MEDICard Philippines, Inc

RxER

The RxER is a new product offered by MEDICard. This health plus ER trauma package offers a lot of benefits when you avail at the MEDICard clinics, including unlimited free consultations with our general practitioners, family medicine doctors, medical internists, pediatricians ob gynecologists and dentists. 30% discounts are also offered when you avail of the laboratory and diagnostic tests, surgical procedures, dental procedures, consultations with other specialists and services at the Skin Care clinic.

The RxER will also cover your emergency trauma cases in all accredited hospitals and will also provide you with accidental death and disability benefit.*

*see specific benefits below.

The RxER also provides you with a free basic 5 preventive package at our MEDICard clinics which includes complete blood count, urinalysis, fecalysis, chest x-ray and physical examination.

Packages

INDIVIDUAL	P 1,800 (FOR 6 MONTHS)
GROUP OF 3	P 3,500 (FOR 6 MONTHS)

(NOTE: GROUP OF 3 MUST HAVE 3 DIFFERENT MEMBERS)

The RxER Packages

MEMBERSHIP ELIGIBILITY
AGE: no limit For GROUP OF 3: no hierarchy & family relationship limitations

OUT-PATIENT: ONLY IN MEDICARD-OWNED CLINICS

FREE unlimited consults with primary care physicians (GP & Family Medicine), Pedia, IM & OB 30% discount for consults with other specialists and sub-specialists* 30% discount for laboratory and diagnostic tests* 30% discount for surgeries 30% discount for procedures at the Skin Care Clinic (available at the MEDICard Lifestyle Center) All other medical services and management not mentioned above are not covered. * Not available in hospital based clinics.

PREVENTIVE: ONLY IN MEDICARD-OWNED CLINICS (except hospital based clinics)
Basic 5: CBC, urinalysis, fecalysis, chest X-ray & PE (one-time availment only)

DENTAL: ONLY IN MEDICARD-OWNED CLINICS (except hospital based clinics)
FREE dental consults 30% discount on dental procedures

EMERGENCY CARE (within 6 hours from the time of incident)

TOTAL LIMITS: INDIVIDUAL: P20,000 GROUP OF 3: P30,000 (aggregate limit) IN ALL MEDICARD ACCREDITED HOSPITALS INCLUDING 5-STAR (THE MEDICAL CITY, ST. LUKE’S MEDICAL CENTER QUEZON CITY, MAKATI MEDICAL CENTER, ASIAN HOSPITAL MEDICAL CENTER AND CARDINAL SANTOS MEDICAL CENTER) & ST. LUKE’S MEDICAL CENTER-GLOBAL CITY Emergency care charges include ER fee, PF (MRV rate) & emergency medications directly related to the treatment of the illness for the following cases only, subject to conditions under exclusion: Trauma cases i.e. vehicular accidents and other forms of accidents not brought about by the member’s own misconduct or not against the laws of the Philippines. Vehicle registration (OR/CR) & driver’s license should be submitted. In some cases, a police report will also be needed. Burns Animal bites Accidental chemical poisoning The following benefits will be covered subject to the emergency trauma care limits. Emergency CDP including Ultrasound, CT scan & MRI covered up to P5k only. Tetanus toxoid, anti-tetanus serum & active immunization for anti-rabies covered (first dose only). Ordinary casting and splints are covered. Patient may avail of emergency services for the mentioned cases more than once as long as the limit is not yet consumed and it is still within the 6-hour period from the time of accident. EXCLUSIONS: Passive immunization or Immunoglobulin for rabies Bandages, fiberglass and other forms of prosthetics, medical appliances, pins, screws and the like Take home medicines & medical supplies Follow-ups at the emergency room IN NON-MEDICARD ACCREDITED HOSPITALS Reimbursement of 100% of approved HB & PFs (MRV rate) up to maximum limit.

