PERSONAL AND FAMILY HEALTHCARE SOLUTION
The importance of having a family medical insurance plan cannot be overstated. It provides a sense of security and peace of mind, knowing that you and your loved ones are covered in case of unexpected medical emergencies. With our family medical insurance offer, you can rest easy knowing that you have access to quality healthcare at an affordable price.
Our plan covers a wide range of medical services, including doctor visits, hospital stays, emergencies, and more. We also offer dental and life coverage.
Don’t wait until it’s too late. Protect your family’s health and financial well-being with our family medical insurance offer. With the right insurance coverage in place, you can rest assured that you’ll have access to the medical care you need, when you need it most.
PERSONAL AND FAMILY HEALTHCARE SOLUTION
The importance of having a family medical insurance plan cannot be overstated. It provides a sense of security and peace of mind, knowing that you and your loved ones are covered in case of unexpected medical emergencies. With our family medical insurance offer, you can rest easy knowing that you have access to quality healthcare at an affordable price.
Our plan covers a wide range of medical services, including doctor visits, hospital stays, emergencies, and more. We also offer dental and life coverage.
Don’t wait until it’s too late. Protect your family’s health and financial well-being with our family medical insurance offer. With the right insurance coverage in place, you can rest assured that you’ll have access to the medical care you need, when you need it most.
Coverage
Inpatient Benefits
- Room & Board according to type of enrollment.
- Services of specialist like anesthesiologists, internists, surgeons, etc.
- Services and medications for general/spinal anesthesia or other forms of anesthesia deemed necessary for a surgical procedure.
- Blood products transfusions and intravenous fluids.
- X-ray and Laboratory examinations.
- Administered medicines.
- Dressings, plaster casts, sutures and other items directly related to the medical management of the patient.
- ICU confinements, Chemotherapy, Radiotherapy, and Dialysis are covered subject to maximum limits and pre-existing conditions coverage.
- Modern therapeutic modalities and interventional surgical procedures such as, but not limited to laparoscopic surgery and lithotripsy, are covered up to P20,000 each per year subject to the pre-existing conditions coverage.
- CT Scan, MRI and ultrasound are covered up to P5,000 each per member per year subject to the pre-existing conditions coverage (inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure).
- The following complex diagnostic examinations and the therapeutic procedures shall be covered up to P5,000.00 each per member per year subject to the pre-existing conditions coverage (inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure):
- Angiography (e.g. coronary, cerebral, retinal, pulmonary, GI, etc.).
- Pulmonary perfusion scan.
- Tests involving use of Nuclear Technologies (Radionuclide Ventriculography/Thallium stress testing/Radionuclide Thyroid scan, etc.), nuclear technologies such as Pyrophosphate Scintigraphy, Positron Emission Tomography, Radio Isotope Scanning, etc.).
- Electromyography, Nerve Conduction Velocity Studies.
- 24-Hour Holter Monitoring, 2-D Echo and Doppler.
- Treadmill Stress Test.
- Myelogram.
- Endoscopy including one of video.
- Orthopedic Arthroscopy.
- Adrenocortical Function (e.g. Primary Aldosteronism, Cushing’s Disease).
- Plasma/Urinary Cortisol, Plasma Aldosterone, etc.
- Mammography (breast cancer) and Sonomammogram.
- Bone densitometry scan (DEXA scan).
- Anti-nuclear antibody (ANA), C-Reactive protein (Rheumatic and its complications), Lupus cell exam.
- Laboratory/ancillary services for conditions whose pathogenesis or subsequent clinical improvement is not yet fully established in Medical Science.
- New modalities and / or diagnostic and treatment procedure for conditions with established etiologies and its use is only as alternative to the conventional methods.
- Genetic / Immunologic studies.
- Radioactive Iodine therapy.
- All other items related to the management of the case.
Excess Charges and Incremental Costs
- Excess charges, also known as excess room and board fees, occur when a patient is placed in a room with a rate higher than their coverage level. If they choose a higher category room than their plan covers, like upgrading to a private room, they’ll incur additional costs on top of any disapproved charges.
- If a member is covered by multiple corporate or group health agreements with Rayocare, they need to pick one agreement per confinement for benefits. They follow the terms and limits of that chosen agreement but can still use benefits from another agreement for different confinements.
Outpatient Benefits
- Regular consultations and treatment (except prescribed medicines).
- Referral to specialist(s).
- Eye, ear, nose and throat treatment.
- Treatment of minor injuries and surgeries not requiring confinement.
- X-ray and laboratory examinations, routine, diagnostic procedures.
- Speech therapy (for stroke patients only).
Emergency Benefits
In cases of emergency where the MEMBER avails of the services of Accredited Hospitals/Clinics, the following will be provided:
- Doctor’s services.
- Medicines used during treatment or for immediate relief.
- Oxygen and intravenous fluids.
- Dressings, plaster casts, and sutures.
- X-ray, laboratory, diagnostic examinations and other medical services related to the emergency treatment of patient.
Non-Accredited Hospitals – Reimbursement up to 80% of the actual hospital bills and 80% of the professional fees, based on Rayocare rates, up to PHP30,000.00 / availment / member.
