• ValuCare

    Value Care Health Systems Health Insurance

    Valu Care Health Systems, Inc was established in 1997. It is founded by a group of physicians who objective was to make healthcare services affordable and accessible to the people. Quality healthcare is provided to the members via the wide network of service providers, healthcare packages, and hospitalization benefits.

    Why Choose ValuCare?

    When you choose ValuCare, you get extensive healthcare benefits coverage, vast network of dental and medical providers, etc. The ValuCare cardholders have the option to choose the doctor and hospital from the wide range of accredited providers. The cardholders can also seek assistance from the medical coordinators if they do not have any particular preference.

    Following are the various reasons why one must choose ValuCare:

    • Medical service group: There is a team of Medical Liaison Officers who have to attend to proper delivery of the medical services. They are capable of making decisions in need of immediate response. This ensures that the members are provided hassle-free services. You will get immediate visitation within 24 hours to give assistance and provide personalized service.
    • After sales service: There is a team of Client Service Staff Specialists to assist you.
    • Call centre: To make sure that there is quick response to any queries at any time of the day regarding the medical availments, ValuCare has 24/7 call centre. The call centre is manned by highly competent in-house Client Services Officers.
    • Network providers: ValuCare has the most comprehensive network of providers in the Health Maintenance Organisations industry. ValuCare has over 1,000 accredited clinics and hospitals. There are over 16,000+ accredited specialists who are equipped to offer medical services to you.
    • Utilization Management: The Utilization Management discusses how to best maximise the services. The medical director heads Utilization Management and Claims Administration. He regularly coordinates with Corporate Accounts.

    Benefits and Availments

    Following are the various benefits and availments offered:

    1. Preventive Healthcare Services:
    2. Following are the various preventive healthcare services offered:

      • Family planning and counselling.
      • Administration of immunization.
      • Medical management of health problems, counselling on diet, health education, and counselling on exercise.
      • On-going records of medical history.
      • Wellness programs, seminars, and lecture on topic of choice.
      • Annual physical examination that includes physician’s assessment, medical history, fecalysis, chest x-ray, complete blood count, urinalysis, pap smear for female above 35 years, and ECG for people over 35 years.
    3. Out-patient Care Services:
    4. Following are the various out-patient care services offered:

      • Referrals to accredited specialists.
      • Consultations and treatments with plan coordinators.
      • Treatment of minor injuries.
      • Dressings, casts, and sutures.
      • Pre or post-natal consultation with accredited OBG.
      • Minor surgical procedures that do not require confinement.

      The availment procedure is as follows:

      • Step 1 – You must proceed to a ValuCare accredited clinic or hospital.
      • Step 2 – You must present your ValuCare card to the plan coordinator for consultation.
      • Step 3 – The plan coordinator will refer you to a specialist, if required.
      • Step 4 – You must return to your plan coordinator to get request for any procedures required.

      Procedures that cost more than P1,000 will need approval.

    5. In-patient Care Services:
    6. Following are the various in-patient care services offered:

      • Standard nursing services.
      • Room and board based on the plan.
      • Use of recovery room, operating room, CCU, or ICU.
      • Professional fees of the attending surgeons, physicians, and anaesthesiologist.
      • Sutures, casts, and dressings.
      • Blood transfusions.
      • Oxygen and inhalation therapy.
      • Prescribed x-rays, diagnostic procedures, and laboratory exams.
      • Drugs, anaesthesia, IV fluids, medicines when confined and its administration.
      • Admission kit.

      The availment procedures are as follows:

      • Step 1 – You must proceed to the Admitting Section of ValuCare accredited hospital.
      • Step 2 – You must then present your ValuCare card and your admitting order.
      • Step 3 – ValuCare will then issue the LOA after verification.
      • Step 4 – You must do the following after discharge:
        • File for PhilHealth.
        • Check the hospital discharge slips.
        • Settle charges that are not covered by ValuCare.
    7. Emergency Care Services:
    8. Following emergency care services are offered:

      • Medications that is used for immediate relief of symptoms.
      • Doctors services and hospital services.
      • Prescribed laboratory, x-rays, and exams & diagnostic procedures.
      • Casts, dressings, and sutures for wound.
      • Medical services that are related to the emergency management which are believed necessary to the treatment of the case.
      • Maximum coverage benefits for foreign territories while on official business trip which is reimbursable is up to P30,000. 80% of the applicable hospital bills will be covered.

      The availment procedures are as follows:

      • Step 1 – You must proceed to the Emergency Room of ValuCare accredited hospital and present your ValuCare card.
      • Step 2 – Emergency Room personnel will render proper treatment.
      • Step 3 – Follow the in-patient procedures for admissions.
      • Step 4 – You must submit the following for non-admissions upon discharge from Emergency Room:
        • Sign the necessary documents.
        • Check the hospital discharge slips.
        • Settle charges that are not covered by ValuCare.
    9. Non-network Emergency:
      • The non-network emergency benefits are as follows:
      • The emergency cases at medical facilities that are not accredited by ValuCare may be reimbursed for up to P30,000.
      • The emergency cases on official business trip outside the Philippines may be reimbursed for up to P30,000.
      • The reimbursements is based on the following schedule:
        • 80% on the room and board based on the plan.
        • 80% on laboratory procedures, medicines, or diagnostic procedures.
        • 100% of the physician’s fee based on ValuCare rates.
    10. Valu+ Features:
    11. You will get Personalised Access to Laboratory Services. There will be no extra cost for blood test that required fasting to be done at office or home. Personalised Access to Laboratory Services is available in Metro Manila area. ValuCare services are available on the mobile website, dynamic website, and Android app.