MEMBER’S FINANCIAL ASSISTANCE

Accidental death and injury up to P50,000 provided that the death or injury results from causes that are covered under Emergency Benefits. Causes of death or injury should also not be under the list of exclusions, pre-existing conditions and dreaded diseases. LOSS PERCENTAGE OF INSURANCE AMOUNT Life 100% Both hands or both feet 100% Both arms or both legs 100% Sight of both eyes 100% One hand & one foot 100% Hearing on both ears 100% Speech 100% Any other injury causing permanent total disablement 100% One arm or one leg 75% One hand or foot or sight of one eye 50% Four fingers of one hand 50% One foot above the ankle 50% Thumb and index finger of either hand 25% All toes of one foot 25% Two fingers of any one hand 15% One big toe 5%

EXCLUSIONS:
OUTPATIENT:

1. Prescribed medicines on an out-patient basis are not provided by MEDICARD Medical Center or Medical Service Units.
2. The absolutely no charge out-patient consultations and discounted medical and health care services are provided only during clinic hours of MEDICard clinics.
3. All other forms of services not provided under Outpatient benefits.

EMERGENCY CARE SERVICES

1. Hospitalization and treatment outside the Philippines is not covered.
2. Cost of medical services, medicine and other expenses incurred as a result of a member's decision to avail of such medical services, treatment or procedure, not prescribed or contrary to what has been prescribed by the attending MEDICard provider, or without MEDICard's express written report shall not be covered by MEDICard.
3. All other cases not specifically mentioned under Emergency Beneftis will not be covered by MEDICard.
4. Plastic and reconstructive surgery for cosmetic purposes and for physical congenital deformities and abnormalities.
5. Slipped disc, herniated disc, scoliosis, spinal stenosis and spondylosis.
6. Experimental medical procedures, acupuncture, acupressure, reflexology and chiropractics.
7. Purchase or lease of durable medical equipment, oxygen dispensing equipment and other medical supplies.
8. Corrective appliances, artificial aids and prosthetic devices.
9. Human blood products like platelets, packed RBC, plasma, gamma globulin, etc. and its processing.
10. Psychiatric and psychological illnesses including neurotic and psychotic behavior disorders.
11. Treatment for alcoholic intoxication and drug addiction or overdose reaction to use of prohibited drugs including illnesses directly related to it and other injuries attributed as a result of it.
12. Rehabilitation treatment and physical therapies.
13. Hazardous job-related illnesses and/or injuries.
14. Injuries or illnesses resulting from participation in war-like or combat operations, riots, insurrection, rebellion, strikes, domestic violence and other civil disturbances.
15. Treatment of self-inflicted injuries or injuries attributable to the MEMBER'S own misconduct, gross negligence, use of alcohol and/or drugs, vicious or immoral habits, participation in acts of crime, violation of a law or ordinance, unnecessary exposure to imminent danger or hazard to health, combat sports and sparring such as tae kwan do, boxing, muai thai, sports injuries without the use of proper equipment and hazardous sports related injuries.
16. Oral surgery or (TMJ) surgery done by dental practitioner.
17. Treatment of injuries sustained in a motor vehicle accident if the member or his guardian fails or refuses to execute the deed of Subrogation.
18. Professional fees of medico-legal officers.
19. Cost of vaccines for active and passive immunization including passive immunization or immunoglobulin for rabies.
20. All other services not specifically mentioned in this agreement are not covered.

Application Procedures:

Member can apply via this website or can go directly to the following:

1. CLINICS
   • MEDICard LIFESTYLE CENTER  Makati
     Address: 51 Paseo de Roxas Avenue cor
     Sen. Gil Puyat Ave,, Makati City
     Contact Number: (02) 894-5720/867-1048/878-5101
     Fax No.: 867-1048
     skin clinic 816-6588 / 816-6988 / 878-5101 loc 5119
     Clinic Schedule: M-F 7am-7pm Sat. 7am-3pm
   • MEDICard  Alabang
     Address: 3/Level Festival Mall Corporate Ave.,
     Filinvest Corporation,Alabang, Muntinlupa City
     Contact Number: (02) 850-32-09 / 850-11-46 / 8079219
     Fax No.: 850-1146
     Clinic Schedule: M-Sun 8am-8pm
   • MEDICard  Calamba
     Address: 2/F Star Honda Bldg., Brgy. Parian, National Hi-way,  Calamba, Laguna
     Contact Number: (049) 502-6300 / (02) 584-4288
     Fax No. (02) 584-4288
     Clinic Schedule: M-F 7am-7pm Sat. 7am-3pm
   • MEDICard  Cavite
     Address: G/F Medicard, Anabu Kostal, Aguinaldo Highway,Anabu II D, Imus, Cavite
     Contact Number: (046) 472-1800 / (046) 515-8903
     Fax No: (046) 472-18009
     Clinic Schedule: M-F 7am to 7pm, Sat 7am to 4pm
   • MEDICard  Fairview
     Address: Unit 31, E & F LF Building Commonwealth Ave.
     corner Camaro St. Fairview Quezon City
     Contact Number: (02) 935-0949/(02)-935-7579
     Fax No: (02) 935-7579
     Clinic Schedule: M -F 7am-7pm, Sat 7am-4pm
   • MEDICard  Las Pinas
     Address: 2/F, Unit E, A C & Sons Bldg., Metrocor St.
     corner Alabang-Zapote Road, Brgy Almanza, Las Pinas City (right accross SM Southmall)
     Contact Number: (02) 519-2259, 519-2260
     Fax No : (02) 519-2259
     Clinic Schedule: M-F 7am to 7pm, Sat 7am to 4pm
   • MEDICard  Makati
     Address: 2129 G/F King’s Court II Bldg.,
     Don Chino Roces Ave., Makati City
     Contact Number: (02) 811-2411 / 811-0390
     Fax Number: (02) 811-2007
     Clinic Schedule: M-F 7am-6pm, Sat 7am-3pm
   • MEDICard  Ortigas
     Address: Unit 105, Parc Royale Condominium,
     Julia Vargas Avenue, Ortigas Centre PASIG CITY
     Contact Number: (02) 638-0595/638-3207/634-1885
     Fax Number: (02) 638-0595
     Clinic Schedule: M-F 7am-7pm, Sat 7am-5pm
   • MEDICard  QC
     Address: 937 G/F MESU Realty Trading Corp., EDSA, Quezon City
     Contact Number: (02) 920-8457, 920-5164, 775-4629
     Fax No: (02) 920-8457
     Clinic Schedule: M-F 7am-7pm, Sat 7am-5pm
   • MEDICard Sta. Rosa
     Address: 2/F Humana Wellness Center, Tagaytay Highway,
     Brgy. Don Jose, Sta. Rosa, Laguna
     Contact Number: (049) 544-0635/ 544-0638
     Direct Number: (02) 584-4048
     Fax Number: (049) 544-0638
     Clinic Schedule: M-F am7-7pm, Sat 7am-3pm
   
   
   MEDICARD PHILIPPINES, INC. HOSPITAL BASED CLINICS
   • ASIAN HOSPITAL & MEDICAL CENTER
     Address: Rm. 715 MOB, Asian Hospital & Medical Center
     Contact Number: (02) 771-1199 / 771-1173
     Fax No: (02) 771-1199
     Clinic Schedule: M-F 7am-7pm Sat 7am-3pm
     
   • MAKATI MEDICAL CENTER
     Address: 3/Flr. Rm. 373 New Wing
     Contact Number: (02) 888-8999 Loc 2373
     Direct Number: (02) 893-7740
     Fax Number: (02) 893-7740
     Clinic Schedule: M-F 7am-7pm Sat 7am-5pm
   • MANILA DOCTOR’S HOSPITAL
     Address: Rm. 405 UN Avenue
     Contact Number: (02) 524-3011 Loc 4240
     Direct Number: (02) 523-7331
     Fax No: (02) 523-7331
     Clinic Schedule: M-F 8-5 Sat 8-12
   • ST. LUKE’S MEDICAL CENTER
     Address: Rm. 713 South Tower CHBC
     Contact Number: (02) 723-0101 loc. 2713
     Direct Number: (02) 725-4429
     Fax No: (02) 725-4429
     Clinic Schedule: M-F 7am-7pm, Sat 7am-4pm
   • THE MEDICAL CITY
     Address: G/F Medical Arts Tower Inc.
     Contact Number: (02) 635-6789/988-7000 or 988-1000 loc. 3008/3009
     Direct Number : (02) 687-1017
     Fax No.: (02) 687-1017
     Clinic Schedule: M-F 7am-7pm Sat 7am-5pm
2. THRU THE CASHIER AT THE MEDICARD HEAD OFFICE:
   8TH FLOOR, THE WORLD CENTER BUILDING, SEN. GIL PUYAT AVENUE, MAKATI CITY
3. BANKS:
   A. METROBANK
   Payment Guidelines
   Via Over-the-Counter (Metrobank)
   1. Go to the nearest / most convenient Metrobank Branch.
   2. Get a copy of Metrobank’s "Payment Slip" and accomplish the required information/details;
   1. Company Name:Medicard Inc.
   2. Subscriber Name:Customer Name
   3. Subscriber No (Max. of 15 characters) : Subscriber No. (11-digit Cellphone No.)
   4. Mode of Payment:Cash / Check / Debit account
   5. Amount of payment
   NOTE: Slips are to be accomplished in duplicate copies. (a.)1st copy- Bank copy, (b.)2nd copy- Client’s copy
   3. Present payment slip to Metrobank teller together with cash/check.
   4. Once validated, Metrobank Teller will give customer a validated copy.
   5. Before leaving, check the copy received (Payment slip serves as proof of payment);
      5.1) if the copy was the one accomplished & presented
      5.2) and, if validated
      
