Long-Term Care
The Ultimate Kaiser Health Builder Plan is a healthcare plan that allows one to control his own health and provide for his own future.
Kaiser International Healthgroup, Inc. is an actuarially-sound, product-based business. It brings together the best features of an HMO, Health Savings Plan, and a financial investment.
- An innovative program, the first of it's kind in the country;
- Guarantees long-term care even after the age of sixty when the client has only himself to rely on;
- Healthcare coverage, savings, emergency fund, and insurance rolled into one;
- An accumulative, self-earning investment that comes with Return of Payment for non-utilization in the first seven (7) years of coverage;
- A portable account! Even if you change or lose jobs, your plan and funds stay with you;
- A four-way insurance coverage:
- Term Life
- Accidental death and dismemberment
- Waiver of installment due to death
- Waiver of installment due to permanent and total disability;
- Outpatient benefits, annual physical examinations and dental coverage;
- Coverage is for individuals but can be installed in companies as a health savings salary deduction program;
- No exclusions from 8th year onward;
- Flexible, Upgradeable within 30 days ;
- Annual lifetime healthcare benefits from years 8 to 20 accumulate with interest in a "Health Savings Account"
- "Health Savings Account" earn interest beyond 20 years.
- Benefits can be used up to any age.
- Payable in 7 years only with fixed rates for the entire paying period;
- Issue age up to 60, but coverability extends after 60; and,
- Reinstatement can be done within 2 years after lapsed policy.
INSURANCE BENEFITS
If, at the time of signing the Membership Application, the Member is in good health, is at least eighteen (18) but not more than seventy-five (75) years old and performing the normal activities of daily life, he shall be insured by Kaiser under a Group Master Insurance Contract underwritten by a reputable and duly authorized insurance company, as described below:
If the Member dies before attaining the age of seventy-five (75) years and prior to entitlement to the Long-Term Care Benefit Value as indicated in the Schedule of Benefits, his beneficiary shall be entitled to an amount equal to the sum of the Long-Term Care Benefit Value (LTCBV) and the Long-Term Health Care Experience incentive Hospital Benefit Limit (LTHCEIHBL) upon approval of the claim by the insurance company.
Should the Member suffer, directly and independently of all other causes, any bodily injury effected solely through external, violent and accidental means, occurring prior to the Member's 75th birthday and prior to entitlement to the Long-Term Care Benefit Value (LTCBV), which result in any of the specified losses below within 180 days after the accident causing the injury, the insurance company will pay a percentage of the sum of the Long-Term Care Benefit Value (LTCBV) and the Long-Term Health Care Experience Incentive Hospital Benefit Limit (LTHCEIHBL) in accordance with the following schedule:
| DESCRIPTION | PERCENTAGE OF LONG-TERM CARE BENEFIT |
|---|---|
| 1. Loss of Life | 100% |
| 2. Loss of both hands | 100% |
| 3. Loss of both Feet | 100% |
| 4. Loss of sight of both eyes | 100% |
| 5. Loss of one hand & one foot | 100% |
| 6. Loss of one hand and sight of one eye | 100% |
| 7. Loss of one foot and sight of one eye | 100% |
| 8. Loss of one hand or one foot | 50% |
| 9. Loss of sight of one eye | 50% |
- Loss shall mean the dismemberment of hands and feet by severance at or above the wrist bone or ankle joints respectively. Loss of eyesight must be total and irrecoverable.
- Any partial benefit already paid for any loss(es) shall not be carried over in the subsequent contract Year i.e., the amount of benefits to be paid in the succeeding contract year shall not be reduced by any amount paid in the preceding contract year.
- The loss of the first joint of the thumb or any other finger or of any toe shall be considered as equal to the loss of one half of the thumb or finger or toe. The loss of more than one phalanx of the thumb or of any other finger or if any toe shall be treated as loss of the entire thumb or finger or toe. Where there is loss of two or more parts of the hand, the percentage payable shall not be more than the loss of one whole hand.
- The aggregate of all percentages payable with respect to any one accident shall not exceed 100%.
If the Member dies during the Accumulation Period and before attaining the age of seventy-five (75), the proceeds of the credit life insurance shall be applied to the balance of total membership fees upon approval of the claim by the insurance company making the contract fully paid.
