• ValuCare Health Systems

    Value Care Health Systems Health Insurance

    Overview of ValuCare Health Systems

    In 1997, a group of medical practitioners decided to start a corporation to make quality medical care accessible and affordable to Filipinos. From a small 40-staff startup, ValuCare Health Systems has matured to become one of the leading Managed Care Companies in the Philippines, employing over 200 staff members. They have also established multiple branch offices around Philippines including branches in Davao, Cebu and Iloilo. Being an official member of the Association of Health Maintenance Organizations of the Philippines, they have also successfully achieved to build a network of service providers and healthcare packages that benefit its ever-growing client base.

    Account Types

    ValuCare offers four account types for their clients. They are Individual, Family, Group and Corporate accounts. Individual account is meant for individuals who are not enrolled within a group or corporate account and who do not have dependents. Family account is for a minimum of three members, of which at least one should be an adult who will be the principal member. Group account is for a group of at least ten individuals who work in the same company. Corporate account is meant for a group of at least twenty regular employees who work in the same company / organization.

    Features and Benefits of ValuCare

    As a ValuCare cardholder, you will be able to choose from a pool of the most competent health services that are accredited with ValuCare. It is also possible to get the medical coordinators to assist you if you are looking for options beyond the accredited list of hospitals and clinics. The following features and benefits is the reason behind ValuCare’s continued success in the market:

    • The exceptional After Sales Service keeps members happy long after they make their initial payment. The team of Client Service Staff Specialists will handhold you through all the procedures and issues you may have.
    • There is a team of Medical Liaison Officers who are dedicated to the task of making sure that you get the best delivery of medical services. This team is trained to make quick decisions when you need it most. They also make sure that the service members get is hassle-free and prompt. Members are assured of visits within 24 hours for personalized service.
    • ValuCare boasts of more than a 1000 accredited hospitals and clinics in Philippines which its members can take advantage of. There are also more than 16,000 specialists who are associated with ValuCare for the members’ benefit. In the dental sphere, there are more than 680 accredited dental clinics and more added periodically making the services of ValuCare accessible to clients around the globe.
    • The competent In-House Client Service Officers are available 24/7 to attend to all of the members’ medical queries
    • The Medical Director for Utilization Management and Claims Administration meet the UM Group regularly to discuss the best ways to improve services.

    Other services include Out-Patient Services, In-Patient Services, Preventive Health Services, Emergency Services, Dental Benefits, Coverage for pre-existing conditions (please call ValuCare to find out more details about this), Valu + Features, Financial Assistance (for primary insured) and Special Modalities.

    Outpatient Services includes:

    • Regular consultations & treatments with plan coordinators
    • You will be referred to accredited specialists
    • Dressings, casts and sutures (except fiberglass supplies)
    • Treatment of minor injuries (such as sprain, laceration, minor burns etc.)
    • Minor surgical procedures which do not require confinement
    • Pre/post-natal consultation with accredited OB-gynecologists

    In-Patient Services includes:

    • Admission kit
    • According to the member’s plan, room and board will be assigned.
    • Professional fees of the attending physicians, anesthesiologist and surgeons
    • Standard nursing services
    • Oxygen and inhalation therapy
    • Blood transfusions, including human blood products except gamma globulins
    • Dressings, casts and sutures (except fiberglass supplies)
    • All drugs, medicines and injectables while confined including anesthesia, IV fluids and its administration
    • Prescribed X-rays, diagnostic procedures and laboratory exams
    • Use of the operating room/recovery room, ICU/CCU

    Preventive Healthcare Services includes:

    • Administration of immunization (but not the cost of the vaccines)
    • Annual Physical Examination (APE)
    • Family planning and counseling
    • Tracking medical history with on-going records
    • Medical Management of health problems, health education, counseling on diet and exercise
    • Members of 35 years and above are entitled to ECG
    • You can choose the topic for wellness programs, seminars or lectures
    • Female members of 35 years and above are entitled to Pap smear
    • Assessment by accredited physicians
    • X-ray of the chest
    • Fecalysis (stool exam)
    • Urinalysis (urine exam)
    • Complete Blood Count (CBC)

