A. Premium (with COVID-19 Coverage)
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Room and Board
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Annual Premium
(18 – 65 years old)
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Annual Premium
(66 – 70 years old)
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Annual Premium
(71 – 75 years old)
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Benefit Limit
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Ward
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P 4,500.00
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P 9,000.00
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P 13,500.00
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60,000.00 per illness
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Semi-Private
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P 10,350.00
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P 20,700.00
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P 31,050.00
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70,000.00 per illness
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Private
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P 17,050.00
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P 34,500.00
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P 51,750.00
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100,000.00 per illness
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Note:
For installment payment please message PATCOMC
B. Health Care Benefits
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HEALTH CARE BENEFITS
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WARD
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SEMI-PRIVATE
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PRIVATE
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Out-Patient:
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Maximum of P 10,000 / year;
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Up to MBL
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Up to MBL
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1. Consultation
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Subject to MBL
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1.1 Accredited Clinic
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Covered
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Covered
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Covered
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1.2 Non-Accredited Clinic
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Covered- subject to 1COOP-Health Contracted rates
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Covered – subject to 1COOPHealth contracted rates
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Covered – subject to 1COOPHealth contracted rates
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1.3 Areas with no provider
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Covered- subject to 1COOP-Health Contracted rates
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Covered – subject to 1COOPHealth contracted rates
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Covered – subject to 1COOPHealth contracted rates
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2. Laboratories
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Covered
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Covered
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Covered
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Out-Patient Emergency Treatment of illness and injury:
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Maximum of P 30,000 / year; Subject to MBL
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Up to MBL
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Up to MBL
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1. Accredited Hospital
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Covered
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Covered
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Covered
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2. Non-accredited Hospital
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Covered- 100% Reimbursement
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Covered- 100% Reimbursement
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Covered- 100% Reimbursement
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3. Medicolegal cases
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Reimbursement only
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Reimbursement only
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Reimbursement only
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4. Anti-rabies and anti-venom
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Covered – single dose only. up to P2,500
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Covered – single dose only. up to P2,500
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Covered – single dose only. up to P2,500
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In-Patient Hospital Confinement:
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P 30,000 / illness for the first single confinement
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Up to MBL
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Up to MBL
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1. Accredited hospital (non-emergency)
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Covered
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Covered
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Covered
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2. Non-accredited hospital (non-emergency)
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Covered - 80% reimbursement
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Covered - 80% reimbursement
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Covered - 80% reimbursement
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3. Emergency confinement
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Covered
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Covered
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Covered
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Maximum Benefit Limit
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P 60,000 / illness
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P 70,000 / illness
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P 100,000 / illness
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Prescribed Take-Home Medicines (Out-Patient)
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Not covered and other standard exclusion
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Not covered and other standard exclusion
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Not covered and other standard exclusion
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Dental Services: (not covered for 66-75 yrs. old)
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1. Simple tooth extraction
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Up to two (2) per day
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Up to two (2) per day
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Up to two (2) per day
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2. Temporary filing
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Up to two (2) surfaces per day
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Up to two (2) surfaces per day
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Up to two (2) surfaces per day
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3. Permanent filing
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Not covered
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One (1) surface per year
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Up to two (2) surfaces per year
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4. Oral Prophylaxis
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Covered
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Covered
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Covered
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Pre-existing Illness
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Covered after 1 year of
membership or for lateral
transfers and renewals
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Covered after 1 year of
membership or for lateral
transfers and renewals
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Covered after 1 year of
membership or for lateral
transfers and renewals
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Physical Therapy Session
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Not covered
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Covered – up to six sessions
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Covered – up to ten sessions
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Annual Physical Examination
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Basic 5:
X-ray, CBC, Urine test, Stool test & Physical Exam
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Basic 5:
X-ray, CBC, Urine test, Stool test & Physical Exam
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Basic 5:
X-ray, CBC, Urine test, Stool test & Physical Exam
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Special Coverage for confirmed Covid-19 cases
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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
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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
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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
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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
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Health Care Benefits
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Coverage/Limit
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a. Phone call consultation (on-duty doctors)
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Covered
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b. Video consultation (on-duty doctors)
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Covered
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C.2 FInancial Assistance given to the beneficiary of the member in case of death.
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Health Care Benefits
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Coverage/Limit
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a. Natural Death
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P 10,000.00
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b. Accidental Death
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P 20,000.00
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c. Unprovoked murder and assault
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P 20,000.00
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C.3 Optical Benefits available at Executive Optical (EO)
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Health Care Benefits
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Coverage/Limit
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1. Free Eye Check-ups
(Computerized Eye Refraction & Color Blindness Test)
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Covered
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2. Guaranteed discounts
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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.
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3. Free cleaning and minor repair services
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Covered
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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
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Health Care Benefits
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Coverage/Limit
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a. Out-patient and Emergency Care Services
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Up to P10,000 per year
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i. RT-PCR Test
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Covered - Up to P2,000.00 per test
Subject to Out-Patient Covid Limit available
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ii. Rapid Antigen Test
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Covered Up to P1,000.00 per test
Subject to Out-Patient Covid Limit available
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b. Hospital confinement for Confirmed Cases
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Up to P10,000 per case
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c. Financial Assistance for Confirmed Cases
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P2,500 per case
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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.
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Health Care Benefits
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Coverage/Limit
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1. Daily Hospital Income
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P 200.00 per day; max of 30 days
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2. Medicine Subsidy
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Reimbursable up to P 4,500.00
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3. Ambulance Transfer
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Reimbursable up to P 2,500.00
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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
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