If the Member becomes totally disabled during the Accumulation Period and before 75th birthday thereby preventing from engaging in any occupation for compensation or profit, is so disabled for life, and such disability continues for at least six (6) months, KIH shall waive the payment of each membership fee becoming due during the period of disability. However, pending approval of the claim, membership fees should be paid as they fall due, subject to refund upon approval.
- All claims under the above Insurance Coverage shall be subject to two (2) years contestability period as provided for by law from the date of issue or reinstatement of this Contract.
- If the Member dies during the Accumulation Period, the Principal Beneficiary named herein shall be substituted as the new Member, but no longer with insurance benefits and subject to the provisions on Pre-existing illness or Injury (Art. II).
FEATURES AND HEALTH CARE BENEFITS
- Accredited Hospital's Room & Board Services of Accredited Physician/Specialist/Surgeon/Anesthesiologist
- Hospital's Intensive Care Unit
- Operating Room Fee
- Over 500 Accredited Hospitals, Hospital's Intensive Care Unit & Operating Room
- Over 1,000 accredited Physicians/Specialists/Surgeons/Anesthesiologists
- Chest X-ray, Stool & Urine Analysis Complete Blood Count
- Electrocardiogram (for 35 yrs old & above)
- Unlimited dental check-ups, once a year free dental prophylaxis, unlimited simple tooth extraction
- Magnetic Resonance Imagin (MRI)
- Nuclear/Radioactive Isotope Scan
- CT Scan, Dialysis, Blood Transfusion
- Physical/ Speech Theraphy
- Anti-Rabies, Venom & Tenanus Vaccine
- Emergency Benefits (Ambulance)
- Guaranteed health benefits as shown in the Schedule of Benefits which can be used at the end of 20th year as part of the Hospital Benefit Limit (HBL) until fully utilized or can be converted into cash on the 20th year.Guaranteed health benefits as shown in the Schedule of Benefits which can be used at the end of 20th year as part of the Hospital Benefit Limit (HBL) until fully utilized or can be converted into cash on the 20th year.
- 10% of the LONG TERM CARE BENEFIT VALUE (LTCBV) earned starting from end of the accumulation period and every year thereafter up to the 20th year.
- Approximately 85% of the total membership fees which can be converted into cash or be part of the Hospital Benefit Limit (HBL) from the 20th year until fully utilized.
- Lifetime access to over 1,000 doctors, over 500 hospitals as long as you have funds available in your health benefits
- With return of Membership Fee for Non-Utilization
- A benefit other than the YEARLY HEALTH CARE HOSPITAL BENEFIT LIMIT (YHCBL) at the end of the accumulation period and every year thereafter up to the 20th year, provided that Kaiser's investment earnings is higher than 6% per annum.
- If the Member dies before attaining the age of seventy-five (75) years and prior to entitlement to the Long-Term Care Benefit Value as indicated in the Schedule of Benefits, his beneficiary shall be entitled to an amount equal to the sum of the Long-Term Care, Benefit Value (LTCBV) and the long-Term Health Care Experience Incentive Hospital Benefit Limit (LTHCEIHBL) upon approval of the claim by the insurance company.
- Should the Member suffer, directly and independently of all other causes, any bodily injury effected solely through external, violent and accidental means occurring prior to the Member's 75th birthday and prior to entitlement to the Long-Term Care Benefit Value (LTCBV), which result in any of the specified losses below within 180 days after the accident causing the injury, the insurance company will pay a percentage of the sum of the Long-Term Care Benefit Value (LTCBV) and the Long-Term Health Care Experience Incentive Hospital Benefit Limit (LTHCEIHBL) in accordance with the schedule.
- If the Member dies during the Accumulation Period and before attaining the age of seventy-five, the proceeds of the credit life insurance shall be applied to the balance of total membership fees upon approval of the claim by the insurance company making the contract fully paid.
- If the Member becomes totally disabled during the Accumulation Period and before 75th birthday thereby preventing from engaging in any occupation for compensation or profit, is so disabled for life, and such disability continues for at least six (6) months, KIH shall waive the payment of each membership fee becoming due during the period of disability. However, pending approval of the claim, membership fees should be paid as they fall due, subject to refund upon approval.
- The Annual Physical Examination is deductible from your Total Health Benefits during the extended period.