ultimate kaiser health builder
DESCRIPTION
ULTIMATE KAISER HEALTH BUILDERTRANSCRIPT
KAISER INTERNATIONAL HEALTHGROUP, INC.
A Health Maintenance Organization (HMO) Companyduly accredited with the Department of Health (DOH)-Bureau of Health Facilities and Services. Our Company islikewise, registered with the Securities and ExchangeCommission (SEC) on June 08, 2004 as a Health CareProvider with an Authorized Capital Stock of Php 160M.
Kaiser's Board of Directors are seasoned experts in theMedical field services and in the health care industry withits President and Medical Director Dr. Ramon B. Abragan,Jr., a former DOH Head Executive Assistant, a formerConsultant to the DOH Secretary and a former member ofMedical Board of Examiner- Philippine RegulationCommission (PRC).
MISSION AND VISIONWe shall aim to be the industry leader in
providing maximum, long-term and short-term health care benefits to all ourmembers.
We help build a secured future and wisefinancial foundation in coping withinevitable medical expenses each of uswould one day face especially afteremployment and during retirement years.
KAISER INTERNATIONAL HEALTHGROUP, INC.
Kaiser International Healthgroup, Inc.,as an HMO Company caters to both corporate, group, family and individual accounts with our various short term plan packages that would suit your health care requirements.
We offer the following HMO Plans:
Kaiser Healthcard Individual Kaiser Healthcard Family Kaiser Healthcard Mini- Group (10-49
members) Kaiser Healthcard Group (50-99
members) Kaiser Healthcard Corporate (100
members and above)
Kaiser International Health Group Inc. isalso offering a one of a kind HMOProduct, the Premium HealthcareBuilder Plan (long term plan).
A five (5) year paying and a ten (10) yearwaiting plan
Designed to provide healthcare beyondthat of an HMO.
Allows individuals to save duringemployment while still being covered byCompany’s health plan
Geared to address the long term healthcare needs of individuals especially afteremployment and retirement years
Securing a more comfortable elderly life.
7-20Prepared By:
Mara I. San Victores
Training and Marketing Officer
During Accumulation Period (1st-7th year)
Plan: K-100Installment Amount:
P 58,821.43
Mode Of Payment:
Annual
Contract Price:
Php 411, 750.00
Annual Payment:
Php 58,821.43
-IN PATIENT BENEFITS ONLY1. Annual Physical Examination2. Dental Health Benefits3. Basic Medical Health Benefits4. Member’s choice of Room and
Board (1,000.00)5. Yearly Benefit Limit of
Php 60,000/year6. Waiver of installment due to
Death/ Credit Life7. Waiver of installment and
Premiums due to Total and Permanent Disability
8. Term Life Insurance Coverage9. Accidental Death &
Dismemberment 10. Family Assistance Service
1. ANNUAL PHYSICAL EXAMINATION
To be administered by an accredited service provider.
APE Coverage ( Basic 5 )
Physical Examination, Chest X-Ray, StoolExamination, Routine urinalysis, Complete BloodCount
ECG for Members above 35 and Pap Smear forFemale Members above 35 years old or as required.
2. DENTAL BENEFITS
Unlimited Dental Check Ups
Once A year Free Dental Prophylaxis
Re cementation of jacket, crowns, inlays, on lays and unlimited tooth extractions
Minor adjustment of Dentures
3.Basic Medical Health Benefits
Hospital’s Room and Board
Accredited Physician’s Fee
Accredited Specialist’s Fee
Accredited Surgeon’s Fee
Accredited Anesthesiologist’s Fee
Operating Room Fee
Hospital Intensive Care
Miscellaneous Fees
Charges for local professional and ambulance service, maximum of PHP 2,000 per usage.
4. Member’s choice of Room and Board, up to Php 1,000.00/
Day
5. Yearly Benefit Limit of Php60,000/ year
6. Waiver of Installment due to Death/ Credit Life
If the policy owner dies during the Accumulation Periodand before exceeding the age of sixty-seven (67).
The Balance Premiums are Waived, rendering the planis Fully Paid.
The Beneficiary will received:
100% Long term Care Benefits Plus Long Term CareBonus
The Plan will be Transferred to his/her Beneficiary.
7. Waiver of installment and Premiums due to Total and Permanent Disability
If the policy owner becomes totally and permanentdisabled for a period of at least six (6) mos. (notexceeding the maximum age 67 years old).
During accumulation period, all the succeedingpayments will be waived.
8. Term Life Insurance Coverage
If the Member dies before attaining the age of sixty-seven (67)
Exceeded the two (2) years contestability period
The Balance Premiums are Waived, rendering the plan is Fully Paid.
The Beneficiary will receive:
100% Long term Care Benefits Plus Long Term Care Bonus.
The Plan will be Transferred to his/her Beneficiary.
