy of signed waiver.


LIST OF UNCOVERED ITEMS



REMINDERS:


 Incident report is required for all animal bite or scratch cases, regardless of the type of availment.

 Incident report is also required for any trauma-related diagnoses, regardless of availment type.

 Stabilization fees are not covered (as indicated in the list of non-covered items).

 Always request the actual itemized billing for all emergency room (ER) cases.

 For Paramount accounts involving MRI or CT scan, coverage is plain only, unless otherwise specified in the Schedule of Benefits (SOB).

 Chief complaint of blurred vision is not covered.

 Tension headache is not covered.

 Physical therapy coverage is limited to basic PT sessions only.

 Save a copy of the Paramount approval using the file naming format: TRN_LOA_MEMBER NAME.

 Upload the file here: Google Drive Folder



CHATS/EMAIL REFERENCE OF CORP VERIFICATIONS


DATE OF ENDORSEMENTMODE OF ENDORSEMENTCORP - FIRST LIFEDETAILSREMARK
7-Jun-2024VIBERFIRST LIFE-GTS INSURANCE BROKERS 2023-2024GENE XPERT COVERAGECOVERED AS PER LYVI OPIANO
5-Jun-2024VIBERFIRST LIFE-SCHOOL INN CORP.PRP COVERAGECOVERED AS PER LYVI OPIANO
9-Jun-2024VIBERFIRST LIFE- NHA PROVIDENT FUND ASSOCITION INC.COST OF VACCINE COVERAGENOT COVERED AS PER MAESHEIL PADASAS
13-Jun-2024VIBERFIRST LIFE - UNIVERSAL ROBINA CORPORATION MEAT AND CANNING DIVISION NEW EMPLOYEES WORKERS UNION LABOANIMAL SCRATCH COVERAGECOVERED AS PER HAZEL EMBESTRO
19-Jun-2024VIBERFIRST LIFE-PCIEERDANIMAL SCRATCH COVERAGECOVERED UP TO LIMIT AS PER MS. LIEZEL OF FIRST LIFE
15-Jun-2024VIBERFIRST LIFE- NHA PROVIDENT FUND ASSOCITION INC.EOR NOT COVEREDNOT COVERED AS PER per MS. LYVI OPIANO
1-Jul-2024VIBERFIRST LIFE-GTS INSURANCE BROKERS 2023-2024PT COVERAGECOVERED UP TO MBL AS PER MAESHEIL PADASAS
3-Jul-2024VIBERFIRST LIFE-POINT AD, INC.Animal bite/scratchcovered up to MBL as per Ms. Lyvi Opiano
27-Jul-2024VIBERFIRST LIFE - NATIONAL MUSEUMLeptospirosisCOVERED AS PER MS. LYVI
27-Jul-2024VIBERFIRST LIFE - OFFICE OF THE OMBUDSMAN (EMPLOYEE)AUTOIMMUNE DSES COVERAGE (MYOSITIS)COVERED AS PER MS. LYVI
9-Sep-2024VIBERFIRST LIFE-PIPOLS SYNERGY MANAGEMENT SERVICES, INC. (MANPOWER)ANTI RABIES VACCINE for animal bite or scratch not coveredNo coverage for anti rabbies vaccine - Lyvi
17-Jul-2024VIBERFIRST LIFE - OFFICE OF THE OMBUDSMAN (EMPLOYEE)ERROR OF REFRACTION - NOT COVEREDERROR OF REFRACTION
24-Sep-2024VIBERFIRST LIFE - URC - CANLUBANG PLANT EMPLOYEES UNION (CPEU OLALIA)SCRATCH - COVEREDSCRATCH - FIRST LIFE - URC - CANLUBANG PLANT EMPLOYEES UNION (CPEU OLALIA).jpg
24-Sep-2024VIBERFIRST LIFE - URC - LABOR UNIONAUTOIMMUNE DSES COVERAGE (RHEUMARHOID A.) - CoveredAUTOIMMUNE DSES COVERAGE (RHEUMARHOID A.) - FIRST LIFE - URC - LABOR UNION.jpg
27-Aug-2024VIBERALL FIRST LIFEHEPA B - NOT COVEREDHEPA B - ALL FL ACCOUNTS.PNG
27-Sep-2024VIBERFIRST LIFE - JMD PERSONNEL MANAGEMENT SOLUTIONS CORP.PEC COVERAGE - COVERED TO ALL PLANSPEC COVERAGE - FIRST LIFE - JMD PERSONNEL MANAGEMENT SOLUTIONS CORP. .PNG
6-Sep-2024VIBERFIRST LIFE - URC - LABOR UNIONANIMAL SCRATCH COVERAGECOVERED PER MAAM HAZEL EMBESTRO; VIBER FL
16-Oct-2024VIBERFIRST LIFE-PRUDENTIALIFE GROUP OF COMPANIESPT COVERAGECOVERED UP TO 12 SESSION PER MS. ANNE POLICARPIO
15-Oct-2024VIBERFIRST LIFE - MANILA METRO RAIL TRANSITAUTOIMMUNE DISEASESCOVERED PER MS. LYVI
23-Oct-2024VIBERFIRST LIFE - OFFICE OF THE OMBUDSMAN (EMPLOYEE)animal scratch covered -sir Jopeth via FL viber GC
6-Nov-2024VIBERFIRST LIFE - EXECUTIVE GENESIS SERVICEScovered animal scratchverification from mam Lyvi
VIBERFIRST LIFE - OFFICE OF THE OMBUDSMANAUTOIMMUNE DISEASES ; PET SCANCOVERED
VIBERFIRST LIFE - OFFICE OF THE OMBUDSMAN (EMPLOYEE)ANIMAL SCRATCH COVERED -sir Jopeth via FL viber GC
26-Nov-2024VIBERFIRST LIFE-GRAINPRO PHILIPPINES, INC.Animal scratch covered as per mam hazel
29-Nov-2024VIBERFIRST LIFE-PCIEERDAutoimmune diseases covered under FIRST LIFE-PCIEERD as per mam lyvi
29-Nov-2024VIBERFIRST LIFE-DOWELL CONTAINER AND PACKAGING CORP. 2023-2024,Sputum Gene Expert covered
5-Dec-2024VIBERFIRST LIFE - DON BOSCO MANDALUYONG ALUMNI ASSOCIATIONw/ coverage for animal scratches up to 40k
11/26/2024VIBERALL FIRST LIFEANIMAL SCRATCHANIMAL SCRATCH IS COVERED AS LONG AS WITH ANTI RABIES COVERAGE