   Via MetrobankDirect (Metrobank):
   1. Go to your Metrobank branch of account and enroll in MetrobankDirect.
   2. Login to https: //www.metrobankdirect. com and select Pay Bills.
   3. Under "Special Bill", choose "Medicard Inc." from the dropdown list of billers.
   4. Enter your 11-digit Cellphone No. (Subscriber Number) (under "Subscriber / Account No.")
   5. Choose account number where payment will be sourced from
   6. Enter the amount you wish to pay.
   7. Select "Immediate Payment" (account is immediately deducted upon approval) or "Future Dated" and click "Continue" button.
   8. Click "Confirm" button for the system to process your payment.
   9. View or print Transaction Acknowledgment Receipt as proof of payment.
   Via Mobile Banking (MetroBank):
   1. Go to your Metrobank branch of account and enroll your Globe, Sun or Smart phone in Mobile Banking.
   2. Access the Metrobank Mobile Banking applet installed in your mobile phone & select "Pay Bill".
   3. Select Biller; select Others; and select Medicard Inc.
   4. Choose account number where payment will be sourced from.
   5. Enter your 11-digit Cellphone No. (Subscriber Number) .
   6. Key in MPIN to confirm the transaction.
   7. Wait for the SMS confirmation of the status of your payment and save the message for future reference.
   B. UNIONBANK
   Via Over-the-Counter (UnionBank)
   1. Proceed to any UnionBank branch.
   2. Fill-out a Bills Payment S    lip (as shown below) in duplicate copies. Once validated by the Teller, you will be given the duplicate copy plus a Transaction Receipt.
      
      (Note that the Payor’s Name and Cellphone Number are MANDATORY fields. For Payor’s Name, pls. indicate your Last Name the First Name. Your payment will be applied based from these references.).
   3. Segregate CHECK from CASH payments.
      
        (For check payments, indicate the Drawee Bank/Branch and the check number; For cash payments, indicate denomination & no. of bills.
   4. If you have an account with UnionBank, and wish to pay via Debit-to-account, fill-out the Account Number field in the upper right-hand portion of the form.
      
   C. BPI
   Via Over-the-Counter (BPI)
   1. Proceed to any BPI branch.
   2. Fill-out a Deposit / Payment Slip (as shown on below) and accomplish the required information/details;
      1. Account Number: 1861-0084-24
      2. Merchant Name: MEDCRD
      3. Policy/Plan/Reference Number: Cellphone Number
      4. Policy/Planholder’s Name: Customer Name
      5. Amount of payment:
   3. Once validated by the BPI Teller, you will be given a copy of Transaction Receipt.
      

