DESCRIPTION:

Gov Employee Medicard Health Plus & RxER bundle, highlighting the features, coverage, and strict exclusions for each component of the plan:

Gov Employee Medicard Health Plus & RxER

Combined Value: ₱3,953.00 (RxER at ₱2,378.00 + Health Plus at ₱1,575.00) Target Age: No age limit

Validity: 1 year from activation date

Medical Check-up: No pre-acceptance medical exam required

Overview: This bundle brings together preventive outpatient care and specialized emergency healthcare coverage, providing access to MediCard’s free-standing clinics for routine needs and MediCard-accredited hospitals for emergencies.

1. Routine Outpatient Care: MediCard Health Plus

This plan gives you access to quality outpatient care in all 18 MediCard Free-Standing Clinics nationwide.

What is Included:

• Annual Physical Exam (APE): Comprehensive Physical Examination, Complete Blood Count (CBC), Urinalysis, Fecalysis (Stool Exam), and Chest X-ray. (Available starting 14 days after effectivity).

• Unlimited Consultations: Unlimited visits to General Practitioners, Family Medicine Physicians, Internal Medicine Physicians, Pediatricians, and Gynecologists. (Available starting 7 days after effectivity).

• Dental Services: One-time free oral prophylaxis and baseline panoramic X-ray.

• Specialist Consultations: A flat rate of ₱600 for consultations with other specialists (e.g., ENT, ophthalmologists, rehab medicine).

• Discounts: 20% discount on all out-patient laboratory and diagnostic procedures.

What is NOT Included (Exclusions for Health Plus):

• Outside Clinics: Services must be availed by appointment from Mondays to Fridays strictly inside MediCard Free-Standing Clinics.

• Maternity: Consultations on maternity-related cases are not covered by the Gynecologist benefit.

• Medicines: Prescribed medicines are not provided or covered.

• Medical Certificates: Issuance of medical certificates during outpatient consultations is excluded.

• Other Specialists: Consultations with specialists not specifically mentioned are not covered (except under the flat rate discount).

2. Emergency Care: MediCard RxER

This plan covers emergency trauma and specialized healthcare, as well as preventive and outpatient care at MediCard Free-Standing clinics.

What is Included:

• Emergency Care Limit: Up to ₱20,000 overall limit for trauma cases within 6 hours of the incident, burns, animal bites, and accidental chemical poisoning at MediCard-accredited hospitals.

• Reimbursement: 100% reimbursement of approved hospital bills and professional fees (subject to the ₱20,000 limit) for emergency availments in non MediCard-accredited hospitals.

• Covered ER Services: Doctor’s services, ER fees, emergency medicines for immediate relief, oxygen, dressings/casts/sutures, tetanus toxoid/anti-tetanus serum, and active immunization for anti-rabies.

• Diagnostics limit: CT scan, MRI, ultrasound, and complex diagnostic/therapeutic procedures are covered up to a ₱5,000 inner limit.

• Outpatient Clinic Benefits: Unlimited free consultations with primary care physicians, a ₱600 flat rate for other specialists, and 30% discounts on lab tests, surgeries, and dental procedures at MediCard free-standing clinics.

What is NOT Included (Exclusions for RxER):

• In-Patient Services: Hospitalization/confinement is strictly not covered.

• Out-of-Country: Hospitalization and treatment outside the Philippines are excluded.

• Medicines & Supplies: Prescribed take-home medicines, purchase of durable medical equipment, artificial aids, and prosthetic devices are not covered.

• Specific Medical Procedures: Plastic/reconstructive surgery, oral surgery by a dental practitioner, experimental procedures, acupuncture, and physical therapy/rehab treatment.

• Mental & Behavioral Health: Psychiatric and psychological illnesses (neurotic and psychotic behavior disorders).

• Specific Injuries & Illnesses: Treatment of self-inflicted injuries, hazardous job-related injuries, injuries from combat sports, intoxication, drug use, crime, or war/riots.

• Spinal Issues: Slipped disc, herniated disc, scoliosis, spinal stenosis, and spondylosis.

• Blood Products: Human blood products (platelets, packed RBC, plasma) and processing.

• Vehicular Accidents without Subrogation: Treatment of injuries from a motor vehicle accident is excluded if the member refuses to execute the deed of Subrogation.

• Cost of Vaccines: Cost of vaccines for active and passive immunization (except specific tetanus/rabies protocols).

• Simultaneous Use: Cannot be used simultaneously or in combination with other MediCard Plans (RxER is not a full HMO plan).