FIRST LIFE- PPA PANTALAN NCR SOUTH



FIRST LIFE - CSSDO EMPLOYEES MULTI PURPOSE COOPERATIVE /  FIRST LIFE - FLH EMPLOYMENT SERVICES


FIRST LIFE - SUBURBIA AUTOMOTIVE VENTURES INC. (MANAGE CARE)

FIRST LIFE - SUBURBIA AUTOMOTIVE VENTURES INC. (MANAGE CARE) ANIMAL BITE For reimbursement po. As per Ms. Aiza Pili


  1. ALL ACCOUNTS


    1. Procedure with inner limit in SOB follow the SOB


    REVISED 09/10/2024: If in the event that the required procedure is not in the SOB, we will deny approval.  However, if the Insured member will provide proof that the procedure is part of the take-over provision then we will accommodate and if the procedure will fall under the new modality, the approved limit is Php5,000.


    2.TB case - covered tuberculin test only


    3. Animal scratch/bite category II and up - covered

    INCREMENTAL CHARGES IN CASE OF ROOM UPGRADE

    DATE VERIFIEDMODE OF ENDORSEMENTCORP - LIBERTYDETAILSREMARKS
    4-Jun-2024VIBERLIBERTY INSURANCE-Welfarefund Employees AssociationANIMAL SCRATCH COVERAGECOVERED AS PER LEILANI MARQUEZ
    23-May-2024VIBERLIBERTY - Manila International Freight Forwarders, Inc. (MIFFI)ANIMAL SCRATCH COVERAGECOVERED AS PER LEILANI MARQUEZ
    26-Apr-2024EMAILLIBERTY.INSURANCE.GENSAN-LOCAL GOVERNMENT UNIT GENERAL SANTOS CITYAUTOIMMUNE DSES COVERAGECOVERED AS PER TONI MATIC
    5-Jun-2024EMAILLIBERTY INSURANCE-WERDENBERG INTERNATIONAL CORPORATIONSLEEP DISORDERNOT COVERED AS PER TONIE MATIC
    7-Jun-2024VIBERLIBERTY INSURANCE-Liwayway Marketing CorporationUPON ADMISSION TO DISCLOSE MBL OF PTAS PER MA'AM IZA
    7-Jun-2024VIBERLIBERTY INSURANCE-WERDENBERG INTERNATIONAL CORPORATIONANIMAL BITE COVERAGENO COVERAGE AS PER MS. TONIE MATIC
    11-Jun-2024VIBERLIBERTY - THICK AND THIN AGRI-PRODUCTS, INC.ANMAL SCRATCH COVERAGECOVERED AS PER LEILANI MARQUEZ
    14-Jun-2024VIBERLIBERTY GSIS-KAPISANAN NG MGA MANGGAGAWASA SA GSISAUTOIMMUNE DSES COVERAGECOVERED AS PER MS NANCY DELA CRUZ
    24-Jun-2024VIBERLIBERTY GSIS-KAPISANAN NG MGA MANGGAGAWASA SA GSISSLEEP STUDY COVEREDCOVERED AS PER MS NANCY DELA CRUZ
    25-Jun-2024VIBERLIBERTY - Philippine Council for Agriculture and Fisheries Employees AssociationNO COVERAGE FOR GENE XPERTWe will cover tubercullin test for any TB related test. - AS PER MAM NANCY
    24-Jun-2024VIBERLIBERTY INSURANCE-Welfarefund Employees AssociationCOVERAGE FOR ANIMAL BITE S/B WITHIN 24HRSAS PER MS LEI
    2-Jul-2024VIBERLIBERTY.INSURANCE-GSIS-KAPISANAN NG MGA MANGGAGAWASA SA GSISPET SCAN COVERAGECOVERED UP TO MBL AS PER MS NANCY
    1-Jul-2024VIBERLIBERTY.INSURANCE.GENSAN-LOCAL GOVERNMENT UNIT GENERAL SANTOS CITYSLEEP STUDY COVERAGECOVERED UP TO MBL AS PER MS TONIE
    28-Jun-2024VIBERLIBERTY INSURANCE-ASIAN TRANSMISSION CORPORATIONCOVID ANTIGENcovid antigen ok to proceed as long as may signs and symptoms yung pt AS PER MS LEI MARQUEZ
    8-Jul-2024VIBERLIBERTY GSIS-KAPISANAN NG MGA MANGGAGAWASA SA GSISEPILEPSYAS PER INSTRUCTION BY CLYDE
    8-Jul-2024VIBERLIBERTY GSIS-KAPISANAN NG MGA MANGGAGAWASA SA GSISGSIS * LIWAYWAY / Autoimmune, Scratch, Genetic/Hereditary coveredAS PER INSTRUCTION BY CLYDE
    8-Jun-2024VIBERLIBERTY INSURANCE-Maynilad Water and Sewerage Union-PTGWOSCRATCH CATEGORY 3COVERED AS PER MS LEI MARQUEZ
    8-Jul-2024VIBERLIBERTY INSURANCE-Liwayway Marketing CorporationGSIS * LIWAYWAY / Autoimmune, Scratch, Genetic/HereditaryAS PER INSTRUCTION BY CLYDE
    27-Jul-2024VIBERLIBERTY INSURANCE - OFFICE OF THE SOLICITOR GENERALLeptospirosisCOVERED AS PER MS. NANCY
    1-Aug-2024VIBERLIBERTY INSURANCE-Maynilad Water and Sewerage Union-PTGWOSCRATCH CATEGORY 2COVERED AS PER MS. NANCY
