12/03/2018 Cocolife HealthCare Schemes & Medical Benefits

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Health Insurance By COCOLIFE HealthCare

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Health
Shield Inc. Overview of Cocolife HealthCare
An ISO 9001:2000 certified company, Cocolife is the biggest life insurance organisation in
COCOLIFE Philippines today. The company offers a full range of life insurance, health care products
HealthCare along with a slew of mutual fund options with branches all over the country. Cocolife
healthcare, the exclusive arm of this insurance major provides an assortment of products for
Medicard employers that are cost effective and offers quality healthcare to the employee base.
Philippines  Cocolife has a massive network consisting of over 800 network hospitals and clinics along
with 11,000 plus top physicians and consultants in various fields of medicine. The company is
Fortune the preferred health insurance provider for more than 1,000 companies in Philippines.
Care
Providing quality health & wellness benefits to employees speaks volumes of the employer's
Philcare efforts to retain talent. Health insurance products from Cocolife helps you in achieving these
Health objectives.
Insurance
Cocolife Healthcare Products
ValuCare Cocolife offers 4 types of insurance schemes covering all aspects of healthcare. Depending
Health on the requisites, you can choose from the following.
Systems
HMO Program
Medical Reimbursement Program
Pioneer Third Party Administration Program
Health Daily Hospitalization Benefit Program
Insurance HMO Program

This insured program requires a fixed premium for the benefits. The delivery system
Maxicare provides easy access to cashless medical treatment at first-rate hospitals and clinics. There
Health are two types of programs offered:
Insurance
Comprehensive HMO Program: This program covers outpatient care, in-patient care,
preventive care, emergency services, dental coverage, annual check-up, and financial
Health Insurance assistance in the event of natural or accidental death.
Related News Unbundled Programs: The client can choose select components of the comprehensive HMO
Program that they deem suitable. The various Unbundled Programs are as follows:
Outpatient only: This covers outpatient consultations, treatment for cases that don’t require
HMO admission to hospital, and laboratory tests.
Philippines In-patient only: This covers admission to hospital due to accident or illness.
ER coverage only: This provides cover for unexpected and sudden life-threatening situation
where urgent medical attention is needed.
Health Medical Reimbursement Program
Card
Philippines Provides reimbursement of medical expenses incurred for treatment at hospitals due to
illness or accident. Treatment can be availed at a wide range of hospitals across the country.

Third Party Administration Program

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12/03/2018 Cocolife HealthCare Schemes & Medical Benefits

The product offers access to Cocolife facilities and network hospitals along with the
flexibility to self-administer along with benefits of an HMO.

Daily Hospitalization Benefit Program

Under this program, daily monetary assistance is provided to hospitalised individuals who
are unable to work and not receive compensation from the employers.

How to Use the Cocolife HealthCare Swipe card?

The Swipe card can be used for referrals or consultations, diagnostic procedures, and
hospital confinements/ emergency availments.

For Referrals or Consultation

You can use the Swipe card for referrals or consultations. You can use the Cocolife Health
Access card as follows:
Swipe the Card at Veridata card terminal.
You will then get a printout that will be generated at the terminal.
You must then present your Cocolife Health Access card along with the printout and a valid
identity card to the plan coordinator.
You can then receive the treatment.
For Diagnostic Procedures
You can use the Swipe card for diagnostic procedures. You can use the Cocolife Health
Access card as follows:
Swipe the card at Veridata card terminal. You will then get a printout strip.
Then the plan coordinator’s secretary will issue a DRF (Diagnostic Request Form).
You must then present your printout strip, DRF, and Cocolife Health Access card at the
laboratory.
Then test or the procedure is performed.
For Hospital Confinements / Emergency Availments
You can use the Swipe card for hospital confinements/ emergency availments. You can use
the Cocolife Health Access card as follows:
You must present your card to the triage team of the hospital or to the receptionist.
Your card will be swiped by the triage team or the receptionist.
The receptionist or the triage team will inform you about the approval of the admission or
consultation.
The admission and the treatment will then be facilitated by the hospital.

Medical Benefits
Following are the various benefits available:

Outpatient benefits: The outpatient benefits include:

Minor surgeries.
Consultations that include specialists’ evaluations.
First aid treatment for injuries sustained in an accident.
Necessary laboratory examination and x-ray.
In-patient benefits: You will get coverage if your attending physician determines that
you have to be admitted to get proper medical attention. Take note of the following:
You will have to secure PhilHealth from your employer before the confinement. The
information required has to be filled and forwarded to the hospital’s billing section.
Your physician has to authorise discharge from the hospital.
You will have to settle expenses that are not covered by Cocolife Healthcare. These
expenses will include:
The difference in the room rates if you choose to upgrade the accommodation than
the one which is specified in your plan.
Non-essential items (extra bed, extra tray, etc.) charges.
Incremental charges if you are restricted in a room of higher classification than the
one which is specified in your plan.
If you choose to stay in the hospital after you have been cleared of discharge, you will
have to pay for the additional stay.
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12/03/2018 Cocolife HealthCare Schemes & Medical Benefits
Emergency care benefits: You get this benefit if you have a sudden illness that could
lead to permanent disability or death. You can get this cover if you have a massive
bleeding, if you have met with an accident, acute myocardial infarction, acute
appendicitis, severe pain, and hypertensive cases. In times of emergency, you can seek
treatment from clinic or hospital that may or may not be Cocolife Healthcare
provider. You will have to do the following in case you are getting admitted to a non-
accredited hospital:
Within 24 hours of admission, you must notify Cocolife Healthcare of your
confinement.
You must settle the professional fees and all hospital bills before discharge.
You must secure the initial requirements for charge slip, Hospital Statement of
Account with PhilHealth Deductions, clinical abstracts, official hospital bill receipts,
police report in case of an accident, and operative reports, if any.
The documents must be submitted to HealthCare Division, Cocolife, 8th Floor, Feliza
Building, 108 V.A. Rufino Street, Legaspi Village, Makati City. The documents are to
be submitted within 30 days from the date of discharge.
The claims will be processed within 10 days. 80% of the expenses will be reimbursed.
Annual physical examination: You get a comprehensive annual physical examination
package which includes:
Chest x-ray examination.
General physical examination.
Urinalysis examination.
General consultation and counselling.
Fecalysis examination.
Pap smear for female members above 35 years.
Complete blood count examination.
Electrocardiogram for member above 35 years.
Dental services: You can get the following services at any of the accredited dental
clinics:
Care of oral wounds, lesions, and burns.
Relief of acute dental pain.
Non-surgical tooth extraction (any number).
Annual oral prophylaxis.
Emergency desensitization of hypersensitive teeth.
Re-cementation of crowns, jackets, minor adjustments of dentures, onlays, and inlays.
Any number of tooth filling (temporary).
The dental consultation that includes aesthetic and orthodontic consultations.
If the treatments are not mentioned above, will be charged for a special discounted
rate.

Medically Necessary: The following medical services are covered:

Services that are in accordance of good medical practice.
Which are consistent with the diagnosis.
Which are not done for the convenience of physician or patient.
Which are performed in a least costly manner.
Services that are accepted by medical professional and are not experimental in
nature. They are:
Iridology.
Chelation therapy.
Acupuncture.
Herbal medications.
Reflexology.
Cell implant therapy.
Holistic approach.
Ultraviolet and other radiation modes.
Incremental cost computation
If you are staying in the benefit’s room category, you will get maximum benefit
coverage. If you occupy a room that is more than the one that is allowed in your plan,
you are required to pay the difference amount and settle it with the hospital before
you get discharged. The incremental costs are calculated as follows:

For instance, the room benefit offered to you is P1,000 per day, but you have
occupied a room that costs P2,000 per day. You have been confined for 4 days, and

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12/03/2018 Cocolife HealthCare Schemes & Medical Benefits

the difference amount for a day is P1,000, hence for 4 days it is P4,000. You will have
to pay P4,000 at the time of your discharge.

If you have occupied a room from a higher category than the one mentioned in your
plan, you will have to pay at least 20% of the actual hospital charges. If the room
benefit offered to you is semi-private and you have opted for regular private room
and the hospitalisation charges are P6,000, you will have to pay P1,200.

The incremental charges are as follows:

Semi-private: 20%

Ward to Private: 40%

Suite: 50%

Private: 20%
Semi-private to
Suite: 40%

Private to Suite: 25%

Pre-existing medical conditions
If you have a pre-existing condition prior to getting a health insurance, you will get
coverage with Cocolife HealthCare. A disease will be considered as pre-existing if:
Illness or injury was evident before the effective date of the coverage.
You have sought prior treatment before the inception date of your coverage.
Medical conditions disclosed in the application form.
Injury or illness that is clinically determined to have started before the inception date
of the coverage.
If there is any pre-existing medical condition that will not be covered, it will be
indicated in your Cocolife Healthcare ID.
Exclusions
If the following do not have any exemptions under the benefits provisions, the policy
will not cover any loss resulting from:
Death, illness, or injury attributed to one’s own misconduct, indulgence to alcohol or
drugs, gross negligence, immoral habits, violation of law, or participation in a crime.
Intentional self-destruction, self-inflicted injury, death, attempt to threat whether
sane or not.
Unnecessary exposure to perils such as use of firecrackers, participating in hazardous
sports, diving, climbing, boxing, hand-gliding, football, hurling, hunting, motor
competitions, ice hockey, motorcycling, polo, parachuting, potholing, racing, power
boating, show jumping, use of wood-working machines, skydiving, winter sports,
water ski-jumps, yachting beyond 5km of coastline, wrestling, and flying except air
travel.
War, an act of foreign enemy, invasion, hostilities, or warlike operations, civil
commotion, mutiny, strike, riot, rebellion, civil war, revolution, rebellion, conspiracy,
insurrections, martial law, quarantine, etc.
Homicide, murder, physical injuries caused by provocation of the insured.
If you get any bodily injury or sickness because you are serving in Armed Forces and
are participating in investigative, political, police, paramilitary, or military activities.
Contamination by radioactivity or ionizing radiation from nuclear waste, or nuclear
fuel.
Congenital conditions and anomalies arising from nervous, mental, or other functional
disorders of the mind.
Treatment for pre-existing conditions that are subject to waiting period.
Hospitalisation for x-ray examination, diagnosis, check-ups, routine physical
examinations, dialysis, custodial, rest cures, non-surgical care for TB, long-term
rehabilitation, treatment of post-natal or neo-natal abnormalities.
Dental work, oral surgery, treatment, treatment for error of refraction, hearing aids
fitting, eyeglasses fitting, cosmetic procedures, and plastic surgery.

