BENEFITS:

• Semi-private is the standard room and board benefit that enrolled employees can avail of. Accommodation is up to the benefit limit of the company’s plan for

enrolled employees (PHP60,000.00).

• General Nursing Services;
• Services of physician(s), specialist(s), surgeon(s) and anesthesiologist.
• Anesthesia & its administration, dressings, sutures, casts and other medical supplies;
• Use of Operating/Recovery Room;
• Prescribed laboratory examinations including complex diagnostic procedures such as, but not limited to, CT scans & MRI;
• Transfusion of blood, blood elements & other intravenous fluids;
• ICU confinements – subject to the Maximum Benefit Limit (PHP60,000.00);
• Chemotherapy, radiotherapy, physical therapy, speech therapy and dialysis, etc. – subject to the provisions on ‘Maximum Benefit Limit’ (PHP60,000.00) &

‘Pre-existing Conditions’;

• All other expenses directly related to the medical management of the illness and/or injury that resulted in the enrolled employee’s confinement, including the

Admissions Kit.

Room Accommodation higher than your "Room & Board" Limit:

• During EMERGENCY Confinement: Should the enrolled employee stay in a room higher than his/her Room & Board-limit as a result of an unavailable room equal to his Room and Board-limit, eligible expenses for the 1st 24-hours of stay will be covered. Should the enrolled employee decide to stay further once an available room equal to or less than his Room and Board-limit becomes available, the enrolled employee will have to pay for any excess costs, ineligible expenses, and/or corresponding incremental costs prior to discharge.

• During NON-EMERGENCY Confinement: Should the enrolled employee stay in a room higher than his Room & Board-limit, the enrolled employee shall pay for any excess costs, ineligible expenses, and/or corresponding incremental costs incurred prior to discharge.

BENEFITS:

• Medical consultations & follow-up consultations;
• Referral/consultations with Specialist(s);

-including pre & post natal consultations

• Outpatient medicines administered in the clinic (not take-home meds);
• Administration of vaccine (not cost of vaccine);
• Prescribed laboratory/diagnostic examinations for covered illnesses/injuries;
• Emergency treatment and minor surgeries not requiring hospitalization;
• Anti-rabies, anti-venom & anti-tetanus (regardless of amount, up to MBL)

BENEFITS:

• Ambulance Services

-Emergency ambulance service expense involving transfer of the enrolled employee to and from anywhere, anytime, for no-cash-out or reimbursement,

shall be reimbursed up to the Maximum Benefit Limit (PHP60,000.00).

-Reimbursement of ambulance service expense is not limited to one claim per enrolled employee per policy year.

• In Accredited Hospitals Nationwide

-All expenses directly related to the medical management of the illness and/or injury that resulted in the enrolled employee’s emergency treatment shall be

covered on a no-cash-out basis. This includes medicines & drugs administered during emergency treatment, except prescribed medicines to be taken

outside the hospital (take home medicines).

• In NON-ACCREDITED Hospitals WORLDWIDE

-100% of eligible medical expenses incurred in the direct medical management of the illness and/or injury that resulted in the enrolled employee’s

emergency treatment shall be covered on a reimbursement basis.

**REIMBURSEMENT will be equal to the amount ETIQA would have paid had the enrolled employee been confined in an accredited hospital.**

• Pre-Existing Conditions covered up to 100% of Maximum Benefit Limit (PHP60,000.00).

-e.g. Chronic asthma, diabetes, hypertension, and heart disease.

• Congenital Conditions also covered up to 100% of Maximum Benefit Limit (PHP60,000.00).