1Coop

A. Premium (with COVID-19 Coverage)

Room and Board	Annual Premium (18 – 65 years old)	Annual Premium (66 – 70 years old)	Annual Premium (71 – 75 years old)	Benefit Limit
Ward	P 4,340.00	P 8,480.00	P 12,620.00	60,000 per illness
Semi-Private	P 10,550.00	P 20,900.00	P 31,250.00	70,000 per illness
Private	P 17,450.00	P 34,700.00	P 51,950.00	100,000 per illness

  

Note:

For installment payment please message PATCOMC

 

B. Health Care Benefits

HEALTH CARE BENEFITS	WARD	SEMI-PRIVATE	PRIVATE
Out-Patient:	Maximum of P 10,000 / year;	Up to MBL	Up to MBL
1. Consultation	Subject to MBL
1.1 Accredited Clinic	Covered	Covered	Covered
1.2 Non-Accredited Clinic	Covered- subject to 1COOP-Health Contracted rates	Covered – subject to 1COOPHealth contracted rates	Covered – subject to 1COOPHealth contracted rates
1.3 Areas with no provider	Covered- subject to 1COOP-Health Contracted rates	Covered – subject to 1COOPHealth contracted rates	Covered – subject to 1COOPHealth contracted rates
2. Laboratories	Covered	Covered	Covered
Out-Patient Emergency Treatment of illness and injury:	Maximum of P 30,000 / year; Subject to MBL	Up to MBL	Up to MBL
1. Accredited Hospital	Covered	Covered	Covered
2. Non-accredited Hospital	Covered- 100% Reimbursement	Covered- 100% Reimbursement	Covered- 100% Reimbursement
3. Medicolegal cases	Reimbursement only	Reimbursement only	Reimbursement only
4. Anti-rabies and anti-venom	Covered – single dose only. up to P2,500	Covered – single dose only. up to P2,500	Covered – single dose only. up to P2,500
In-Patient Hospital Confinement:	P 30,000 / illness for the first single confinement	Up to MBL	Up to MBL
1. Accredited hospital (non-emergency)	Covered	Covered	Covered
2. Non-accredited hospital (non-emergency)	Covered - 80% reimbursement	Covered - 80% reimbursement	Covered - 80% reimbursement
3. Emergency confinement	Covered	Covered	Covered
Maximum Benefit Limit	P 60,000 / illness	P 70,000 / illness	P 100,000 / illness
Prescribed Take-Home Medicines (Out-Patient)	Not covered and other standard exclusion	Not covered and other standard exclusion	Not covered and other standard exclusion
Dental Services: (not covered for 66-75 yrs. old)
1. Simple tooth extraction	Up to two (2) per day	Up to two (2) per day	Up to two (2) per day
2. Temporary filing	Up to two (2) surfaces per day	Up to two (2) surfaces per day	Up to two (2) surfaces per day
3. Permanent filing	Not covered	One (1) surface per year	Up to two (2) surfaces per year
4. Oral Prophylaxis	Covered	Covered	Covered
Pre-existing Illness	Covered after 1 year of membership or for lateral transfers and renewals	Covered after 1 year of membership or for lateral transfers and renewals	Covered after 1 year of membership or for lateral transfers and renewals
Physical Therapy Session	Not covered	Covered – up to six sessions	Covered – up to ten sessions
Annual Physical Examination	Basic 5: X-ray, CBC, Urine test, Stool test & Physical Exam	Basic 5: X-ray, CBC, Urine test, Stool test & Physical Exam	Basic 5: X-ray, CBC, Urine test, Stool test & Physical Exam
Special Coverage for confirmed Covid-19 cases	Maximum of P 10,000 / year; Subject to MBL i. RT-PCR Test – Up to P 2,000.00 per test ii. Rapid Antigen Test – Up to P 1,000.00 per test	Maximum of P 10,000 / year; Subject to MBL i.  RT-PCR Test – Up to P 2,000.00 per test ii.  Rapid Antigen Test – Up to P 1,000.00 per test	Maximum of P 10,000 / year; Subject to MBL   i. RT-PCR Test – Up to P 2,000.00 per test ii.  Rapid Antigen Test – Up to P 1,000.00 per test

 

Note:

 1. Annual Physical Examination (APE) guidelines:

a. Member/ Cooperative must send a letter of request for an APE schedule to patcomc.1coop@gmail.com (10 days prior to APE date).

 

b. APE can be utilized 3 months after enrollment.

c. APE will be done in a designated accredited clinic of 1COOPHealth only.

d. Rescheduling of APE will be allowed once only.

e. If in case of no accredited clinic in the area, 1COOPHealth can reimburse up to a maximum of P500.00, subject to the maximum benefit limit.

2. In-Patient Hospital Confinement guidelines:

a. For enrollees that are PhilHealth members, the PhilHealth portion for which the enrollee is eligible shall be applied to or deducted from allowable charges.

b. In case an enrollee is not a PhilHealth member, the PhilHealth portion must be paid by the enrollee directly to the hospital at the point of availment or upon discharge. 1COOPHealth will not pay or advance the costs of such benefits, nor be responsible for filing any claims under PhilHealth or ECC

3. Dental Services guideline:

 a. If in case of no accredited clinic in the area, 1COOPHealth can reimburse dental services up to a maximum of P250.00 per procedure, subject to a maximum benefit limit.