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12/03/2018 Cocolife HealthCare Schemes & Medical Benefits
Treatment that involves sophisticated procedures like angiography, thallium
scintigraphy, hyperalimentation, dialysis, chemotherapy, radiotherapy, organ
transplantation, brachytherapy, open heart surgery, treatments where conventional
treatment modes exist, speech therapy, respiratory therapy, occupational therapy,
physical therapy, and other similar forms of treatments.
Human anti-rabies vaccine, anti-tetanus vaccine, other vaccines, take home drugs,
and medicines.
Treatment related to pregnancy, miscarriage, childbirth, sterilization, sex
transformation, artificial insemination, care for infertility, and treatment of AIDS.
Treatment of scoliosis, cataract, Guillain-Barré syndrome, benign prostatic
hypertrophy, chronic glomerulonephritis, vitiligo, spinal stenosis, rheumatic heart
disease or cardiac valvular, epilepsy, and chronic dermatoses.
Treatment that is not recommended and performed by a physician.
Charges that are not covered by the insurance company, treatments that are provided
for free, or treatment for a communicable disease that has caused a state of
emergency in a particular area.
Purchase of oxygen dispensing unit, use of durable medical equipment, artificial aids,
expenses of prosthetic appliances, orthopaedic hardware, and surgically-implanted
external device.
Limitations
The hospital services are subject to its regulations, discretions, and rules. Cocolife
Healthcare is not liable for failure or delay in the services provided by the hospital.
The admissions, availability of personnel and facilities, discharges, accreditation with
the Company, acknowledgement of coverage and validation of identification are
included in the rules, discretions, and regulations.

Cocolife Healthcare will not be responsible for providing care for the condition if the
patient is refusing the recommended treatment or procedure. The Cocolife
Healthcare Plan coordinator will be doing the recommendation.

Things to Remember

You must remember the following:

You must file for PhilHealth before or on the day of discharge for in-patient confinement and
outpatient procedures.
You must stay within your room limit and must downgrade to a lower rate if there is a non-
availability of assigned room plan. This will help you from incurring excess charges.
If it is a case of an emergency, you must proceed to the emergency room. For cases of
accidents, a police report is required.

Rights and Responsibilities of an Insured

A Cocolife Healthcare member has the following rights:
To be informed of your medical condition and to get the right advice.
To receive appropriate and prompt treatment.
To take part in decision-making concerning your care.
To refuse treatment.
To be informed of the medical consequences.
To be informed of the plan’s benefits and limitations during a confinement.
To have your medical records held confidentially.
To be treated with respect and recognise your right to privacy.
A Cocolife Healthcare member will have the following responsibilities:
To understand the basic procedures and healthcare benefits.
To practice good health habits.
To keep you Cocolife Healthcare ID on you at all times.
To cooperate with the Cocolife Healthcare staff.
To attend all scheduled appointments on time.
To understand the medical treatments.
To be considerate of all attendants and staff.
To promptly call Cocolife Healthcare if there is any difficulty with the service provider.
Cocolife Healthcare FAQs
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12/03/2018 Cocolife HealthCare Schemes & Medical Benefits
Where do I find the list of network hospitals and clinics of Cocolife healthcare?
A list is available on cocolifehealthcare.com.ph in the form of drop down options
which help you in getting details of the nearest network hospital in your locality.
How do I contact Cocolife for a medical reimbursement?
You can call the 24 hour member assistance hotlines on the numbers below for
information regarding reimbursement.

PLDT: (+632) 812-9090

Globe: (+63917) 536-0962

Sun: (+63922) 892-8828

Smart: (+63908) 894-7763

I would like to enrol my dependents for the medical insurance program provided by
my company? How do I do that?
You need to contact the HR department in your company for further information in
this regard. As Cocolife provides customised insurance programs for companies, the
enrollment depends on the agreed terms.
Does Cocolife provide reimbursement for costs of medicines and tests availed outside
the network hospital?
Yes, it does provide a reimbursement, provided the charges are covered in the policy
terms and have been recommended by the doctor/staff treating the patient.
I lost my Cocolife Healthcare card and need to undergo hospitalization for a surgery.
How do I proceed?
Please call the Member Assistance Hotline on the phone numbers provided for
endorsement of the treatment by Cocolife representatives. You’re required to
produce a valid identification proof at the hospital.

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