MEDICAL ALLOWANCE
Date posted: September 04, 2026 5:33 am| Coverage |
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| Annual Benefit Limit (ABL) | P400,000.00 |
Maximum Benefit Limit (MBL) Per illness, per coverage, per year (Shared limit: Out-Patient (OP) and In-Patient (IP) | P100,000.00 |
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| I. IN-PATIENT BENEFITS | |
| Room Type | Regular Private |
| Use of operating, ICU, isolation, or recovery Rooms | As charged, subject to MBL |
| Professional Fees (Physicians/Surgeon/Anesthesiologists) | As charged, subject to MBL |
| Standard nursing services, medicines, diagnostics, and supplies | As charged, subject to MBL |
| Blood transfusion and fluids (recipient only) | As charged, subject to MBL |
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| II. OUT-PATIENT BENEFITS | |
Consultation to Accredited Physicians | P60,000 Annual OP limit |
Treatment for minor injuries and minor surgery (except outpatient medicines) | |
Dressings, conventional casts (plaster or paris) and sutures | |
Laser Eye Therapy (retinal tear, hole, detachment, glaucoma only). | |
| Routine diagnostic examinations and therapeutic procedures | |
Sclerotherapy for varicose veins | Up to P10,000/member/year, subject to OP limit |
Botox (non-Cosmetic) | Up to P10,000/member/year, subject to OP limit |
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| III. EMERGENCY CARE BENEFITS | |
Emergency treatment in non-affiliated hospitals/clinics | 80% reimbursement (subject to plan limits), based on Amaphil RUV, subject to OP Limit |
Emergency treatment in affiliated hospitals/clinics | As charged, subject to OP Limit |
| Areas without Accredited Hospital | 100% reimbursement (subject to plan limits) based on AMAPHIL RUV |
Ambulance Service (Accredited Hospital/Clinic to Accredited Hospital/Clinic) | Up to P2,500 per conduction |
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| IV. PREVENTIVE HEALTH CARE SERVICES | |
Physical Exam, CBC, Urinalysis, Fecalysis, Chest X-ray | Can be availed at Amaphil accredited clinics with APE arrangement, or APE Assistance of up to P650 |
Passive and active vaccines, including anti-tetanus, animal bites, as well as snake bites and its administration | Up to P2,500/member/year, subject to MBL |
Mental Health Consultation | P1,500 consultation assistance/year to an Amaphil-accredited psychiatrist |
FLU Shot Vaccine | P500 Assistance (Administered by RMC2 Consultancy Corporation) |
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| V. BENEFITS COVERED WHETHER OUT-PATIENT OR IN-PATIENT | |
| 1. ROUTINE PROCEDURES | |
Blood Chemistries | As charged, subject to OP Limit for Out-Patient; MBL for In-Patient |
Chest X-Ray | |
Complete Blood Count (CBC) | |
Fecalysis | |
Urinalysis | |
| 2. DIAGNOSTIC PROCEDURES | |
| Standard procedures and imaging (Diagnostic X-rays, ECG, Ultrasounds, etc.) | As charged, subject to OP Limit for Out-Patient; MBL for In-Patient |
| 2D-Echo with Doppler | As charged, subject to OP Limit for Out-Patient; MBL for In-Patient |
| Adrenocortical Function | |
| Arterial Blood Gas | |
| Arthroscopic procedures, Orthopedic Arthroscopy | |
| Audiograms and Tympanograms | |
| Cardiac Stress Tests (Thallium and Dipyridamole Stress Tests) | |
| Computed Tomography (CT) Scan | |
| Duplex scan | |
| Electroencephalogram (EEG) Monitoring | |
| Endoscopic Procedures | |
| Impedance Plethysmography | |
| Magnetic Resonance Angiography (MRA) | |
| Magnetic Resonance Imaging (MRI) | |
| Mammogram and Sonomammogram | |
| Myelogram | |
| Nuclear Radioactive Isotope Scan | |
| Paps Smear | |
| Perfusion Scan | |
| Plasma Urinary Cortisol, Plasma Aldosterone | |
| Pulmonary Function Tests | |
| Radionuclide Ventriculography | |
| Surface Electromyography (SEMG) | |
| Thallium Scintigraphy | |
| Treadmill Stress Test (TMST) | |
| 3. THERAPEUTIC PROCEDURES | |
| Intravenous or Oral Chemotherapy | Subject to OP Limit |
| Arthrocentesis | |
| Dialysis | |
| Physical Therapy | Up to six (6) sessions, subject to OP Limit |
| Thoracentesis | P4,000/illness/year; subject to MBL |
| 4. OTHER PROCEDURES AND LATEST MODALITIES | |
| Angiography (gastrointestinal, brain, retinal and peripheral vascular) | P5,000/illness/year; subject to OP Limit; MBL for In-Patient |
| Coronary Angiogram and/or Angioplasty/Coronary Artery Bypass Graft | P5,000/illness/year; subject to OP Limit; MBL for In-Patient |
| Cryosurgery | Up to P1,000/area, subject to MBL |
| Gamma Knife Surgery | As charged, subject to MBL |
| Hysteroscopic Myoma Resection | P7,000/illness/year; subject to OP Limit; MBL for In-Patient |
| Hysteroscopic-guided D&C | |
| Laparoscopy | |
| Lithotripsy | |
| Percutaneous Ultrasonic Nephrolithotomy | |
| Stereotactic Brain Biopsy | |
| Conventional Hemorrhoidectomy | |
| Scalpel Hemorrhoidectomy | P7,000/illness/year; subject to OP Limit; MBL for In-Patient |
| Stapled Hemorrhoidectomy | |
| Mammotome / Vacuum Assisted Breast Biopsy | |
| 4D Ultrasound except maternity-related cases | |
| Esophageal Manometry | |
| Positron Emission Tomography (PET) Scan | |
| CT Pulmonary Angiography | |
| Photodynamic Therapy | |
| Other medically necessary modalities not mentioned above and those for which there are no comparable, conventional or traditional counterparts | |
| Transurethral Microwave Therapy of Prostate | |
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| VI. ADDITIONAL BENEFITS | |
Motor Vehicular Accidents (subject to evaluation; Police Report is required before coverage) | As charged, subject to OP limit for OP, MBL for IP |
Unprovoked Assault / domestic violence | |
Sports-related injuries (non-hazardous) | |
Scabies / Chronic Dermatoses | Consultations Only |
| Hepatitis B (treatment only) | As charged, subject to OP limit for OP, MBL for IP |
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| VII. DENTAL BENEFITS - Administered by RMC2 Consultation Corporation | |
Consultation & Dental examination | Free & unlimited |
Simple tooth extraction except surgery for impaction | Unlimited / Maximum of 3 teeth per day |
Temporary Fillings | Up to 3X per year |
Oral prophylaxis (mild to moderate) | 2X a year, which can be availed of after active membership |
Simple denture adjustment and repair | Covered |
Recementation of loose Jacket Crowns | Covered |
Treatment of dental-related pain excluding cost of medicine | Covered |
Emergency desensitization of Hypersensitive teeth | Covered |
Annual dental examination | Covered |
Orthodontic and aesthetic dental consultation | Covered |
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| Financial Assistance - PRINCIPAL ONLY | |
| HEALTHCARE BENEFITS | Administered by Standard Insurance |
| 1. Accidental Death | P100,000 |
| 2. Burial | P10,000 |
| 3. Terminal Illness Benefit (TIB) | P50,000 |
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