MEDICAL ALLOWANCE
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 Regular Private As charged, subject to MBL As charged, subject to MBL As charged, subject to MBL As charged, subject to MBL 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). 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 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 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 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) Blood Chemistries As charged, subject to OP Limit for Out-Patient; MBL for In-Patient Chest X-Ray Complete Blood Count (CBC) Fecalysis Urinalysis As charged, subject to OP Limit for Out-Patient; MBL for In-Patient As charged, subject to OP Limit for Out-Patient; MBL for In-Patient Subject to OP Limit Up to six (6) sessions, subject to OP Limit P4,000/illness/year; subject to MBL P5,000/illness/year; subject to OP Limit; MBL for In-Patient P5,000/illness/year; subject to OP Limit; MBL for In-Patient Up to P1,000/area, subject to MBL As charged, subject to MBL P7,000/illness/year; subject to OP Limit; MBL for In-Patient P7,000/illness/year; subject to OP Limit; MBL for In-Patient 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 As charged, subject to OP limit for OP, MBL for IP 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 Administered by Standard Insurance P100,000 P10,000 P50,000Coverage Annual Benefit Limit (ABL) I. IN-PATIENT BENEFITS Room Type Use of operating, ICU, isolation, or recovery Rooms Professional Fees (Physicians/Surgeon/Anesthesiologists) Standard nursing services, medicines, diagnostics, and supplies Blood transfusion and fluids (recipient only) II. OUT-PATIENT BENEFITS Routine diagnostic examinations and therapeutic procedures III. EMERGENCY CARE BENEFITS Areas without Accredited Hospital IV. PREVENTIVE HEALTH CARE SERVICES V. BENEFITS COVERED WHETHER OUT-PATIENT OR IN-PATIENT 1. ROUTINE PROCEDURES 2. DIAGNOSTIC PROCEDURES Standard procedures and imaging (Diagnostic X-rays, ECG, Ultrasounds, etc.) 2D-Echo with Doppler 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 Arthrocentesis Dialysis Physical Therapy Thoracentesis 4. OTHER PROCEDURES AND LATEST MODALITIES Angiography (gastrointestinal, brain, retinal and peripheral vascular) Coronary Angiogram and/or Angioplasty/Coronary Artery Bypass Graft Cryosurgery Gamma Knife Surgery Hysteroscopic Myoma Resection Hysteroscopic-guided D&C Laparoscopy Lithotripsy Percutaneous Ultrasonic Nephrolithotomy Stereotactic Brain Biopsy Conventional Hemorrhoidectomy Scalpel Hemorrhoidectomy 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 VI. ADDITIONAL BENEFITS Hepatitis B (treatment only) VII. DENTAL BENEFITS - Administered by RMC2 Consultation Corporation Financial Assistance - PRINCIPAL ONLY HEALTHCARE BENEFITS 1. Accidental Death 2. Burial 3. Terminal Illness Benefit (TIB)
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ALL DOJ-COOP MEMBERS - RMC2-AMAPHIL
ANNOUNCEMENT
We are pleased to announce that RMC2-Amaphil is the new HMO provider for DOJ employees.
- For employees who plan to use RMC2-Amaphil, please make sure to bring your Certificate of Coverage and your DOJ ID.
- DOJ Coop members who are interested in enrolling their dependents and/or enhancing their HMO coverage are encouraged to submit their application forms, which are available on the DOJ Coop Portal.
- For employees who avail of Medical Allowance in CASH who wish to enroll in AMAPHIL should coordinate with the DOJ Personnel Division not later than SEPTEMBER 30, 2026. Also, please review the Summary of Benefits before completing the application form, which must be submitted on or before SEPTEMBER 30, 2026.
For inquiries or further information, please coordinate with the DOJ-COOP office or personnel.
Thank you!