    Types of Accounts in ValuCare

    Following are the various types of accounts one can hold with ValuCare:

    • Individual account: An individual who does not have any dependents and if he/she is not enrolled with any group or corporate account can open an individual account.
    • Group account: Group account can be opened by a group of individuals who work in the same company. A minimum of 10 employees are required to open this account.
    • Family account: Family account can be opened by a minimum of 3 members. There has to be an adult who will be the principal member.
    • Corporate account: A corporate account can be opened by individuals who are working in the same organisation or a company. There must be at least 20 regular employees to be eligible to open this account. All the regular employees can be a part of this account.

    Coverage Offered by ValuCare

    Following are the various coverages offered by ValuCare:

    1. Pre-existing Conditions Coverage:
      • An injury or illness that exists prior to the effective date of the coverage is considered as follows:
      • The professional advice or treatment has been obtained for the injury or illness prior to the date of coverage.
      • An injury or illness that is evident to you prior the effective date of your membership.
      • Natural history of the illness or injury can be determined clinically to have started prior to the effective date of coverage.

      You will have to submit the required documents when applying for ValuCare. The pre-existing conditions are covered after the first year of membership unless the condition is excluded. You will get 50% coverage in the 2nd year. In the 3rd year, you will get 100% of the coverage as per your illness per year. For gall stones and kidney stones, the coverage is 75% of the aggregate limit. There will be no coverage for the dreaded diseases except for cases that are acquired during the effectivity of the membership. From the 4th year, you will get 100% coverage for all medical cases.

      The following conditions are considered pre-existing if occurred during the first year of coverage:

      • Benign growth or tumors.
      • Acquired hernias.
      • Buerger's disease.
      • Bronchial asthma.
      • Chronic ENT conditions that require surgery.
      • Fatty liver.
      • Eye disorders such as glaucoma and cataract.
      • Gastric and duodenal ulcers.
      • Gallbladder diseases.
      • Gynaecological conditions.
      • Hypertension, dyslipidemia, and atherosclerosis.
      • Haemorrhoids and anal fistula.
      • Neurological disorders.
      • Peptic ulcer disease.
      • Osteoarthritis, hyperuricemia, and gout.
      • Tuberculosis.
      • Thyroid disease.
      • Prostate diseases.
      • Varicose veins.

      The following diseases are considered to be dreaded:

      • Central Nervous System lesions.
      • Cerebrovascular Accident.
      • Cardiovascular disease.
      • Chronic Obstructive. Pulmonary Disease.
      • Chronic Kidney Disease.
      • Liver Parenchymal Disease.
      • Chronic Gastrointestinal Tract Disease.
      • Diabetes Mellitus and its complications.
      • Collagen diseases.
      • Cancer, Leukemia, etc.
      • Complications of an apparent ordinary illness.
      • Injuries from assaults or accidents, frustrated murder or homicide subject to police report.
      • Chronic pain syndrome.
      • Conditions that require dialysis.
      • Any illness that would require ICU confinement.
    2. Special Modalities:
      • Following are the special modalities coverage available:
      • Cataract surgery.
      • 24 hour Holter Monitoring.
      • Chemotherapy.
      • 2D Echo with Doppler.
      • CT scan.
      • Eye Laser Therapy.
      • Dialysis.
      • Laparoscopic procedures.
      • Herniorrhaphy.
      • Lithotripsy.
      • Nuclear Radioactive Isotope Scan.
      • Magnetic Resonance Imaging.
      • Out-patient physical therapy.
      • Open heart surgery.
      • Ultrasound which is not pregnancy related.
      • Radiotherapy.
      • Prostate Surgery.

    FAQs about Valu Care Health Systems

    1. Can I get a medical consultation if I go to an accredited hospital on a Sunday?
    2. Yes, you can get a medical consultation as the doctors will be available for emergency cases. You can call ValuCare customer service hotline for more information.

    3. If I am admitted in an accredited hospital and the doctor treating me is not accredited what will be my coverage?
    4. You will not get any coverage if the Services are availed from a non-ValuCare accredited physician.

    5. What should I do if ValuCare coordinators are not available during the clinic hours at an accredited hospital?
    6. You can directly go to the emergency room and call the ValuCare customer service hotline. If it is a non-emergency case, you must call the ValuCare customer service hotline, where you will be recommended for a suitable doctor.

    7. How do I find out my present remaining maximum coverage benefit?
    8. You can find out the maximum coverage benefit by calling the ValuCare customer service hotline at 02 – 702 – 3310.

    9. If I have a government subsidized discount, will it be deducted from the maximum coverage benefit?
    10. No, the applicable discount will not be deducted from the maximum coverage benefit computation. You must avail the discount to maximize the usage of your maximum coverage benefit.


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