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AMENDED POLICY GUIDELINES ON THE GRANT OF HOSPITALIZATION ASSISTANCE (effective June 7, 2016)

Date posted: July 11, 2016 1:24 pm

The grant of Hospitalization Assistance (HA), as well as Medical Assistance (MA) shall be available to ALL QUALIFIED MEMBERS in the amount of FIVE THOUSAND PESOS (P 5,000.00) and shall be availed of ONCE A YEAR ONLY, chargeable against the Cooperative Guarantee Fund (CGF), the social fund of OSJEMPC, subject to the following guidelines,viz;

a) The Hospitalization Assistance can be availed of provided that the member has been confined in any hospital for not less than one (1) day due to his/her illness or accident;

Note: The hospitalization or confinement due to self inflicted incidents; pregnancy related cases; as well as cosmetics/vanity procedures shall not be covered.

b) The Medical Assistance can be availed of for Out Patient Services which shall be limited to treatment of minor surgery procedures; cancer patients undergoing chemotherapy/radiation; blood transfusion and hemodialysis treatment.

c) The total cost of hospitalization/medical treatment, including charges to Philhealth (Medicare) and/or health card (HMO) of the member/patient, shall NOT BE LESS THAN Five Thousand Pesos (P 5,000.00).

d) Submission of the original or certified true copies of the following supporting documents MUST BE IN THE NAME OF THE MEMBER/PATIENT, viz:

• Medical Certification from the attending physician/hospital;
• Medical Abstract, hospital bills, official receipts for medicines purchased, laboratories and professional fee of attending physicians/doctors;

e) The application of HA/MA shall be FILED WITHIN SIX (6) MONTHS from the date of hospital discharge or medical treatment for out-patient services;

f) The grant of HA/MA shall be subject to the approval of the Board of Directors and the availability of the CGF.

These Policy guidelines shall be implemented effective immediately.

Signed this 6th day of June 2016.


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