• COCOLIFE HealthCare

    COCOLIFE HealthCare

    Overview of Cocolife HealthCare

    An ISO 9001:2000 certified company, Cocolife is the biggest life insurance organisation in Philippines today. The company offers a full range of life insurance, health care products along with a slew of mutual fund options with branches all over the country. Cocolife healthcare, the exclusive arm of this insurance major provides an assortment of products for employers that are cost effective and offers quality healthcare to the employee base. Cocolife has a massive network consisting of over 800 network hospitals and clinics along with 11,000 plus top physicians and consultants in various fields of medicine. The company is the preferred health insurance provider for more than 1,000 companies in Philippines.

    Providing quality health & wellness benefits to employees speaks volumes of the employer's efforts to retain talent. Health insurance products from Cocolife helps you in achieving these objectives.

    Cocolife Healthcare Products

    Cocolife offers 4 types of insurance schemes covering all aspects of healthcare. Depending on the requisites, you can choose from the following.

    • HMO Program
    • Medical Reimbursement Program
    • Third Party Administration Program
    • Daily Hospitalization Benefit Program

    HMO Program

    This insured program requires a fixed premium for the benefits. The delivery system provides easy access to cashless medical treatment at first-rate hospitals and clinics. There are two types of programs offered:

    • Comprehensive HMO Program: This program covers outpatient care, in-patient care, preventive care, emergency services, dental coverage, annual check-up, and financial assistance in the event of natural or accidental death.
    • Unbundled Programs: The client can choose select components of the comprehensive HMO Program that they deem suitable. The various Unbundled Programs are as follows:
      • Outpatient only: This covers outpatient consultations, treatment for cases that don’t require admission to hospital, and laboratory tests.
      • In-patient only: This covers admission to hospital due to accident or illness.
      • ER coverage only: This provides cover for unexpected and sudden life-threatening situation where urgent medical attention is needed.

    Medical Reimbursement Program

    Provides reimbursement of medical expenses incurred for treatment at hospitals due to illness or accident. Treatment can be availed at a wide range of hospitals across the country.

    Third Party Administration Program

    The product offers access to Cocolife facilities and network hospitals along with the flexibility to self-administer along with benefits of an HMO.

    Daily Hospitalization Benefit Program

    Under this program, daily monetary assistance is provided to hospitalised individuals who are unable to work and not receive compensation from the employers.

    How to Use the Cocolife HealthCare Swipe card?

    The Swipe card can be used for referrals or consultations, diagnostic procedures, and hospital confinements/ emergency availments.

    For Referrals or Consultation

    You can use the Swipe card for referrals or consultations. You can use the Cocolife Health Access card as follows:

    • Swipe the Card at Veridata card terminal.
    • You will then get a printout that will be generated at the terminal.
    • You must then present your Cocolife Health Access card along with the printout and a valid identity card to the plan coordinator.
    • You can then receive the treatment.

    For Diagnostic Procedures

    • You can use the Swipe card for diagnostic procedures. You can use the Cocolife Health Access card as follows:
    • Swipe the card at Veridata card terminal. You will then get a printout strip.
    • Then the plan coordinator’s secretary will issue a DRF (Diagnostic Request Form).
    • You must then present your printout strip, DRF, and Cocolife Health Access card at the laboratory.
    • Then test or the procedure is performed.

    For Hospital Confinements / Emergency Availments

    • You can use the Swipe card for hospital confinements/ emergency availments. You can use the Cocolife Health Access card as follows:
    • You must present your card to the triage team of the hospital or to the receptionist.
    • Your card will be swiped by the triage team or the receptionist.
    • The receptionist or the triage team will inform you about the approval of the admission or consultation.
    • The admission and the treatment will then be facilitated by the hospital.

    Medical Benefits

    Following are the various benefits available:

    1. Outpatient benefits: The outpatient benefits include:
      • Minor surgeries.
      • Consultations that include specialists’ evaluations.
      • First aid treatment for injuries sustained in an accident.
      • Necessary laboratory examination and x-ray.
    2. In-patient benefits: You will get coverage if your attending physician determines that you have to be admitted to get proper medical attention. Take note of the following:
      • You will have to secure PhilHealth from your employer before the confinement. The information required has to be filled and forwarded to the hospital’s billing section.
      • Your physician has to authorise discharge from the hospital.
      • You will have to settle expenses that are not covered by Cocolife Healthcare. These expenses will include:
        • The difference in the room rates if you choose to upgrade the accommodation than the one which is specified in your plan.
        • Non-essential items (extra bed, extra tray, etc.) charges.
        • Incremental charges if you are restricted in a room of higher classification than the one which is specified in your plan.
        • If you choose to stay in the hospital after you have been cleared of discharge, you will have to pay for the additional stay.
    3. Emergency care benefits: You get this benefit if you have a sudden illness that could lead to permanent disability or death. You can get this cover if you have a massive bleeding, if you have met with an accident, acute myocardial infarction, acute appendicitis, severe pain, and hypertensive cases. In times of emergency, you can seek treatment from clinic or hospital that may or may not be Cocolife Healthcare provider. You will have to do the following in case you are getting admitted to a non-accredited hospital:
      • Within 24 hours of admission, you must notify Cocolife Healthcare of your confinement.
      • You must settle the professional fees and all hospital bills before discharge.
      • You must secure the initial requirements for charge slip, Hospital Statement of Account with PhilHealth Deductions, clinical abstracts, official hospital bill receipts, police report in case of an accident, and operative reports, if any.
      • The documents must be submitted to HealthCare Division, Cocolife, 8th Floor, Feliza Building, 108 V.A. Rufino Street, Legaspi Village, Makati City. The documents are to be submitted within 30 days from the date of discharge.
      • The claims will be processed within 10 days. 80% of the expenses will be reimbursed.
    4. Annual physical examination: You get a comprehensive annual physical examination package which includes:
      • Chest x-ray examination.
      • General physical examination.
      • Urinalysis examination.
      • General consultation and counselling.
      • Fecalysis examination.
      • Pap smear for female members above 35 years.
      • Complete blood count examination.
      • Electrocardiogram for member above 35 years.
    5. Dental services: You can get the following services at any of the accredited dental clinics:
      • Care of oral wounds, lesions, and burns.
      • Relief of acute dental pain.
      • Non-surgical tooth extraction (any number).
      • Annual oral prophylaxis.
      • Emergency desensitization of hypersensitive teeth.
      • Re-cementation of crowns, jackets, minor adjustments of dentures, onlays, and inlays.
      • Any number of tooth filling (temporary).
      • The dental consultation that includes aesthetic and orthodontic consultations.

      If the treatments are not mentioned above, will be charged for a special discounted rate.

    6. Medically Necessary: The following medical services are covered:
      • Services that are in accordance of good medical practice.
      • Which are consistent with the diagnosis.
      • Which are not done for the convenience of physician or patient.
      • Which are performed in a least costly manner.
      • Services that are accepted by medical professional and are not experimental in nature. They are:
        • Iridology.
        • Chelation therapy.
        • Acupuncture.
        • Herbal medications.
        • Reflexology.
        • Cell implant therapy.
        • Holistic approach.
        • Ultraviolet and other radiation modes.
    7. Incremental cost computation
    8. If you are staying in the benefit’s room category, you will get maximum benefit coverage. If you occupy a room that is more than the one that is allowed in your plan, you are required to pay the difference amount and settle it with the hospital before you get discharged. The incremental costs are calculated as follows:

      For instance, the room benefit offered to you is P1,000 per day, but you have occupied a room that costs P2,000 per day. You have been confined for 4 days, and the difference amount for a day is P1,000, hence for 4 days it is P4,000. You will have to pay P4,000 at the time of your discharge.

      If you have occupied a room from a higher category than the one mentioned in your plan, you will have to pay at least 20% of the actual hospital charges. If the room benefit offered to you is semi-private and you have opted for regular private room and the hospitalisation charges are P6,000, you will have to pay P1,200.

      The incremental charges are as follows:

      Ward to

      Semi-private: 20%

      Private: 40%

      Suite: 50%

      Semi-private to

      Private: 20%

      Suite: 40%

      Private to Suite: 25%
    9. Pre-existing medical conditions
    10. If you have a pre-existing condition prior to getting a health insurance, you will get coverage with Cocolife HealthCare. A disease will be considered as pre-existing if:

      • Illness or injury was evident before the effective date of the coverage.
      • You have sought prior treatment before the inception date of your coverage.
      • Medical conditions disclosed in the application form.
      • Injury or illness that is clinically determined to have started before the inception date of the coverage.

      If there is any pre-existing medical condition that will not be covered, it will be indicated in your Cocolife Healthcare ID.

    11. Exclusions
    12. If the following do not have any exemptions under the benefits provisions, the policy will not cover any loss resulting from:

      • Death, illness, or injury attributed to one’s own misconduct, indulgence to alcohol or drugs, gross negligence, immoral habits, violation of law, or participation in a crime.
      • Intentional self-destruction, self-inflicted injury, death, attempt to threat whether sane or not.
      • Unnecessary exposure to perils such as use of firecrackers, participating in hazardous sports, diving, climbing, boxing, hand-gliding, football, hurling, hunting, motor competitions, ice hockey, motorcycling, polo, parachuting, potholing, racing, power boating, show jumping, use of wood-working machines, skydiving, winter sports, water ski-jumps, yachting beyond 5km of coastline, wrestling, and flying except air travel.
      • War, an act of foreign enemy, invasion, hostilities, or warlike operations, civil commotion, mutiny, strike, riot, rebellion, civil war, revolution, rebellion, conspiracy, insurrections, martial law, quarantine, etc.
      • Homicide, murder, physical injuries caused by provocation of the insured.
      • If you get any bodily injury or sickness because you are serving in Armed Forces and are participating in investigative, political, police, paramilitary, or military activities.
      • Contamination by radioactivity or ionizing radiation from nuclear waste, or nuclear fuel.
      • Congenital conditions and anomalies arising from nervous, mental, or other functional disorders of the mind.
      • Treatment for pre-existing conditions that are subject to waiting period.
      • Hospitalisation for x-ray examination, diagnosis, check-ups, routine physical examinations, dialysis, custodial, rest cures, non-surgical care for TB, long-term rehabilitation, treatment of post-natal or neo-natal abnormalities.
      • Dental work, oral surgery, treatment, treatment for error of refraction, hearing aids fitting, eyeglasses fitting, cosmetic procedures, and plastic surgery.
      • Treatment that involves sophisticated procedures like angiography, thallium scintigraphy, hyperalimentation, dialysis, chemotherapy, radiotherapy, organ transplantation, brachytherapy, open heart surgery, treatments where conventional treatment modes exist, speech therapy, respiratory therapy, occupational therapy, physical therapy, and other similar forms of treatments.
      • Human anti-rabies vaccine, anti-tetanus vaccine, other vaccines, take home drugs, and medicines.
      • Treatment related to pregnancy, miscarriage, childbirth, sterilization, sex transformation, artificial insemination, care for infertility, and treatment of AIDS.
      • Treatment of scoliosis, cataract, Guillain-Barré syndrome, benign prostatic hypertrophy, chronic glomerulonephritis, vitiligo, spinal stenosis, rheumatic heart disease or cardiac valvular, epilepsy, and chronic dermatoses.
      • Treatment that is not recommended and performed by a physician.
      • Charges that are not covered by the insurance company, treatments that are provided for free, or treatment for a communicable disease that has caused a state of emergency in a particular area.
      • Purchase of oxygen dispensing unit, use of durable medical equipment, artificial aids, expenses of prosthetic appliances, orthopaedic hardware, and surgically-implanted external device.
    13. Limitations
    14. The hospital services are subject to its regulations, discretions, and rules. Cocolife Healthcare is not liable for failure or delay in the services provided by the hospital. The admissions, availability of personnel and facilities, discharges, accreditation with the Company, acknowledgement of coverage and validation of identification are included in the rules, discretions, and regulations.

      Cocolife Healthcare will not be responsible for providing care for the condition if the patient is refusing the recommended treatment or procedure. The Cocolife Healthcare Plan coordinator will be doing the recommendation.

    Things to Remember

    You must remember the following:

    • You must file for PhilHealth before or on the day of discharge for in-patient confinement and outpatient procedures.
    • You must stay within your room limit and must downgrade to a lower rate if there is a non-availability of assigned room plan. This will help you from incurring excess charges.
    • If it is a case of an emergency, you must proceed to the emergency room. For cases of accidents, a police report is required.

    Rights and Responsibilities of an Insured

    A Cocolife Healthcare member has the following rights:

    • To be informed of your medical condition and to get the right advice.
    • To receive appropriate and prompt treatment.
    • To take part in decision-making concerning your care.
    • To refuse treatment.
    • To be informed of the medical consequences.
    • To be informed of the plan’s benefits and limitations during a confinement.
    • To have your medical records held confidentially.
    • To be treated with respect and recognise your right to privacy.

    A Cocolife Healthcare member will have the following responsibilities:

    • To understand the basic procedures and healthcare benefits.
    • To practice good health habits.
    • To keep you Cocolife Healthcare ID on you at all times.
    • To cooperate with the Cocolife Healthcare staff.
    • To attend all scheduled appointments on time.
    • To understand the medical treatments.
    • To be considerate of all attendants and staff.
    • To promptly call Cocolife Healthcare if there is any difficulty with the service provider.

    Cocolife Healthcare FAQs

    1. Where do I find the list of network hospitals and clinics of Cocolife healthcare?
    2. A list is available on cocolifehealthcare.com.ph in the form of drop down options which help you in getting details of the nearest network hospital in your locality.

    3. How do I contact Cocolife for a medical reimbursement?
    4. You can call the 24 hour member assistance hotlines on the numbers below for information regarding reimbursement.

      PLDT: (+632) 812-9090

      Globe: (+63917) 536-0962

      Sun: (+63922) 892-8828

      Smart: (+63908) 894-7763

    5. I would like to enrol my dependents for the medical insurance program provided by my company? How do I do that?
    6. You need to contact the HR department in your company for further information in this regard. As Cocolife provides customised insurance programs for companies, the enrollment depends on the agreed terms.

    7. Does Cocolife provide reimbursement for costs of medicines and tests availed outside the network hospital?
    8. Yes, it does provide a reimbursement, provided the charges are covered in the policy terms and have been recommended by the doctor/staff treating the patient.

    9. I lost my Cocolife Healthcare card and need to undergo hospitalization for a surgery. How do I proceed?
    10. Please call the Member Assistance Hotline on the phone numbers provided for endorsement of the treatment by Cocolife representatives. You’re required to produce a valid identification proof at the hospital.

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