    17-Aug-2024VIBERLIBERTY INSURANCE-BIOCARE LIFESCIENCES INC.AUTOIMMUNE DSES COVERAGECOVERED AS MS. TONIE
    19-Aug-2024VIBERLIBERTY INSURANCE-SAN PEDRO LAGUNA LGUPERIPHERAL INJECTION THERAPYNOT COVERED AS PER MS. NANCY - OPD medicine is not covered. Only physical Thepathy.
    19-Aug-2024VIBERLIBERTY INSURANCE-SAN PEDRO LAGUNA LGUACCUPUNTURE TherapyNOT COVERED AS PER MS. TONIE
    22-Aug-2024VIBERLIBERTY INSURANCE-ALTITUDE MARITIME TRAINING AND ASSESSMENT CENTER INC.ANIMAL BITE/SCRATCHCOVERED AS PER MS. TONIE CATEGORY 2 AND UP
    27-Aug-2024VIBERLIBERTY INSURANCE-Maynilad Water and Sewerage Union-PTGWOPT COVERAGECOVERED UP TO MBL IF NO INDICATED LIMIT AS PER MS. LEI CONTACTED BY SIR GERICK
    9-Sep-2024VIBERLIBERTY INSURANCE-RTU-KAWANI MULTI-PURPOSE COOPERATIVEANIMAL SCRATCH COVERAGECATEGORY 2 ABOVE COVERED - LEI MARQUEZ
    10-Sep-2024VIBERLIBERTY INSURANCE-Liwayway Marketing CorporationSLEEP STUDYCOVERED AS PER MS. NANCY - CHECK EMAIL ENDORSEMENT
    17-Oct-2024VIBERLIBERTY INSURANCE - JORGEN ADVERTISING INC.,AUTOIMMUNE DISEASESNO COVERAGE FOR AUTOIMMUNE DSE PER MS. LEI MARQUEZ
    10/25/2024VIBERLIBERTY INSURANCE - COMELEC EMPLOYEES DEVELOPMENT COOPERATIVE-CEDCADMISSION: COVIDFor COVID cover, it should be RT-PCR positive result and not Antigen test. -maam nancy from Liberty Gc
    29-Oct-2024VIBERLIBERTY - INDUSTRIAL TECHNOLOGY DEVELOPMENT INSTITUTERAPID ANTIGEN TESTNot covered , RT-PCR only if with symptoms -as per sir gerick verified to Ms. Lei Marquez
    1-Nov-2024viberLIBERTY INSURANCE-ONEIMUS JOB CONTRACTING SERVICESANIMAL BITE COVERAGECovered 20k only per Ms. Lei Marquez
    2-Nov-2024VIBERLIBERTY INSURANCE-Welfarefund Employees AssociationPassive and active vaccines for treatment of tetanus, animal bites, snake bitesmam Lei Marquez: let's initially cap the limit up to 30k, will review the documents and revert on this
    31-Oct-2024VIBERLIBERTY INSURANCE-ONEIMUS JOB CONTRACTING SERVICESfirst dose coverage - Anti rabies up to 20k onlyper maam Lei of Liberty viber GC
    VIBERLIBERTY INSURANCE-ALTITUDE MARITIME TRAINING AND ASSESSMENT CENTER INC.PEC OVEREDper maam Lei of Liberty viber GC
    16-Nov-2024VIBERLIBERTY INSURANCE-ISLAND RESORT TOUR SERVICES INCanimal scratch category 3 covered
    16-Nov-2024VIBERLIBERTY - COUNTRYSIDE BUILDERS MULTI-PURPOSE COOPERATIVE (CBMPC)Pt session is up to 12 per mam Lei Liberty viber GC
    22-Nov-2024VIBERLIBERTY INSURANCE - GUADALUPE COMMUNITY MULTI-PURPOSE COOPERATIVEEndoscopic procedures, IP & OP- 5k only, confirmed to liberty.
    22-Nov-2024VIBERLIBERTY INSURANCE - SAMAHAN PARA SA IKAUUNLAD NG MGA KAWANI NG AGHAM AT TEKNOLOHIYA (SIKAT)AUTO-IMMUNE NOT COVERED
    25-Nov-2024VIBERLIBERTY INSURANCE - NAFC- DA MULTI PURPOSE COOPERATIVEcovered animal scratch category 2 and up
    27-Nov-2024VIBERLIBERTY INSURANCE - INLAND AQUATIC RESEARCH AND DEVELOPMENT (IARRD)IF ER CASE AND CATEGORY 2 UPPER SIR GERICK_MAM LEI OF LIBERTY
    29-Nov-2024VIBERLIBERTY INSURANCE - OPTIONS - PRIMERA MULTI-PURPOSE COOPERATIVEFor primera this is the same as the other agencies like cavcon golden manna and oneimus meron coverage up to specified limit. Extended to cover scratches if CAT 2 and above. Kindly accommodate our member as advised by sir jerome PER MAM LEI OF LIBERTY VIBER GC / UP TO 20K
    5-Jul-2024VIBERLIBERTY.INSURANCE-GSIS-KAPISANAN NG MGA MANGGAGAWASA SA GSISCOVID 19 INFECTION for RT PCRIf screening not covered. If positive we can reimburse.
    LIBERTY.INSURANCE-LANDBANK EMPLOYEES ASSOCIATION - AUTOIMMUNE 50% OF ABL


