Senior Care Plan
KAISER SENIOR CARE
Medical Healthcare Plan for Seniors
From 61-100 years old
FEATURES AND BENEFITS
- Medical healthcare plan especially designed for those ages 61 years of age and up.
- Reimbursement of actual hospitalization expenses based on coverage. Reimbursement may be done midway of hospitalization provided confinement is coverable and required documents submitted.
- Patient’s choice for doctor, hospital and specialist.
- Comprehensive range of Medical Healthcare Benefits with a maximum coverage limit of up to Php1,000,000.00
- Member to shoulder the 1st P10,000.00 from the total bill plus an additional 10% of the claimable amount. The remaining 90% of the claimable amount shall be shouldered by Kaiser.
- Surgical Cases are based on PhilHealth RUVs to calculate the maximum amount payable to the surgeon for the surgical procedure. This means that the payment received from Kaiser may be less than the professional fee charged by the surgeon.
- Coverage is one (1) year upon effectivity of the plan.
- Renewal is guaranteed up to age 100. However, KAISER reserves the right to adjust premiums and other policy conditions upon written advice of 45 days prior to renewal.
|BENEFITS||Plan 250K||Plan 500K||Plan 1M|
|1. Maximum Benefit Limit for each disability for the life of the insured. (The Member/Owner must pay a Co Payment fee equivalent to the first Php 10, 000 AND 10% of the final hospital bill.)||P250,000||P500,000||P1,000,000|
|2. BASIC HOSPITAL BENEFITS Room and Board Max 45 days per disability per year||P750.00||P1,000||P2,500|
|3. Miscellaneous Hospital Expenses for required drugs, laboratory and diagnostic procedures||As Charged||As Charged||As Charged|
|4. Physicians Visit (Non-Surgical) daily visit fee to a limit of 45 days per disability, per year||P550.00||P750.00||P1,500.00|
|5. Specialist’s Fee for 10 days for each disability per year to a daily limit of||P600.00||P900.00||P1,800.00|
|6. CRITICAL CARE BENEFITS Intensive Care Unit, Coronary Unit max 10 days per disability, per year.||As Charged||As Charged||As Charged|
|7. SURGICAL BENEFITS Operating Theater Fee||As Charged||As Charged||As Charged|
|8. Surgeon’s Fee Based on Kaiser RUV||P60,000.00||P90,000.00||P180,000.00|
|9. Anaesthesiologist’s Fee Not to exceed 30% of the approved Surgeon’s Fee||P18,000.00||P30,000.00||P60,000.00|
|10. Artificial Limb Including rental of mechanical devices excluding implantable devices.||As Charged||As Charged||As Charged|
|11. Emergency Out-patient for emergency treatment provided by the out-patient department of a hospital or a licensed doctor in his clinic for a covered disability, Maximum limit per disability, per year||P3,000.00||P4,000.00||P5,000.00|
|12. Emergency Dental Services due to a covered accident||As Charged||As Charged||As Charged|
|13. Emergency Local Ambulance Service to nearest Facility||As Charged||As Charged||As Charged|
|14. Private duty nurse when certified necessary by attending Physician to a max of 5days, post hospitalization||P600.00 (per day)||P900.00 (per day)||P1,800.00 (Per day)|
(The Member/Owner must pay a Co Payment fee equivalent to the first Php 10, 000 AND 10% of the final hospital bill.)
* Effective rates as of June 15,2019. The Company reserves the exclusive right to change, update and revise prices at any given time.
- Premiums are inclusive of all applicable taxes.
- Premiums may change subject to the result of medical evaluation of applicable form.
- Hospitalization & treatment outside the Philippines is not covered
1. All Pre-existing illnesses are not covered & Kaiser will not be liable within the first twelve (12) months from the effectivity of this policy or from the date of latest re-issuance or re-instatement thereof.
Pre- existing illnesses
- Uterine Myoma, Ovarian Cysts, Endometriosis
- ENT conditions requiring surgery
- Buerger’s disease
- Bronchial Asthma
- Varicose Veins
- Benign Tumors
- Acquired Hernias
- Gastric/duodenal or peptic ulcers
- Chronic Cholelithiasis (gall bladder stones)
- Migraine headache
- Prostate disorders
- Hemorrhoids and Anal Fistulae
- Goiter (Hypo/Hyperthyroidism)
Dreaded diseases shall be covered after 24 months of continuous membership.
Dreaded diseases are potential or life threatening conditions or illness which may require intensive care management or prolonged or repetitive hospitalization, sepsis due to pneumonia, typhoid ileitis, cerebral malaria, etc.
- Cerebro- vascular accident (stroke)
- Cardiovascular Disease (Coronary, Valvular/ Hypertensive Heart Disease/ Cardiomyopathy )
- Diabetes Mellitus and its complications
- Central nervous system lesions (poliolyelitis, Meningitis, Encephalitis, Nerosurgical Conditions)
- Liver Parenchyma disease (Cirrhosis, Hapatitis (except type A) new growth)
- Chronic Obstructive Pulmonary Disease (Chronic Bronchitis/ Emphysema), Restrictive lung disease
- Chronic Kidney/ Urological disease (Urolithiasis, Obstructive Uropathies, Etc.)
- Chronic Gastrointestinal Tract Disease requiring bowel resection and/or anastomosis
- Collagen diseases (Rheumatoid Arthritis, Systemic Lupus Erythematosus)
- Malignancies and Blood Dyscrasisas (Cancer.Leukemnia, Idiopathic, Thrombocytopenic Purpura)
- Single or multiple organ dysfunction and failure (MODS and MOF)
- Conditions that may require dialysis
- Chronic pain syndrome (greater than six weeks)
- Any illness other that the above which would require Intensive Care Unit confinement
- Any other illness that is not mentioned above and is not self-inflicted is included.
List of conditions considered to be EMERGENCY CASES Injury & illness
- Abdominal pain, severe
- Appendicitis (leading to peritonitis)
- Ballistic trauma (gunshot wound)
- Flail chest
- Head trauma
- Hyperthermia (heat stroke or sunstroke)
- Malignant hyperthermia
- Hypothermia or frostbite
- Ruptured spleen
- Septicaemia blood infection
- Severe burn (including scalding and chemical burn
- Intestinal obstruction
- Venomous animal bite
- Pharmacologi cal overdose
- Lyme disease infection
- Malaria infection
- Rabies infection
- Salmonella poisoning
- Necrotizing Fasciitis
- Bacterial Meningitis
- Air embolism (Arterial)
- Internal bleeding
- Cardiac arrest
- Cardiac arrhythmia
- Cardiac tamponade
- Hypertensive emergency
- Myocardial infarction (heart attack)
- Ventricular fibrillation
- Acute renal failure
- Addisonian crisis (seen in those with Addison's disease)
- Dehydration, advanced
- Electrolyte disturbance, severe (along with dehydration, possible with severe diarrhea or vomiting, chronic laxative abuse, and severe burns)
- Lactic acidosis
- Malnutrition and starvation
- Subarachnoid hemorrhage
- Subdural hematoma, acute
- Convulsion or seizure
- Syncope (fainting)
- Acute spinal cord compression
ANNUAL MODE OF PAYMENT
SEMI-ANNUAL MODE OF PAYMENT
|AGE||PLAN 250K||PLAN 500K||PLAN 1M||PLAN 250K||PLAN 500K||PLAN 1M|
This is to inform you that I, _____________________________, except as provided above, understands that the terms and conditions of our health care contract shall be in full force and effect.