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FAQs:
1.
What is a Health Maintenance Organization
or HMO?
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An
HMO is one of the latest alternatives
in delivery of health care services.
It provides access to a predetermined
health care services to either
an individual or a group of enrollees.
These services are paid at a pre-determined
fixed rate for an agreed period |
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2.
What are the advantages in Enrolling
in an HMO?
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It
provides comprehensive care (preventive,
out patient, and rehabilitation) |
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It
is convenient because there is
no hospital deposit on admission |
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The
budget process is easier as cost
is predictable |
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Members
are entitled to standardized discounted
professional fees |
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Since
HMOs screen the doctors and Hospitals
that they affiliate, an enrollee
can be assured of their credibility
and competence. Also, HMO's affiliate
doctors in the entire range of
specialization |
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3.
Will the member be issued a card?
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4.
Can anyone just avail your health plans?
What are the requirements for eligibility?
| For
Individual Health Plans: |
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Individuals
who are in good health and doing
normal activities from 7-55 years
old (note: for applicants 51 yrs.
Old and above, physical examination
is required. |
| For
Corporate Health Plans: |
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Principal
Members, all regular and full
time employees actively working
for the client and at least 18
years old but not more than 59
years old on their eligibility
date. |
| Health
Assure Plus: |
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Minimum
of 6 months old to a maximum of
59 years old. If minor, guardian/payor
may sign for the applicant, Individual
dependent rate shall apply. |
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5.
What are the basic package that Prudentialife
Care products can offer to the market?
| Individual
Health Plan: |
| Health
Protect |
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15
years fixed rate coverage, payable
in 5 years, includes in patient
services and medical fund Health
Protect Plus |
| Health
Protect Plus |
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15
years fixed rate coverage, payable
in 5 years, Includes Out patient,
In patient services, preventive
health care, emergency care, dental,
and medical fund |
| Individual
/ Family Plan: |
| Health
Assure |
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Yearly
renewable health plan for individuals
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Includes
out patient, in patient, preventive
health care program, emergency
treatment |
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Health
Assure Plus Prestige: All
affiliated hospitals including
MMC, AHMC, SLMC, TMC, and Cardinal
Santos. |
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Health
Assure Plus Classic: All
affiliated hospitals except
MMC, AHMC, SLMC, TMC, and Cardinal
Santos. |
| Corporate
/ Group Plan |
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Baby
group: 5-19 members, Standard
regular group: 20-99, Customized:
100 and more |
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Out
Patient services (Consultations,
EENT, treatment of minor injuries,
etc.) |
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Emergency
Care (Doctor's services, medications,
etc.) |
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In
Patient Services (Room and board
according to type of plan, use
of operating and recovery room,
etc.) |
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Preventive
Health Care (Wellness programs,
Health education on diet and exercise,
etc.) |
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6.
What are the limitations of the health
care plans?
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Non
coverage of pre-existing conditions |
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Other
general exclusions (refer to the
policies) |
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7.
How soon can the members avail of the
benefits?
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Effective
date of coverage will be the basis
on when the members can start
availing the services. |
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8.
What are pre-existing conditions? Will
these be covered?
| Whether
known or unknown, disclosed
or undisclosed, an illness or
condition shall be considered
as pre-existing if during the
period prior to: |
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The
effective date of the agreement |
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The
approval date of reinstatement |
| a) |
any professional
advise or treatment was given
for such illness or condition |
| b) |
such illness or
condition was in any way evident
to the member, |
| c) |
any professional
advise or treatment was given
for such illness or condition |
| All
new members will be subject
to the pre-existing condition
clause on the first year of
coverage. If a pre-existing
illness comes out on the first
year, it will not be covered
by PrudentialifeCare and shall
be automatically excluded from
an enrollee's coverage. |
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