9. Accidental Death & Dismemberment
If the Policy Owner dies due to an accident (not beyond the age of 67 during paying period)
The nominee will receive an Additional of 100% of the Long Term Care Benefit plus Long Term Care Bonus
DismembermentIf The Policy Holder suffers Dismemberment not beyond 67
years of age. Loss of Both Hands 100% Loss of Both Feet 100% Loss of Sight of Both Eyes 100% Loss of One Hand and One foot 100% Loss of One Hand and Sight of One 100%
Eye Loss of one foot and sight of one 100%
EyeThe Member will receive the Long Term Care Benefit PLUS
Long Term Care Bonus
10. Family Assistance Service Policy should be in ACTIVE status and plan should have completed at least one
(1) year payment
Nominated patient must be an immediate family member of the Policy Holder or within the 1st degree of consanguinity
Policy Holder agrees to avail only of the services of Kaiser’s Accredited Doctors and Affiliated network of Hospitals
Assistance to be provided by Kaiser shall only be to the extent of the allowable benefits due to the plan holder under his policy.
Prior to discharge of the nominated patient, payment should have been settled with Kaiser.
If Plan Holder requested or opted to pay on a “term basis”- Payment scheme is on case to case basis and subject to Kaiser approval.
Please note that this assistance is an accommodation and not considered a benefit of the plan, hence approval & denial on the a ailment solely depends on Kaiser Management Evaluation.
ADDITIONAL INFORMATION The Plan Holder is insured up to the maturity,
provided the she/he is not beyond the age 75 years ofage.
Extended PeriodDuring Extended Period (8th year-end of 20th year)
Annual Health Benefit or Total Annual Health Benefit
Long Term Care Benefit
Long Term Care Bonus
Additional Health Care Benefit
Out Patient Benefits
Pre- Existing Illness is Covered
Dreaded Illness is Covered
Maternity Benefits
1. Annual Health Benefit
Out Patient BenefitIn-Patient BenefitPre-ExistingDreaded IllnessMaternity BenefitAnnual Health Benefit plus the
additional Health Benefit
2. Long Term Care
Benefit
3. Long Term Care
Bonus
Additional Health Benefit
PRE-EXISTING MEDICAL
CONDITION
Those illnesses/injuries considered to be in existence prior to the effective date of the contract
Any professional advice or treatment was given for such illness or condition
Such Illness or condition was in anyway evident to the member before the effective date of the contract
The pathogenesis of such illness or condition started whether or not the member is aware of it.
The following illnesses will be covered during extended period (8th-20th year)
Bronchial Asthma
PTB
COPD
Diabetes
Thyroid Diseases
Systemic Allergies
Hernias
DUB
Chronic Hemmoroids
Anal Fistula
Gastric or Duodenal Ulcers
Liver Cirrhosis
Kidney Diseases
Blood Dyscrasia
Immunologic & Collagen Diseases
Endometriosis
Cholecystitis
Hallux Valgus
Lithiasis
Cancer
Atherosclerosis
CVD
CVA
PHILHEALTH
Your Philhealth benefit is integrated with Kaiser.
Once admitted, you will be advised to file your PHILHEALTH REIMBURSEMENT FORM. The Philhealthreimbursement due shall be deducted from the total hospital bills.
Kaiser members without Philhealth membership, shall shoulder and pay the corresponding portion of Philhealth.
Additional Health BenefitYearly Health Bonus- which start
on the 2nd year up to end of 20th
year.
Accumulated Yearly Bonus
If Member decide to Cancel his/her Plan- He/she will onlyreceive 80% of the Additional Health Benefit together withcomputation of his/her Cash Value.
GRACE PERIOD
If payment is made after the grace period the contractshall be considered LAPSED. However, the owner shallbe given a grace period of 60 days/2 months to pay thedue installment benefits may be provided to themember only after the due installment is paid.
REINSTATEMENT UPDATE- member will pay the premiums due on all the missed months +
surcharge of 1.5%/months or 18%/annum from the date of each unpaidinstallment.
REDATE- member will only pay the premium for the month but the maturityperiod will be moved
Requirements:
Surrender the Lapsed contract
Re installment application form
Re-instatement fee of Php 300.00
Can be done within 2 years of the first unpaid due date
The member shall be considered a new applicant subject to pre-existingconditions and for purposes of contestability of insurance coverage and to anyother requirements for a new applicant for membership in effect at that time
Kaiser will cancel the contract without need of notice to the owner if he fails toreinstate within the prescribed period.
CASH VALUE SURRENDER
The owner may surrender the contract for its cash value stated in the Schedule of Benefits provided the Plan is active for at least a year.
TRANSFER The owner is allowed to transfer his rights under his
contract at any time.
Written request
Surrender of the agreement
Membership application signed by the transferee
Payment of processing fee (Php 300.00)
UPGRADING OF PLAN & MODE OF PAYMENT
Plan can be upgraded within 30 days after its effectivity date.
Filled up amendment form
Payment of processing fee- P300.00
Payment of additional installment corresponding to the updated plan
Mode of payment can be upgraded anytime after completion of its respectivecycle
If within 30 days after purchase
Filled up amendment form
Payment of additional installment due corresponding to the amount ofthe updated mode of payment
If beyond 30 days after purchase
Filled up amendment form
Payment of Processing fee- P 300.00
Computation of dues based on the desired mode of payment
Downgrading of plan and mode of payment is not allowed.
THANK YOU!!!