Areas Without Accredited Hospitals – Reimbursement of 100% of hospital bills and professional fees based on Rayocare rates.
Outside the Philippines – Reimbursement of 100% of actual costs up to PHP30,000.00 / availment / member.
Ambulance Service up to P2,500.00 per conduction.
Preventive Healthcare Benefits
The following no-charge Preventive Health Care Services will be provided to members at any designated Rayocare Medical Service Clinic:
- Annual Physical Examination (APE) to include:
- History & Physical Exam
- Complete Blood Count
- Urinalysis (urine examination)
- Fecalysis (stool examination)
- Chest X-ray
- Routine Immunization (except cost of vaccines).
Dental Benefits
Members may avail of the following dental care services from any of the accredited dental clinics:
- Consultations and oral examinations
- Once a year oral prophylaxis
- Simple tooth extractions, except surgery impacted tooth
- Temporary fillings
- Gum treatment and adjustment of dentures
- Recementation of loose jackets, crowns in-lays and on lays
- Treatment of mouth lesions, wounds and burns
Dental care services availment procedures:
- Call or text our dental network, 1-Worldwide Health to set up appointment.
- Landline: (02) 7592402
- Mobile:
- (Globe; Call or SMS): (0917) 884-8859
- (Smart): (0920) 502-4535
- (Sun): (0922) 898-6481
- Email: [email protected]
- Visit dentist and present valid ID to avail of service.
- Sign all related documents and forms after treatment/ procedure was done.
Impatient Benefits
- Room & Board according to type of enrollment.
- Services of specialist like anesthesiologists, internists, surgeons, etc.
- Services and medications for general/spinal anesthesia or other forms of anesthesia deemed necessary for a surgical procedure.
- Blood products transfusions and intravenous fluids.
- X-ray and Laboratory examinations.
- Administered medicines.
- Dressings, plaster casts, sutures and other items directly related to the medical management of the patient.
- ICU confinements, Chemotherapy, Radiotherapy, and Dialysis are covered subject to maximum limits and pre-existing conditions coverage.
- Modern therapeutic modalities and interventional surgical procedures such as, but not limited to laparoscopic surgery and lithotripsy, are covered up to P20,000 each per year subject to the pre-existing conditions coverage.
- CT Scan, MRI and ultrasound are covered up to P5,000 each per member per year subject to the pre-existing conditions coverage (inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure).
- The following complex diagnostic examinations and the therapeutic procedures shall be covered up to P5,000.00 each per member per year subject to the pre-existing conditions coverage (inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure):
- Angiography (e.g. coronary, cerebral, retinal, pulmonary, GI, etc.).
- Pulmonary perfusion scan.
- Tests involving use of Nuclear Technologies (Radionuclide Ventriculography/Thallium stress testing/Radionuclide Thyroid scan, etc.), nuclear technologies such as Pyrophosphate Scintigraphy, Positron Emission Tomography, Radio Isotope Scanning, etc.).
- Electromyography, Nerve Conduction Velocity Studies.
- 24-Hour Holter Monitoring, 2-D Echo and Doppler.
- Treadmill Stress Test.
- Myelogram.
- Endoscopy including one of video.
- Orthopedic Arthroscopy.
- Adrenocortical Function (e.g. Primary Aldosteronism, Cushing’s Disease).
- Plasma/Urinary Cortisol, Plasma Aldosterone, etc.
- Mammography (breast cancer) and Sonomammogram.
- Bone densitometry scan (DEXA scan).
- Anti-nuclear antibody (ANA), C-Reactive protein (Rheumatic and its complications), Lupus cell exam.
- Laboratory/ancillary services for conditions whose pathogenesis or subsequent clinical improvement is not yet fully established in Medical Science.
- New modalities and / or diagnostic and treatment procedure for conditions with established etiologies and its use is only as alternative to the conventional methods.
- Genetic / Immunologic studies.
- Radioactive Iodine therapy.
- All other items related to the management of the case.
Excess Charges and Incremental Costs
- Excess charges, also known as excess room and board fees, occur when a patient is placed in a room with a rate higher than their coverage level. If they choose a higher category room than their plan covers, like upgrading to a private room, they’ll incur additional costs on top of any disapproved charges.
- If a member is covered by multiple corporate or group health agreements with Rayocare, they need to pick one agreement per confinement for benefits. They follow the terms and limits of that chosen agreement but can still use benefits from another agreement for different confinements.
Outpatient Benefits
- Regular consultations and treatment (except prescribed medicines).
- Referral to specialist(s).
- Eye, ear, nose and throat treatment.
- Treatment of minor injuries and surgeries not requiring confinement.
- X-ray and laboratory examinations, routine, diagnostic procedures.
- Speech therapy (for stroke patients only).
Emergency Benefits
In cases of emergency where the MEMBER avails of the services of Accredited Hospitals/Clinics, the following will be provided:
- Doctor’s services.
- Medicines used during treatment or for immediate relief.
- Oxygen and intravenous fluids.