PROCEDURES IN TEXTING: (TO BE DONE AFTER PAYING THRU BANKS)

For Globe and Sun: 0917-8512648

1. INDIVIDUAL
   After paying thru the bank, member will text the following from his cell phone:
   rxreg<space>last name/first name/middle initial/birthdate(mmddyy)/bank/email address
2. GROUP OF 3
   After paying thru the bank, "principal paying" member will text 3x the following:
   1ST TEXT: FOR MEMBER 1 DETAILS:
   rxreg<space>group<space>last name/first name/middle initial/birthdate (mmddyy)/bank/email address
   2nd TEXT: FOR MEMBER 2 DETAILS
   rxreg<space>phone number of member 2/ last name/first name/middle initial/birthdate (mmddyy)/email address
   3rd TEXT: FOR MEMBER 3 DETAILS
   rxreg<space>phone number of member 3/ last name/first name/middle initial/birthdate (mmddyy)/email address
   
   TxtMEDICard will reply the following after the first text and will ask for the home address:
   "We have received your application for the RxER. Pls reply RxREG HOME followed by your complete mailing address to complete your membership application.” After texting your mailing address, Txtmedicard will reply the following: “We have received your address. This completes your registration. Please wait for your confirmation sms. Thank you "
   
   For Group Of 3, TxtMEDICard will send the above message to the cell phone numbers indicated for members 2 and 3.
   
   For those who did not text back their home address, status will be incomplete and thus membership will not be processed. TxtMEDICard will text the member every hour till he texts his home address back.

MEMBERSHIP CONFIRMATION

NOTE: Effectivity of membership will start from the day MEDICard sends a text message and email.

After 2 working days from date of payment, member will receive a text message and an email that will serve as the proof of membership. Please save this text message or print a copy of the email to present to the MEDICard clinics and accredited hospitals’ emergency rooms together with one valid ID.

1. Template for text message:
   RxER <account number> <name of member> valid for <valid from> to <valid to>. Pls show SMS with one 1 valid ID to avail. For questions call <884-9-911>.
2. Template for email:
   

   Dear <name of member>:
   Here are the details of your RxER membership. RxER <account number> <name of member> valid for <valid from> to <valid> to.

   Please show this email with one 1 valid ID to avail. For questions call <884-9-911> or click into this link.

   Please do not reply to this email.

REIMBURSEMENT PROCEDURES AND AVAILMENT OF MFA

REIMBURSEMENT PROCEDURE

1. All claims for reimbursement must be submitted or forwarded to MEDICard Head Office within thirty (30) calendar days from the date of availment. Failure to do so shall invalidate the claim, except if it can be shown in writing that it was not reasonably possible to furnish such documents within thirty (30) days.
2. Required documents in availing reimbursement:
   • Fully accomplished MEDICard RxER reimbursement claim form
   • Cover letter/incident report
   • Medical Certificate stating chief complaints and final diagnosis
   • Emergency room record
   • Original Official Receipt
   • Results of laboratory examinations and other diagnostic tests
   • Operative technique (for Emergency Surgical cases)
   • Police report if due to accident or medico-legal case
   • Itemized breakdown of charges
3. Required documents in availing the Member’s Financial Assistance
   • Fully accomplished MEDICard RxER Reimbursement claim form,
   • Certified true copy of death certificate,
   • Photocopy of any ID of the deceased,
   • Duly notarized affidavit of next of kin /marriage contract, duly notarized attending physician’s statement form (in the absence of the APR, we require morgue or post-mortem examination),
   • Police report and copy of autopsy report for death of unknown causes.
     
     *All documents received beyond the cut-off time will be dated the following day.
     Cut-off time is at 3:00pm from Monday thru Friday (except holidays).
     

     *A pre-screening will be done to determine the completeness of documents needed. This is not part of the evaluation process. MEDICard also has the right to ask for additional documents to further evaluate the claim. A screening form must be attached when re-submitting the additional documents

     *The processing of RxER reimbursements is 15 working days after the receipt of the complete documents.

     *MEDICard may also give an action memo for denied claims or incomplete documents. Release of action memo for claims with lacking documents is 7 working days while for disapproval memo the release is 15 working days. Reimbursements that were initially given an action/disapproval memo are being processed at 7 working days after receipt of the complete documents.

RECONSIDERATION OF DENIED REQUEST FOR PAYMENT

1. If a request for reimbursement is denied, the Member or the Member's authorized representative may appeal the decision by filing a written request with MEDICard Head Office within thirty (30) days after receiving a negative decision. The request must set forth why the Member believes that the decision was in error. The Member may examine pertinent documents not subject to "privileged communication" or disclosure and may submit additional written statements for consideration of the appeal.
2. Upon completion of the procedure, the Member will receive a written notice stating the final MEDICard decision and the reason for such decision.