Short Term Care - Claims And Procedures

Introduction

In response to the numerous queries from our distribution channels, KAISER INTERNATIONAL HEALTH GROUP - the first name in healthcare is making available the most responsive immediate health care program in the market -HE KAISER HEALTHCARD.

Our Five-Point HealthCard Program:

• Preventive Health Care - Prevention is always better that the cure, we provide annual physical check-ups to ensure wellness
• In-Patient Care - Revolutionary swipe technology using Visa-Eon for cash-free hospital admittance
• Out-Patient Care - All year-round medical care
• Dental Care
• Emergency Care

PREVENTIVE HEALTHCARE:

Package of Annual Physical

Examination (APE) at Kaiser Designated Clinics

1. Complete Blood Count
2. Urinalysis (Urine examination)
3. Fecalysis (Stool examination)
4. Chest X-Ray
5. Electrocardiogram (Adults age 40 and above, or if prescribed)
6. Pap Smear (Women age40 and above, or if prescribed)

For In-Patient and Emergency Care - Automatic admission using a revolutionary swipe card technology.

IN-PATIENT CARE

• No deposit upon admission (for surgical cases, please contact Kaiser)
• Room and board according to plan benefit
• Operating Room and Recovery Room
• Administered medicines
• X-Ray and laboratory examinations
• Services of Kaiser Specialists like anesthesiologists, internists, surgeons, etc.
• Services and medications for general/spinal anesthesia or other forms of anesthesia necessary for a surgical procedure
• Intravenous fluids and transfusion of fresh whole flood
• Modern therapeutic modalities and interventional surgical procedures such as, but not limited to laparoscopic surgery and lithotripsy, are covered up to Php20,000 each per year subject to pre-existing conditions coverage
• ICU confinements, dialysis, chemotherapy, and radiotherapy subject to the maximum limit and pre-existing condition coverage
• Complex diagnostic procedures shall be covered up to Php5,000 each per member per year subject to the pre-existing conditions coverage (Inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure):

1. Angiography (e.g. coronary, cerebral, retinal, pulmonary, GI, etc.)
2. Pulmonary perfusion scan
3. Tests involving use of Nuclear Technologies
4. 24-Hour Holter Monitory, 2-D Echo and Doppler
5. Treadmill Stress Test
6. Bone densitometry scan (Dexascan)
7. Plasma/Urinary Cortisol, Plasma Aldosterone, etc.
8. Mammography (Breast cancer) and Sonomammogram
9. Laboratory/ancillary services for conditions whose pathogenesis or subsequent clinical Improvement not yet fully established in Medical Science
10. New modalities and/or diagnostic and treatment procedures for conditions with established etiologist and its use is only as alternative to the conventional methods
11. Genetic/Immunologic studies
12. All other items related to the management of the case (Partial listing only)

OUT-PATIENT CARE

In the event that the assured member suffers illness or injury not requiring confinement in a hospital, Kaiser shall provide:

• Referral to specialists
• Regular consultations and treatment (except prescribed medicines)
• Laboratory and X-Ray examinations
• Treatment of minor injuries and surgery not requiring confinement
• Eye, ear, nose and throat treatment

EMERGENCY CARE

Designated Hospitals

During an emergency case, a member who is in a critical condition caused by an illness or injury, the following benefits are:

• Physician's services
• Medicines utilized during treatment or for immediate relief
• Casts, dressing and sutures
• Oxygen and intravenous fluids
• X-Ray, laboratory and other diagnostic examinations directly related to the emergency management of the patient

Non-Designated Hospitals

• KAISER will reimburse 80% of the total hospital bills inclusive of professional fees based on KAISER Accredited Units (KAU) but exceed Php5,000
• KAISER shall only pay the said amount (80% but not to exceed Php5,000) when it is verified that the use of a KAISER non-designated provider would entail a delay resulting in death, serious disability and significant jeopardy to the member's condition or the choice of hospital was beyond the control of the member or member's family
• The member is required to submit all billings relative to such admission to the Kaiser office for the reimbursement of compensable expenditures within a period of 15 days form the date of discharge

DENTAL CARE

The member shall be entitled to dental services administered by an accredited service provider. The dental benefits shall cover the following services:

• Consultation and Dental Examinations
• Dental Nutrition and Dietary Counselling
• Dental Health Education
• Restorative and Prosthodontic Treatment
• Simple tooth extractions
• Temporary filling-unlimited (as needed)
• Annual prophylaxis (mild cases only)
• Simple tooth Adjustment of Dentures
• Recementation of loose crowns, in-lays and on-lays