DATEMODE OF ENDORSEMENTCORP - HC&DDETAILSREMARKS
9/11/2024VIBERALL HC&D ACCOUNTSANIMAL SCRATCHcovered, we do consider scratch under animal bite - Rowena
11/12/2024VIBERHC&D - DEPT. OF SCIENCE AND TECHNOLOGY - SCIENCE EDUCATION INSTITUTERADIATION THERAPYCovered up to 12 Session under therapeutic procedures radioactive-Rowena
12/9/2024VIBERHC&D - F.F. INTERNATIONAL MANUFACTURING CORPORATIONRADIOTHERAPYCovered up to 12 Session under therapeutic procedures radioactive-Rowena

DATE OF ENDORSEMENTMODE OF ENDORSEMENTCORP - STARDUSTDETAILSREMARKS
4-Jul-2024VIBERStardust-Infant Wears Inc.PHYSICAL THERAPY COVERAGEEffective immediately, absolutely no PT covered AS PER S PIA BRIEN

DATE OF ENDORSEMENTMODE OF ENDORSEMENTCORP - LAWINA/RIBAIDETAILSREMARKS
13-Jul-2024VIBERLAWINA-CSM Manila Inc. - Career Philippines Shipmanagement Inc.TETANUS VACCINECOVERED AS PER SIR CARLO
13-Jul-2024VIBERLAWINA-CSM MANILA, INC. - SENATOR CREWING (MANILA), INCTETANUS VACCINECOVERED AS PER SIR CARLO
8-May-2024VIBERLAWINA-HARREN & PARTNER CREW MEDICAL INSURANCEAnimal biteFirst dose only
27-May-2024VIBERRIB-CASA BELLA HOME AND LIVING CORPESWLESWL - covered up to MBL
N/AN/A*Intermodal Shipping IncER CASEK-line group Emergency case - IP LIMIT - for UK account charge to OP limit
N/AN/A*New Filipino Maritime Agencies Inc
N/AN/A*Ventis Maritime Corp - KRBS
N/AN/A*Veritas Maritime Corporation
N/AN/A*Ventis Maritime Corp - SGP
N/AN/A*K LNG Maritime Services Inc - KMSM
N/AN/A*Ventis Maritime Corp - SPT
N/AN/A*Ventis Maritime Corp - KMSM
N/AN/A*K LNG Maritime Services Inc - UK
2-Nov-2024VIBERLAWINA-PGA Upstart-Gorilla Geo Industries, Incfor TB Genexpert procedure - DX pulmonary tuberculosisIt’s covered in their pre-existing. Thanks. per Sir Carlo ong via RIBAI gc
2-Aug-2024VIBERLAWINA-CSM MANILA, INC. - SENATOR CREWING (MANILA), INCFirst dosed of anti rabies up to 10k
19-Jun-2024VIBERLAWINA-CSM Manila Inc. - Career Philippines Shipmanagement Inc.10k Limit for Animal Bite

Email Subject:  Additional Exclusion & Revision of Benefits
from:Mark Paquita <mark.paquita@rayomarinsurance.com>

Hi Ma’am / Sir,

Kindly see the below changes in benefits and additional exclusion for the following accounts as stated below:

  1. Sexually transmitted diseases such as AIDS, Hepatitis B, Condyloma, Gonorrhea, Syphilis, Herpes, etc., and their attendant complications.