4. Special Covid 19 Benefits guidelines:

a. Covered for Symptomatic Patients Only.

b. Not covered for screening test purposes.

 

C. Additional Benefits

C.1 Telemedicine Consultations thru 1COOPTelehealth

Health Care Benefits	Coverage/Limit
a.   Phone call consultation (on-duty doctors)	Covered
b.   Video consultation (on-duty doctors)	Covered

 

C.2 FInancial Assistance given to the beneficiary of the member in case of death.

Health Care Benefits	Coverage/Limit
a.              Natural Death	P 10,000.00
b.              Accidental Death	P 20,000.00
c.               Unprovoked murder and assault	P 20,000.00

 

C.3 Optical Benefits available at Executive Optical (EO)

Health Care Benefits	Coverage/Limit
1.        Free Eye Check-ups (Computerized Eye Refraction & Color Blindness Test)	Covered
2.       Guaranteed discounts	Up to 20% discount on exclusive signature frames and sunglasses purchases shall be given from the Suggested Retail Price (SRP) except Oakley, Rudy Project, Mango, and Spyder & Oakley brands.
3.       Free cleaning and minor repair services	Covered

 

Note:

1. Discounts shall not be applicable to lenses, contact lenses, solutions, and accessories. Discounts shall not also be used in conjunction with any other existing promotion.

2. Purchase of items/goods in connection with the availment will be honored in ALL the branches of OPTICAL nationwide except the OPTICAL's Landmark branches and Bazaar branch in Zamboanga City.

 

C.4 Enhanced Covid-19 Benefits in exchange for an additional annual premium of P200.00 per enrollee

Health Care Benefits	Coverage/Limit
a.   Out-patient and Emergency Care Services	Up to P10,000 per year
i.   RT-PCR Test	Covered - Up to P2,000.00 per test Subject to Out-Patient Covid Limit available
ii. Rapid Antigen Test	Covered Up to P1,000.00 per test Subject to Out-Patient Covid Limit available
b. Hospital confinement for Confirmed Cases	Up to P10,000 per case
c. Financial Assistance for Confirmed Cases	P2,500 per case

 

Note:

1. Members who were found to be infected with the COVID-19 virus before the effectivity of the policy will not be covered.

2. For financial assistance, a member may claim once he/she was tested and found to be symptomatic or asymptomatic and infected with COVID-19 but was only subjected to an Isolation Facility for fourteen (14) days of Quarantine.

3. In case of a claim, the member must submit the following requirements:

i. In case of Home Quarantine or Facility Quarantine:

1. Submit an original copy of the SWAB or RT-PCR Test Result

2. Photocopy of members and claimant's valid ID

ii. In case of confinement to a non-accredited provider:

1. Original copy of Certificate of Confinement

2. Official Receipts

3. Other requirements stated above.

4. Submission of claim requirements must be within 1 month or thirty calendar days from the result of the SWAB or RT-PCR Test or from the date the member tested positive for COVID-19.

5. Exclusion:

1. Frontliners - shall mean any person working either an employee o a volunteer, in a medical facility who has direct interaction or is in close contact with a COVID patient being treated in the institution or facility. For this agreement, direct interation or close contact shall mean exposure to a probable or confirmed COVID-19 case, from 2 days before and ten days after the person's onset of illness and/or face-to-face contact with a person with COVID-19 within 1 meter for ≥ 15 minute

 

D. Optional Benefits

Hospital income benefit in exchange for an additional annual premium of P500.00 per enrollee.

Health Care Benefits	Coverage/Limit
1.    Daily Hospital Income	P 200.00 per day; max of 30 days
2.    Medicine Subsidy	Reimbursable up to P 4,500.00
3.    Ambulance Transfer	Reimbursable up to P 2,500.00

 

Note:

1. Members who were found to be infected with the COVID-19 virus before the effectivity of the policy will not be covered.

2. For financial assistance, a member may claim once he/she was tested and found to be symptomatic or asymptomatic and infected with COVID-19 but was only subjected and brought to an Isolation Facility for fourteen (14) days of Quarantine.

3. In case of a claim, the member must submit the following requirements:

i. In case of Home Quarantine or Facility Quarantine:

1. Submit an original copy of the SWAB or RT-PCR Test Result

2. Photocopy of members and claimant’s valid ID

ii. In case of confinement to a non-accredited provider:

1. Original copy of Certificate of Confinement

2. Official Receipts

3. Other requirements stated above.

4. Submission of claim requirements must be within 1 month or thirty calendar days from the result of the SWAB or RT-PCR Test or from the date the member tested positive for COVID-19.

5. Exclusion:

1. Frontliners - shall mean any person working either as an employee or a volunteer, in a medical facility who has direct interaction or is in close contact with a COVID patient being treated in the institution or facility. For this agreement, direct interaction or close contact shall mean exposure to a probable or confirmed COVID-19 case, from 2 days before and ten days after the person’s onset of illness and/or face-to-face contact with a person with COVID-19 within 1 meter for ≥ 15 minutes.

 

 

Telemedicine – Online Consultation

https://chmf.coop/telemed/

NOTE:  For booking an online consultation, please follow 3 easy steps.

Step 1  Send a message in their Facebook Page (1COOPTeleHealth)
Step 2  Accomplish the information need for Appointment Setting
Step 3  Your request will be processed by Telemedicine Team  
            and online consultation schedule will be sent within the day.

For accredited providers click this
1COOPHEALTH Downloadable Forms click this