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.

Email address of contact persons:

coo@polaris-finance.com

support@polaris-finance.com

info@polaris-finance.com

insurance@polaris-finance.com

operation@polaris-finance.com

helpline@polaris-finance.com

xguirao@polaris-finance.com

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)

PROVIDED LIST OF PEC:

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