The additional exclusion above applies to the following corporations:

  1. BIODIVERSITY MANAGEMENT BUREAU
  2. OPTIONS-DICT
  3. OPTIONS-DNEA
  4. GENERAL MARIANO TECHNOLOGICAL HIGH SCHOOL ( GMATHS )
  5. GRACE ASIA INC
  6. KEDICA
  7. MANILA INTERNATIONAL FREIGHT FORWARDERS INC.
  8. MIFFI LOGISTICS CO,. INC.
  9. NAMRIA
  10. OPTIONS NEATS
  11. NATIONAL HOUSING AUTHORITY
  12. NATIONAL HOUSING AUTHORITY FAMILY UNIT
  13. OWWA
  14. PEA-OPTIONS
  15. RTU-KMPC
  16. RTU-AFCI
  17. Tubotech Plumbing Products Philippines Corporation
  18. DHVTSU MULTI-PURPOSE COOPERATIVE
  19. Department of Tourism
  20. Department of Trade and Industry-Employees Union
  21. Department of Transportation and Communication
  22.  IOI HEALTH AND WELLNESS TRADING INC.
  23. ALTITUDE MARITIME TRAINING CENTER
  24. San Jose Electric Cooperative
  25. KABUHAYAN SA GANAP NA KASARINLAN CREDIT AND SAVINGS COOPERATIVE (K - COOP)
  26. LIVING STONE INTERNATIONAL SCHOOL
  27. Central Luzon District Council of the Assemblies of God

 PEME Amounts for Kline Group

Account Code Corporates Member Type Peme Amount
294 One Sea Solutions Principal                              5,000
669 K LNG Maritime Services Inc-KMSM Principal                              5,000
686 Ventis Maritime Corp-KMSM Principal                              5,000
284 Ventis Maritime Corp - KRBS Principal                            10,000
283 Newfil Maritime Agencies Inc Principal                            10,000
324 Veritas Maritime Corporation Principal                            10,000
282 Intermodal Shipping Inc Principal                            10,000

 
LAWINA-CSM Manila Inc. - Career Philippines Shipmanagement Inc.

EWSL - COVERAGE
 

LAWINA-Marlow Navigation Philippines lnc. /Galant Maritime Services, lnc-Seafarers
Emergency Local Ambulance Service P 5,000


LAWINA-K LNG Maritime Services Inc - UK
12PT SESSION



LAWINA-K LNG Maritime Services Inc - UK
Physical Therapy coverage up to 12 sessions

 

LAWINA-New Filipino Maritime Agencies, Inc.
Physical Therapy coverage


LAWINA - OPTIONS
SKIN GRAFTING NOT COVERED


LAWINA - OPTIONS
covid coverage

anti-rabies vaccine and its administration - up to MBL


DATE OF ENDORSEMENTMODE OF ENDORSEMENTCORP - FIRST LIFEDETAILSJUSTIFICATION
Sep 26, 2024VIBERBUSINESS MACHINES CORPORATIONPT COVERAGE - BASIC PT ONLY UP TO 12 SESSIONSPT COVERAGE - BUSINESS MACHINES CORPORATION.PNG

Special Approval Meizel Barquilla

Requesting approval for Meizel Barquilla for access to Medical City Makati Waltermart Branch

WITH ACCESS TO ALL MAJOR HOSPITAL/CLINICS

EXCLUSIONS FOR HOSPITALIZATION BENEFIT
No benefit shall be made for any loss resulting from or cause by:
 
1. Self-inflected injuries; nervous or mental disease or disorder; pregnancy, childbirth, miscarriage, abortion or any complications of any of these; congenital deformities and defects; drug addiction; continued excessive or compulsive use of alcohol drinks; declared or undeclared war or civil strife; routine physical check-up and rest cures, or
2. Cosmetic surgery for beautification purposes, or plastic surgery for any condition existing on the effective date of the insurance, except for the repair or alleviation of damage caused solely by accidental bodily injuries, or
3. Treatment of Acquired Immune Deficiency Syndrome (AIDS) nor changes for the examination, immunization and detection of human immune deficiency virus and other related viruses, or
4. Hospital confinement and charges caused by riot, civil commotion, war, invasion, act of foreign enemy, Hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military usurped power. Military or police operations against domestic rebellious groups, kidnapping or ransom groups. Military personnel activities are covered provided it is in line with duty; or
5. Hospital confinement and charges caused ionizing radiations or contamination by radioactivity from nuclear waste from process of nuclear fission, or from any nuclear weapons material which is due to the profession or line of work of the insured, or
6. The use or acquisition of special braces or prosthetic appliances such as artificial limbs, hearing aids and others but payable under Major Medical Benefits, or
7. Any dental treatment or surgery, except dental operation to repair injury sustained in accident, or
8. Treatments of any mental and nervous disorder such as psychosis, schizophrenia and others, any treatment arising from alcohol or drug addiction, or
9. Any confinement for physical check-up or diagnostic purposes; treatment or surgical operations for congenital deformities such as harelip, clubfoot, cerebral palsy and others, for physical therapy; or for recuperative purposes such as confinement in a sanitarium or convalescent home, or
10.Non-surgical care of tuberculosis and venereal diseases; or for treatment of communicable diseases such as small pox, cholera, bubonic plague, etc., Acquired Immune Deficiency Syndrome (AIDS) and other forms of complications attributed thereto, or
11. Hospital services not in accordance with the diagnosis and treatment of the conditions for which hospital confinement is required, or
12.Hospital confinement occasioned by or happening through pregnancy or childbirth with respect to women, or
13.In the case of misstatement of age of which is not insurable at the time of enrollment, the benefit is not compensable, or

