Cooperative Owners Online Portal (e-COOP)

MEDICAL ALLOWANCE

Coverage

 

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

 

 

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

 

 

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

 

 

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

 

 

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)

 

 

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

 

 

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

 

 

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

 

 

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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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!

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