    Emergency Care Services include:

    • Services of hospitals and doctors
    • Any medications that are used for immediate relief of the patient’s symptoms
    • Dressings, casts and sutures (except fiberglass supplies)
    • Prescribed X-rays, diagnostic procedures and laboratory exams

    Any other medical services that are related to the emergency situation which are considered to be absolutely essential for the treatment.

    • If you are in an area without accredited hospitals and you go for emergency care in an alternate hospital, you are eligible to Maximum Coverage Benefit (MCB) based on VC Relative Units globulins. You will be reimbursed up to P30,000.
    • If you are on an official business trip abroad, emergency medical care is reimbursable up to P30,000. ValuCare takes care of 80% of the hospital bills that you pay. Also based on ValuCare Relative Values, 100% of PF will be covered.
    • 80% on Room & Board will be reimbursed based on the member's plan. 80% reimbursement of medicines and laboratory/diagnostic procedures. Based on ValuCare rates, 100% of the physicians’ fee will be reimbursed.
    • You are entitled to receive blood tests (which require fasting) at home or at your office at no extra cost. However, this service is only available for members in Metro Manila area.

    ValuCare Health Systems FAQs

    1. As a member, can I get medical consultation or out-patient healthcare services (non-emergency) if I go to an accredited hospital on Sundays?
    2. Doctors are available only for emergency cases on Sundays. Out-patient healthcare services are available only on weekdays (on Saturdays, most doctors work half day). You can call the ValuCare Customer Service Hotline for more information. You will be referred to the nearest accredited clinic. Most of the clinics on the list are available on Sundays, particularly those inside malls. These doctors have different specializations which make them the best option for out-patients.

    3. I was an in-patient at an accredited hospital, but the doctor treating me was not accredited, what will the coverage for my bill be?
    4. As it is mentioned in the Exclusions & Limitations, the case will not be covered. It is stated that ‘Service from Non-VALUCARE Accredited Physicians and / or Non-VALUCARE Accredited Hospitals and other health / medical providers, including adverse medical conditions arising from treatment of the same except those stipulated under the provisions on emergency care services.

      You will be eligible to get your service reimbursed if you have Point of Service provision.

      In case you find that you cannot find a specialist doctor suitable for your particular health care in the list of accredited doctors, you may go to another hospital and your bill will be reimbursed by ValuCare. The Professional Fee will however be on a reimbursement basis which is subject to Exclusions, MCB and Limitations, as well as ValuCare reimbursement procedures.

    5. If ValuCare Coordinators are not available during regular clinic hours at an accredited hospital what shall I do?
    6. If the medical care you need is an emergency, you may go directly to the emergency room or for immediate endorsement to emergency room personnel, you could call ValuCare Customer Service Hotline (02.702.3310).

      In case of non-emergency medical care, you must call ValuCare Customer Service Hotline (02.702.3310) and follow these steps:

      A) ValuCare will recommend a suitable doctor in the hospital, from the accredited list.

      B) The ValuCare staff member will provide all the necessary documents as required by accredited hospital. If there are no suitable doctors for your medical care in the hospital, the ValuCare staff will refer you to another accredited clinic/hospital.

    7. How can I find out my present remaining Maximum Coverage Benefit (MCB)?
    8. To find out your MCB, all you have to do is contact the ValuCare Customer Service Hotline (02.702.3310) or the account officer-in-charge. They will give you your updated MCB computation.

    9. I have applicable government subsidized discounts. Does this mean that it will be deducted on the MCB (Maximum Coverage Benefit)?
    10. Applicable discounts will not be deducted from the MCB computation. It is wise to avail discounts so that you maximize the usage of your MCB.

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