NOT COVERED ITEMS: COVERAGE GENERAL EXCLUSIONS
ALCOHOL NOT COVERED Unless exceptions to the following exclusions are made under the Benefits Provisions, this Memorandum Of Agreement shall not cover the following:
ARM BAND/ ID BAND/NAME TAG/WRIST BAND NOT COVERED A. EXCLUSIONS SECONDARY TO SELF-CULPABILITY
BEDPAN NOT COVERED 1 Injury and its complications resulting from self-inflicted injuries including:
CALIBRATED GLASS NOT COVERED ·        attempted suicide or self-destruction, whether sane or insane
COLD/ HOT WATER BAG NOT COVERED ·         infections as a result of tattoos, piercing on any body part aside from the ears, whether self- inflicted or done by a third party
DIAPER NOT COVERED 2 Disabilities, injuries, or illnesses resulting from domestic violence; Healthcare Provider may rely on the Police or Doctor’s report to evaluate such claim.
DIET PLAN/DIETARY/NUTRITION ASSESSMENT PLAN NOT COVERED 3 Injuries or illnesses attributable to the individual’s own misconduct , gross negligence, vicious or immoral habit, including:
DISTILLED WATER/ DRINKING WATER / MINERAL WATER NOT COVERED ·         unauthorized use of prohibited and regulated drugs
DRY SHEET / CURITY PAD NOT COVERED ·         alcoholic liquor intake
ELECTRICITY USED NOT COVERED ·         direct or indirect participation in the commission of a crime
ENVIRONMENTAL LEVY/WASTE DISPOSAL FEE NOT COVERED ·         violation of a law or ordinance
EXTRA BED / LINEN NOT COVERED ·         unnecessary exposure to imminent danger
EXTRA MEALS/FOODS NOT COVERED Healthcare Provider may rely on the Police or Doctor’s report to evaluate such claim.
EXTRA PILLOWS NOT COVERED 4 Injuries or illnesses caused directly or indirectly by engaging in any risky sport or hazardous activity such as but not limited to handling firecrackers and explosives, scuba diving, boxing, mountain climbing, surfing, water-skiing, yachting, parachuting, drag racing, target shooting, motor sports, winter sports, skydiving, use of wood-working machinery
FACE TOWEL / TOWEL NOT COVERED 5 Illnesses resulting from exposure to ionizing radiation of any source
FAMILY PLANNING NOT COVERED 6 Injuries resulting from direct participation in any act of war and in state of civil, military, or political unrest (i.e. riots, strikes)
FAX NOT COVERED 7 Injuries or illnesses resulting from any combat-related activity or from participation in any political, police, investigative, firefighting activities while in military service
FORMS/PHIC NOT COVERED 8 Injuries resulting from conducting murder, assault, homicide or any attempt thereof, including injuries occasioned by provocation of the member
HOSPITAL SERVICE FEE / MISCELLANEOUS CHARGES  (UNSPECIFIED/NOT ITEMIZED) NOT COVERED B. DIAGNOSTIC/THERAPEUTIC PROCEDURES AND MEDICATIONS NOT COVERED
RISK ASSESSMENT / MEDICATION MANAGEMENT FEE NOT COVERED 1 Routine physical examinations required for obtaining or continuing insurance, schooling, government licensing, health permit, travel documents, and other similar purposes, including routine PE for
IV TRAY NOT COVERED employment (i.e. pre-employment PE, Annual PE) unless otherwise specified in the Schedule of Benefits
KIDNEY BASIN NOT COVERED 2 All screening tests, including tests for Hepatitis screening
MEASURING CUP NOT COVERED
MEDICAL CERTIFICATE NOT COVERED
MEDICAL RECORDS NOT COVERED 3 Aesthetic, cosmetic, and reconstructive surgery or any consultation and treatment for beautification purposes, including varicose vein treatment (i.e. sclerotherapy, Endovenous Laser Therapy (ELT)),
OFFICE FORMS NOT COVERED except if necessary to treat a functional defect due to accidental injury within the initial confinement
PHOTOCOPY NOT COVERED 4 Treatment involving new diagnostic and therapeutic modalities such as but not limited to LASIK,
PILLOWS NOT COVERED PET scan, physical therapy modalities (i.e. shockwave therapy, cold laser therapy, targeted radiofrequency, etc.)
PRIVATE NURSE NOT COVERED 5 Experimental and/or investigational medical procedures and its complications
RAZOR NOT COVERED 6 Cost of intravenous immunoglobulin (IVIG), hyperalimentation, multivitamins and nutritional/food/herbal supplements, and vaccines for immunization, unless otherwise specified in
RENT OF APPLIANCES (TV/REMOTE CONTROL/ELECTRIC FAN, ETC) NOT COVERED the Schedule of Benefits
SANITARY NAPKINS NOT COVERED 7 Outpatient medicine and take-home medicine except chemotherapy medicine and medicine administered during an emergency treatment
SLIPPERS NOT COVERED 8 Cost of blood donor screening
SPECIMEN CUP NOT COVERED 9 Circumcision (except for treatment of phimosis), sex transformation, artificial insemination,
SPOON & FORK NOT COVERED sterilization of either sex or reversal of such, and diagnosis, treatment and procedures related to fertility or infertility
TAKE HOME MEDICINES NOT COVERED 10 Procedures for desensitization for hypersensitivity, including allergy testing, unless otherwise specified in the Schedule of Benefits
TELEPHONE BILLS/CALLS NOT COVERED 11 Hormone replacement therapy (HRT) for pre-menopausal or menopausal men/women or any other treatment for menstrual syndrome or menopausal syndrome
THERMOMETER NOT COVERED 12 Acupuncture, chirotherapy, and other forms of alternative medicine and their complications
