AWPI continues to send financial aid to displaced artist during the COVID-19 pandemic

HMO for Artists 2023-2024



1Consultations during regular clinic hours, except prescribed  medicines Covered
Pre and Post Natal consultations 14 sessions
3Eye, ear, nose and throat (EENT) treatment prescribed by an Accredited Physician/Specialist Covered
4Treatment for minor injuries such as lacerations, mild burns, sprains and the like Covered
Dressings, conventional casts (plaster of Paris) and sutures Covered
6X-Ray, laboratory examinations, routine, diagnostic and therapeutic procedures prescribed by an Accredited Physician/Specialist, provided however that the cost of diagnostic and therapeutic procedures covered shall be limited to a specific amount.Covered
7Minor surgery not requiring confinement prescribed by an Accredited Physician /Specialist Covered
8Eye laser therapy only for retinal hole, retinal detachment and glaucoma, excluding eye correction such as lasik, PRK and the likeUp to Php10,000 per eye
Cauterization of Warts (neck down except genital warts) Up to Php1,000
10 Sclerotherapy Up to Php5,000
11 Allergy Testing/ allergy screening and other related examinations Up to Php2,500
12 Speech Therapy 12 sessions
13 Tuberculin Test (on reimbursement) Up to Php600
Room and Board Accommodation Subject to the Member’s Room and  Board limit
2Use of operating room, Intensive Care Unit (ICU), isolation room (if prescribed by Attending Accredited Physician) and recovery room.Covered
Professional fees in accordance with HMO rates
a. Attending Physicians Covered
b. Surgeons Covered
c. Anesthesiologists 50% of Surgeon’s Fee
d. Cardio-pulmonary clearance before surgery and cardiac  monitoring during surgery. Covered
Standard Nursing Services Covered
Medicines for in-patient use Covered
6Blood products transfusions and intravenous fluids, including blood screening and cross matching. Covered
7X-Ray, laboratory examinations, routine, diagnostic and therapeutic procedures incidental to confinement Covered
Dressings, conventional casts (plaster of Paris) and sutures Covered
Anesthesia and its administration Covered
10 Oxygen and its administration Covered
11 Standard Admission kit Covered
12All other items directly related in the medical management of the patient, as deemed medically necessary by the Attending Accredited PhysicianCovered
24 Holter Monitoring Covered
2D Echo with Doppler Covered
Adrenocortical Function Covered
Anti Nuclear Antibody, C-Reactive Protein, Lupus Cell Exams Covered
Arterial Blood Gas Covered
Audiograms and Tympanograms Covered
Bone Densitometry Scan (Dexascan) Covered
Bone Mineral Density Studies Covered
Cardiac Stress Tests Covered
10 Conventional Hemorrhoidectomy Covered
11 Cyrosurgery (once a year) Covered
12 CT Scan Covered
13 Electromyelography and Nerve Conduction Studies Covered
14 Endoscopic Procedures Covered
15 Hysteroscopic Myoma Resection Covered
16 Hysteroscopically Guided D&C Covered
17 Impedance Plethysmography Covered
18 Lung Function Studies Covered
19 Magnetic Resonance Imaging Covered
20 Mammography and Sonomammogram Covered
21 Microscopic Examinations Covered
22 Myelogram Covered
23 Neuroscan (Professional fee will be subject for reimbursement) Covered
24 Nuclear Radioactive Isotope Scan Covered
25 Organ Donation/Transplant (except cost of organs) Covered
26 Percutaneous Ultrasonic Adrenalectomy Covered
27 Perfusion Scan Covered
28 Plasma Urinary Cortisol/Plasma Aldosterone Covered
29 Radionuclide Ventriculography Covered
30 Radioscope Scans and Function Studies Covered
31 Scalpel Hemorrhoidectomy Covered
32 Treadmill Stress Test Covered
33 Video Gastroscopy Covered
34 Chemotherapy 12 sessions
35 Dialysis 12 sessions
36 Physical Therapy 12 sessions
37 Radiotherapy 12 sessions
