How does Philhealth benefits apply to room & board and hospital bill?
Cocolife Benefit and room & board entitlement are inclusive of Philheath, which also translate that benefits are being applied after Philhealth Coverage has been exhausted.
Since Philhealth is incorporated w/ Cocolife plan, it should be filed prior to discharge otherwise, it will be shouldered by the member and will be collected by the hospital.
Claim Form 2 (CF2) – to be filled-out by the accredited doctor Member Data Record (MDR) – to be accomplished by the member.
If there was an upgrade of room & board of the same category (e.g. from Small Private to Large Private), only excess for room & board will be charged to the patient. If there was an upgrade of room & board to a higher room category, aside from the excess room & board, the patient will be charged of incremental cost of the hospital bills and professional fees.
The applicable incremental costs are as follows:
Ward to Semi-Private
| -
| 20%
|
Ward to Private
| -
| 40%
|
Ward to Suite
| -
| 50%
|
Semi-Private to Private
| -
| 20%
|
Semi-Private to Suite
| -
| 40%
|
Private to Suite
| -
| 25%
|
Computation of incremental cost:
(Total hospital bills)-(actual room/board charges)-(disapproved charges) x__%=incremental charge
Yes, the member will be treated by the accredited hospital. Medical Benefits will be subject to evaluation of the police report. Cocolife Healthcare’s primary basis for such coverage is the statement stipulated in the police report.
Is it possible for the insured to change dependents?
Yes, if there is a change of marital status: from Single to Married.
Can the insured choose upon his preference whom to enroll as his dependent?
No, hierarchy of enrollment for dependent must be followed:
- Married employee: must enroll the spouse first, followed by the children from eldest to youngest.
- Single employee: parents or siblings may be enrolled.
- Single parent: children, parents or siblings may be enrolled
- Single members with a common law or same gender partner will have the same eligibility of a married member
Is it possible for the insured to transfer the benefit of one dependent to the other based on the possibility of utilization increase of the latter?
No, since the benefit is per individual basis.
Is there benefit coverage of Philhealth for special procedures?
Yes, for scheduled out-patient availment procedures like chemotherapy & cataract extraction. Philhealth is required to be filed whenever applicable.
In case of non-availability of room, would the insured still pay for the incremental costs?
Yes, only if the Insured avails of the room with a higher category and to avoid incurring additional expense, downgrading is suggested. Bank of Commerce’s employees are allowed to upgrade within 24 hours, only on emergency cases.
What happens if the personal doctor of the insured whom he has previous records is not accredited?
As a card holder member, both the hospital and the doctor must be accredited. If in any case the member avails of the service of the personal doctor, the case will not be covered. However, Cocolife Healthcare is open for accreditation subject for evaluation.
During emergency cases, and there’s no accredited doctor or hospital, what would the insured do?
The E.R. officer on duty will then take charge. If confinement is necessary, the patient will be turned over to an accredited doctor and will have to choose a room according to his plan. The member has to declare that he is a card holder.
What should be done if an accredited doctor asks to cash out professional fee?
Don’t pay. Call HR or Intellicare and refer the concern.
Is voluntary upgrading of plan benefits (room & board, mbl) allowed as requested personally by the cardholder provided the member offers to personally pay for whatever premium difference.
No. Only what is reflected in the Schedule of Benefits as designed / proposed by the Client-Company shall be the applicable plan benefits for the member.
What happens if the cardholder who doesn’t have maternity benefit had undergone a diagnostic test and was later discovered that she’s pregnant? Will it be covered?
For BOC, this will not be covered. BOC employees are entitled to have 14 consultations; excluding laboratory.
Can a cardholder who has 2 cards (as employee and as dependent) use both at the same time?
No, as a hospital policy he has to exhaust the 1st card before the other could be applied. He has to choose which to use first and should follow the benefits according to the plan limit. But he can use the 2nd card as supplementary to the 1st card as long as the 1st card has been exhausted.
Patient has to inform both HMO’s.
If the medicine prescribed by the doctor during an in-patient confinement is not available in the hospital, and will have to be bought outside, could the patient reimburse the corresponding amount?
Yes, provided it was necessary to be taken as in-patient medicine. Ask for a certification from the hospital pharmacy that the prescribed medicine is not available. Keep all official receipts and submit a letter explaining the reason for reimbursement.
Yes. This has to be requested formally. The report has reference date since the details reflected are still temporary because current availment may not have been reported yet.
How much is the cost for lost ID? Do we have to submit some documents as part of your requirements?
Submit an affidavit of loss and payment – Php200