TISSUE / PAPER TOWEL NOT COVERED 13 Cost incurred in the process of organ donation and transplantation, and its complications, if the member is the donor in such procedure/s
TONGUE DEPRESSOR NOT COVERED C. DISEASES/ILLNESSES NOT COVERED
TRANSFER FEE NOT COVERED 1 Psychiatric and/or psychological illnesses and conditions including but not limited to anxiety
TUMBLERS NOT COVERED disorders (i.e. stress-related anxiety or anxiety attacks), psychotic disorders, bipolar disorders, depressive disorders, and personality disorders
UNDERPADS NOT COVERED 2 Neurodevelopmental disorders including but not limited to:
URINAL BAG/ WEE BAG NOT COVERED ·         Intellectual Disability (previously called mental retardation)
VITAMINS/ FOOD SUPPLEMENT NOT COVERED ·         Communication disorders (i.e. speech sound disorder)
CLAIMS PROCESSING / PROCESSING FEE NOT COVERED ·         Autism Spectrum disorder (i.e. Asperger’s disorder)
SCREENING NOT COVERED ·         Attention-Deficit/Hyperactivity Disorder (ADHD)
SHOE COVER NOT COVERED ·         Specific learning disorders
PPE NOT COVERED ·           Motor disorders (i.e. tic disorders, Tourette’s disorder)
ISOLATION GOWN/BLUE GOWN NOT COVERED ·         Cerebral Palsy, Epilepsy, Down syndrome, etc.
HEAD CAP NOT COVERED 3 Congenital, genetic, hereditary diseases, and their complications, except if congenital benefits are covered as indicated in the Schedule of Benefits
KN95 NOT COVERED 4 Neonatal illnesses resulting from complications of pregnancy and delivery of the newborn infant
JANITORIAL SERVICE NOT COVERED
BEDDINGS NOT COVERED 5 Maternity care and all other conditions related to and/or resulting from pregnancy and delivery including its complications, except if maternity benefits are covered as indicated in the Schedule of Benefits
CLINICAL SERVICES (NURSING, MEDICAL TECHNOLOGIST, RADIOLOGY TECHNOLOGIST, ORDERLIE) NOT COVERED 6 Obesity and its treatment including but not limited to bariatric surgery, liposuction, weight reduction programs, etc.
DIETARY SERVICES NOT COVERED 7 Sleep Disorders and Eating Disorders
SECURITY SERVICES NOT COVERED 8 Error of refraction, including diagnostic procedures and treatment, except consultation
MAINTENANCE FEE (ELECTRICAL/MECHANICAL) NOT COVERED 9 Chronic Dermatoses such as:
HOUSEKEEPING NOT COVERED ·          Chronic Idiopathic and/or Psychogenic Dermatoses (i.e. acne, alopecia areata, psychogenic purpura, rosacea, chronic urticaria)
COMMUNICATION FEE NOT COVERED ·          Primary Psychiatric Dermatologic disorders (i.e. bromosiderophobia, delusion of parasitosis, dysmorphophobia, factitial dermatitis, trichotillomania)
RT-PCR TEST (UPTO 1 ONLY TEST ONLY OF PATIENT) NOT COVERED ·          Autoimmune and Hormonal Dermatoses (i.e. ichthyosis, psoriasis, vitiligo, atopic dermatitis, seborrheic dermatitis
10 Demyelinating diseases of the nervous system (i.e. multiple sclerosis), Autoimmune neurologic disorders (i.e. myasthenia gravis, Guillain Barre syndrome), and Neurodegenerative diseases (i.e. Alzheimer’s disease, Parkinson’s disease)
11 Sexually transmitted infections (STIs) including but not limited to condyloma acuminata, genital warts, gonorrhea, chlamydia, molluscum contagiosum, syphilis, trichomoniasis, etc.
12 HIV infection, AIDS, and their complications; Suspected HIV infection (subject to medical evaluation by the Healthcare Provider or unless proven otherwise by member through submission of a valid negative HIV test result)
13 Dental-related condition or illnesses, including its complications (i.e. maxillary sinusitis of odontogenic origin), except if dental benefits are covered as indicated in the Schedule of Benefits
14 Injuries or illnesses attributable to third party liabilities, if Member refuses to execute a Deed of Subrogation and Reimbursement
  Diseases that are declared epidemic or pandemic by the Department of Health, World Health Organization, or any recognized health authority (i.e. Avian flu, Meningococcemia, etc.)
15
16 Pre-existing medical conditions or illnesses unless otherwise specified in the Schedule of Benefits
D. MISCELLANEOUS EXCLUSIONS
1 Custodial, domiciliary, convalescent and intermediate care
2 Professional fees for medico-legal cases; Professional fees of assistant surgeons except when the
service of an assistant surgeon is medically necessary, subject to the approval of the Healthcare Provider
3 Benefits covered by PhilHealth and all other government funded healthcare entitlements as provided
for by law
4 Charges for non-medical services such as those of private duty nurses or physicians; charges for non-medical amenities such as telephone, radio, television, refrigerator, extra bed/ beddings,
toiletries and the like unless these are included in the Member’s room and board accommodation
5 Purchase or use of durable medical equipment such as but not limited to oxygen dispensing unit, except if rented while confined at the hospital
6 Cost of corrective/prosthetic appliances, artificial aids, surgically implanted external devices, orthopedic hardware, and hearing aids and its fitting
7 Cost of hospital confinement wherein the Member went home against medical advise (HAMA), or was discharged against medical advise (DAMA), or has absconded, including succeeding availments for the same illness, subject to the approval of the Healthcare Provider
 