38 Angiogram/Angioplasty/Coronary Artery Bypass Graft Up to MBL
39 Arthroscopic Procedures Up to MBL
40 Flourescein Angiography Up to Php30,000
41 Magnetic Resonance Angiography Up to Php30,000
42 Transurethral Microwave Therapy of Prostate Up to Php30,000 (once a year)
43 Percutaneous Ultrasonic Nephrolithotomy Up to Php30,000 (once a year)
44 Stapled Hemorrhoidectomy Up to Php10,000
45 New or sophisticated procedures Up to Php5,000
46 Polysomnograms (Sleep Recording) Up to Php5,000
47 Laparoscopic Cholecystectomy/Adrenalectomy Up to MBL
48 Lithotripsy Up to Php30,000
49 Thallium Scintigraphy Covered
50Other modalities of treatment and/or diagnosis requiring sophisticated equipment for which there are no conventional counterpartsMaximum limit of Php5,000
In Accredited Hospitals
a. Doctor’s services Covered
b. Emergency Room Fees Covered
c. Medicines used for immediate relief during treatment Covered
d. Oxygen, Intravenous fluids and blood products Covered
e. Dressings, conventional casts (plaster of Paris) and sutures Covered
f. X-Rays, laboratory and diagnostic examinations, and other  medical services related to the emergency treatment of the  patientCovered
Room Upgrade in case of room unavailability Covered for the first 24 Hours
In Non-Accredited Hospitals (within the Philippines) 100% up to MBL based on relative unit  value rates
Outside the Philippines 80% up to Php30,000 based on relative  unit value rates
Areas without Accredited Hospitals 100% up to MBL based on relative unit  value rates
Ambulance Service (hospital to hospital) Up to Php2,500 (reimbursement basis)
Anti Tetanus, Rabies and Venom Covered within the first 24 hours
Principals Covered up to P15,000  /yearAll pre existing lumped together
PEC conditions of Mr. Fernando Josef Covered up to P15,000/illness/year
Work Related Conditions Covered
Cataract Extraction (except cost of lens) Php20,000/member
3Motor Vehicular Accident (subject to Police Report Evaluation &  Standard Exclusion Covered
Unprovoked Assault Covered
Scoliosis, Spinal Stenosis, Slipped disc & Spondylosis Up to Php20,000
6Congenital Conditions except physical therapy sessions and  developmental disorders
Dental consultation including orthodontic & aesthetic services Covered
Simple oral prophylaxis 1
Any number of non-surgical tooth extraction Covered
Recementation of jacket, crowns, inlays and onlays NA
Emergency desensitization of hypersensitive teeth NA
Gum treatment excluding the cost of prescribed medicines NA
Minor adjustments of dentures NA
Care for oral lession, wounds & burns Covered
Temporary Fillings 1
10 Relief of acute dental pain Covered
11 2 teeth light cure filling NA
To be conducted at a designated Affiliated Clinic (except Healthway Medical Clinic)
Taking of Medical History Covered
Physical Examination Covered
Chest X-ray Covered
Urinalysis Covered
Stool examination Covered
Complete Blood Count (CBC) Covered
Electrocardiogram For members 35 years old & above
Pap smear For female members 35 years old &  above
ECU IP Not Covered
ECU OP Not Covered
Maternity Benefit Not Covered
Point of Service Not Covered
Refund Formula for Cancelled Members (Number of days covered) / Number of  days in the billing period x Premium
Medico Legal Case (Reimbursement; Subject to Police Report) Not Covered
5Cost of artificial limbs, joint prosthesis and heart valve  prosthesis Not Covered
Experience Discount Not Applicable
Filing of Reimbursement Claims 30 calendar days
Bill-back Arrangement 12% service fee
PhilHealth Fee Php3,300 per individual
Natural Death (amount of insurance) Php10,000
Accidental Death and Disablement (amount of insurance) Php10,000

About the Author

Leave a Reply

Your email address will not be published. Required fields are marked *

Related Posts