I. Excess bills arise out of/come from the following:        
         
1. Professional Fees  for Doctors not affiliated with Philamcare        
2. Exhaustion of Maximum Benefit Limit/DDL   – Excess Benefit        
3. Laboratory Exams and Other medical procedures not covered by the plan      
4. Pregnancy related diseases        
5. Philhealth portion not covered due to age limit or not filed        
         
         
II. The following cases that give rise to excess bills will be settled upon discharge as follows:    
         
Item/Case Chargeable to Fund? Requirement Application Treatment of Employee Share
         
Instrument or other equipments needed by the patient Yes HR Approval for P10K & above 100% Employee Medical Loan payable based on amount
Laboratory exams needed & prescribed by Doctor Yes HR Approval for P10K & above 50/50 Sharing Medical Loan payable based on amount
Additional Prof. Fees (additional doctor but not accredited) Yes HR Approval for P10K & above 50/50 Sharing Medical Loan payable based on amount
Blood Screening & Transfusion Yes HR Approval for P10K & above 50/50 Sharing Medical Loan payable based on amount
Ambulance Transport – outside Metro Manila (emergency case) Yes HR Approval for P10K & above 50/50 Sharing Medical Loan payable based on amount
Pregnancy Related but admitted already for other sickness Yes HR Approval for P10K & above 100% Employee Medical Loan payable based on amount
Diagnosed as Congenital Disease prior to the final evaluation Yes HR Approval for P10K & above 100% Employee Medical Loan payable based on amount
         
         
         
Philhealth portion (not covered due to age limit)        
         
  -  HR to provide the list of dependents not covered by Philhealth        
     due to age limit (see attached)        
   -  HR will provide assistance in enrolling with Philhealth those        
      dependents who are not covered due to age limit.        
  -  Once enrolled. Employee to pay monthly contribution and        
     the treatment will be : No N/A 100% Employee N/A
         
  Meanwhile, while the above arrangement is  not yet in place Yes HR Approval for P10K & above 50/50 Sharing Medical Loan payable based on amount
  treatment will be as follows. (We will finalize cut-off date for the        
  transition).        
         
Philhealth portion (employee’s failure to submit documents) No N/A Employee can file with Philhealth. N/A
  (Employee to Pay)   HR to assist in filing claim with Philhealth.  
         
Philhealth portion (If late filing by the doctor and the employee Yes HR Approval for P10K & above 100% Company/Philamcare N/A
submitted the Philhealth Form on time).        
         
Prof. Fees of Unaccredited Doctor No N/A Employee to file claim to Philhealth. N/A
  (Employee to Pay)   HR to assist.  
         
         
Incremental charges due to upgrade of R&B (by Choice of employee) No N/A Employee to Pay upon discharge. N/A
  (Employee to Pay)      
         
Use of Telephone, TV, Ref, Etc (By Choice or requested by Employee) No N/A Employee to Pay upon discharge. N/A
  (Employee to Pay)      
         
         
         
         
Pending Item:  For  clarification and alignment with Philamcare.        
         
         
Prof. Fees of Unaccredited Doctor – Assigned by the Hospital Yes HR Approval for P10K & above 100% Company/Philamcare N/A
if no accredited Philamcare doctor was assigned.