PRE-EXISTING MEDICAL CONDITIONS
An illness is considered to be pre-existing if any of the following conditions are present:
1.    Such illness or condition was, in any way, evident to the Individual before the effective date of the Memorandum of Agreement.
2.    Any professional advice or treatment for such illness or condition was obtained prior to the effective date of the Memorandum of Agreement.
3.    The pathogenesis of such illness or condition has started prior to the effective date of the Memorandum of Agreement, whether or not the Individual is aware of such illness.
4.    Illnesses or conditions disclosed in the application form.
The following, among others, when occurring within the first 12 months of coverage, are considered as Pre-existing Conditions:
PRE-EXISTING NON-DREADED CONDITIONS
1.    Anal Fistulae
2.    Benign Prostatic Hypertrophy
3.    Calculi of the urinary tract, kidney, and gallbladder (except choledocholithiasis and other stones in the biliary tract)
4.    Endometriosis, simple ovarian cyst (10 cm (excluding ruptured ovarian cyst), Polycystic
Ovarian Syndrome (PCOS)
5.    Uncomplicated hypertension (essential/primary hypertension alone)
6.    Gastritis, duodenitis, uncomplicated gastric/duodenal ulcer (non-bleeding ulcers)
7.    Hemorrhoids
8.    Hernia (unless congenital)
9.    Non-toxic goiter
10.  Migraine headache
DREADED CONDITIONS are defined as “generally chronic and irreversible” diseases that require frequent and/or prolonged hospitalization.
PRE-EXISTING DREADED CONDITIONS
1.    Arthritis (such as rheumatoid arthritis, osteoarthritis, chronic gouty arthritis)
2.    Benign or malignant new growth
3.    Blood dyscrasias (such as leukemia, idiopathic thrombocytopenic purpura)
4.    Cataract and glaucoma
5.    Cerebrovascular diseases (such as stroke, aneurysm, etc.)
6.    Choledocholithiasis and other stones in the biliary tract (except in the gallbladder)
7.    Chronic cardiovascular diseases (such as aortic dissection, abdominal aortic aneurysm, myocardial infarction, congestive heart failure, coronary artery disease, cardiomyopathies, valvular heart disease, cardiac arrhythmias, and peripheral vascular disease)
8.    Chronic EENT diseases (such as chronic otitis media, primary acquired cholesteatoma)
9.    Chronic endocrine disorders (such as diabetes, dyslipidemia, hormonal dysfunctions, thyroid dysfunctions except non-toxic goiter)
10.  Chronic gastrointestinal diseases (such as irritable bowel syndrome, Crohn’s diease)
11.  Chronic genito-urinary disorders
12.  Chronic kidney diseases
13.  Chronic liver parenchymal diseases (such as liver cirrhosis, chronic hepatitis, non-alcoholic fatty liver disease/steatohepatitis)
14.  Chronic pulmonary diseases (bronchial asthma, chronic obstructive pulmonary diseases such as emphysema, chronic bronchitis)
15.  Collagen, connective tissue, immunologic disorders
16.  Muscular dystrophy (such as Duchenne, Becker, limb-girdle dystrophy)
17.  Secondary hypertension (such as hypertension sec. to chronic kidney disease) and hypertension with complications (such as HCVD, HASCAD, hypertension and CVD or stroke, hypertension with co-existing diabetes)
18.  Tuberculosis, pulmonary and extrapulmonary
19.  All complications resulting from above list of conditions
20.  Any pre-existing illness other than above which would require prolonged hospitalization and/or critical care or confinement to intensive care unit
CATHASTROPIC ILLNESSES are defined as any illness, other than pre-existing dreaded illnesses, requiring prolonged hospitalization or recovery, usually life-threatening, and may leave residual disability.
PRE-EXISTING CATHASTROPIC ILLNESSES
Injuries or illnesses due to or caused by accident requiring major surgery and prolonged hospitalization
for more than 14 days. (Occupational, Vehicular Accident, Fall, Accidents cause by Natural calamities, and Accidents with Third-Party involvement)
Burns requiring Intensive care, Isolation, skin grafting and hospitalization for more than 14 days.
*Conditions considering the contestability period for new members (3 months, 6 months, 12 months)


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