- Dressings, plaster casts, and sutures.
- X-ray, laboratory, diagnostic examinations and other medical services related to the emergency treatment of patient.
Non-Accredited Hospitals – Reimbursement up to 80% of the actual hospital bills and 80% of the professional fees, based on Rayocare rates, up to PHP30,000.00 / availment / member.
Areas Without Accredited Hospitals – Reimbursement of 100% of hospital bills and professional fees based on Rayocare rates.
Outside the Philippines – Reimbursement of 100% of actual costs up to PHP30,000.00 / availment / member.
Ambulance Service up to P2,500.00 per conduction.
Preventive Healthcare Benefits
The following no-charge Preventive Health Care Services will be provided to members at any designated Rayocare Medical Service Clinic:
- Annual Physical Examination (APE) to include:
- History & Physical Exam
- Complete Blood Count
- Urinalysis (urine examination)
- Fecalysis (stool examination)
- Chest X-ray
- Routine Immunization (except cost of vaccines).
Dental Benefits
Members may avail of the following dental care services from any of the accredited dental clinics:
- Consultations and oral examinations
- Once a year oral prophylaxis
- Simple tooth extractions, except surgery impacted tooth
- Temporary fillings
- Gum treatment and adjustment of dentures
- Recementation of loose jackets, crowns in-lays and on lays
- Treatment of mouth lesions, wounds and burns
Dental care services availment procedures:
- Call or text our dental network, 1-Worldwide Health to set up appointment.
- Landline: (02) 7592402
- Mobile:
- (Globe; Call or SMS): (0917) 884-8859
- (Smart): (0920) 502-4535
- (Sun): (0922) 898-6481
- Email: [email protected]
- Visit dentist and present valid ID to avail of service.
- Sign all related documents and forms after treatment/ procedure was done.
Plan Types
BUDGET
- Semi-Private Room & Board
- Php60,000.00 Maximum Benefit Limit
STANDARD
- Semi-Private Room & Board
- Php100,000.00 Maximum Benefit Limit
PREMIUM
- Private Room & Board
- Php150,000.00 Maximum Benefit Limit
Rates
| Members |
Budget |
Rayocare Standard |
Premium |
|---|---|---|---|
|
Principal Member only |
PHP 10,350.00 |
PHP 16,100.00 |
PHP 21,500.00 |
|
Principal Member + 1 Dependents |
PHP 21,978.00 |
PHP 33,376.00 |
PHP 38,640.00 |
|
Principal Member + 2 Dependents |
PHP 32,742.00 |
PHP 49,500.00 |
PHP 57,120.00 |
|
Principal Member + 3 Dependents |
PHP 43,680.00 |
PHP 66,340.00 |
PHP 74,520.00 |
|
Principal Member + 4 Dependents |
PHP 54,912.00 |
PHP 81,690.00 |
PHP 91,980.00 |
|
In excess if 4 Dependants (per dependent) |
PHP 11,534.40 |
PHP 16,320.00 |
PHP 19,264.00 |
NOTE:
Non-PhilHealth members shall pay the corresponding portion during confinements
For medical, surgical, hospital and professional services expenses NOT EXPLICITLY COVERED under this Agreement, member must settle all billings upon discharge from the hospital.
MEMBERSHIP ELIGIBILITY
Principal Member:
Employed Filipino seafarer 18 years old up to age 60.
Dependents:
For Married Principal Members
- The legal spouse at least 18 years old up to 60 years old
- Legitimate and/or legally adopted children 30 days and up to 23 years old
- Unemployed, unmarried and living in the same household as the principal member
For Single Principal Members
- Parents up to age 60, unemployed and dependent upon the principal member
- Brothers and sisters 30 days old and up to 23 years old
- Unemployed, unmarried and living in the same household as the principal member
Note: The choice of enrolling dependents must follow a hierarchy. This means that the spouse first must be enrolled followed by the eldest child, second child and so on for principal member. For single, the parents must be enrolled first followed by the eldest brother/sister and so on.
Principal members will be covered while they are on official vacation, maximum of 9 months. Dependents will be covered for a full year whether the Principal member is on board or on vacation.
Deadline for enrollment of dependents:
For dependents who meet the eligibility requirements within the agreement period -30 days form the date dependent become eligible for membership. (copy of birth certificate or marriage contract must be submitted)
Any additional dependents other than the above can be enrolled upon the renewal of agreement.
After the lapse of the period specified above, Rayocare will no longer receive, evaluate and accept any designation or application to be a qualified dependent from any PRINCIPAL MEMBER.
Underwriting cut-off dates in assigning effectivity date:
Date of Receipt of Application/Endorsement
Effectivity Date
11th to 25th of the month
1st of the following month
26th to 10th of the month
15th of the same month
New enrollees who are approaching age of ineligibility must be enrolled at least six (6) months counting from the date of effectivity up to the date that the enrollees become ineligible for them to be accepted as members. All pre-existing condition/ dreaded disease limits will be computed on a prorated basis (i.e. If age of eligibility is up to 60 years old, only who are 60 years and 6 months old and younger will be accepted for membership).