- What is Union Health Care?
Union Health Care (UHC) is a healthcare program of General Santos City Government Employees Association. Established in April 2006 exclusively for GSCGEA principal members and its immediate dependents, the UHC is now expanding its coverage to other
public sector unions in Socksargen area. The UHC offers probably the most low-priced premium in the country today but provides comprehensive healthcare services to its members.
2. Who is Eligible to be UHC Members?
(a.)
Principal Member – an employee of the City Government
of General Santos, member of GSCGEA or other government employees association,
who is at least eighteen (18) but not more than sixty-five (65) years of age
and an active member of PhilHealth.
(b.) Dependent
Spouse – Legal husband or wife of principal member who is at least eighteen
(18) but not more than sixty-five (65) years of age and an active
member/beneficiary of PhilHealth.
(c.) Dependent
Children – Unmarried and unemployed legitimate, legitimated, legally adopted,
or step-children, including the principal member’s natural children or
illegitimate children who are at least three (3) but not more than twenty-one
(21) years of age and active members/beneficiaries of PhilHealth.
(d.) Dependent
Parents – The principal member’s natural or adopting parents who are not more
than sixty-five (65) years of age and active members/beneficiaries of PhilHealth.
(e.) Dependent
Brother or Sister – The unmarried principal member’s unmarried and unemployed
legitimate, legitimated, legally adopted, or step-brother or step-sister who
are at least three (3) but not more than twenty-one (21) years of age and an
active member/beneficiary of PhilHealth.
GSCGEA
UNION HEALTH CARE PROFILE
SUMMARY OF UHC BENEFITS
(1.)
Room & Board – P550.00 per day of confinement
(2.)
Professional Fee – P550.00 per day of confinement
(3.)
Medicines – maximum of P6,000.00 for every single
period of confinement
(4.)
Other Hospital Services – maximum of P4,000.00 for every single period of confinement.
(5.)
Maternity Services – P10,000.00
for caesarian section delivery and P2,000.00 for miscarriage case, five (5) pre-natal
examinations, and one (1) post-natal examination.
(6.) Financial Assistance – Death benefit of P2,000.00.
(7.)
Annual Maximum Limit – P40,000.00
after one year of continuous coverage and every year thereafter.
IN-PATIENT SERVICES
(1.) Room & Board
(2.) Use of operating room
(3.) Use of recovery room
(4.) Professional fees of accredited physicians
(5.) Medicines, whole blood, products and cost of attendant services, and intravenous
fluids
(6.) Laboratory exams and diagnostic procedures
(7.) Dressings and casts
(8.) Services and supplies related to the medical management of patient
(9.) All
other hospital services deemed necessary by the UHC accredited primary health
care physician.
OUT-PATIENT SERVICE
(1.) Complete medical history
(2.) Physical examination
(3.) Chest x-ray
(4.) Minor out-patient surgery
(5.) Treatment of minor illness or injury
(6.) Laboratory exams and diagnostic procedures
(7.) Vaccination (excluding prescribed vaccines)
(8.) Periodic medical check-up services
(9.) Referral to an accredited Specialist by UHC
primary care physician
10. Health education, counseling, diets or
exercises
11. Counseling on family planning
EMERGENCY CARE SERVICES
A. ACCREDITED HOSPITAL
(1.) Professional
services of Emergency Room Physicians
(2.) Medicines
used during treatment, except vaccines
(3.) Oxygen and
intravenous fluids
(4.) Dressings,
casts, sutures
(5.) Laboratory
exams and diagnostic procedures
(6.) Services
and supplies related to the medical management of the patient.
B. NON-ACCREDITED HOSPITAL
UHC will reimburse 80% of the total hospital bills including professional fees based on UHC standard rates, but not to exceed the maximum benefit of the program.
OUT-PATIENT DENTAL SERVICES
(1.) Four (4)
dental extractions per year
(2.) Simple
annual prophylaxis
(3.) Temporary
fillings
(4.) Treatment
of oral pain lesion and burns.
MATERNITY SERVICES
(1.) Financial
assistance in case of caesarian section delivery
(2.) Financial
assistance in case of miscarriage or abortion
(3.) Pre-natal
and post-natal care
FINANCIAL ASSISTANCE
The legal heir, dependent, or beneficiary shall be entitled to a financial assistance in
case of death of a member in the amount of P2,000.00.
ELIGIBILITY DATES AND STAGGERED SCHEDULE OF BENEFITS
ELIGIBILITY DATE | SCHEDULE OF | |
FROM | TO | |
Start of effectivity of coverage | Last day of 3rd month | P 00 |
Start of 4th month | Last day of 6th month | P |
Start of 7th month | Last day of 9th month | P |
Start of 10th month | Last day of 11th month | P |
Start of 12th month | Last day of 12th month | P |
Start of first year of coverage | Continuous coverage | P |
PREMIUM RATES
Eligible Member | Monthly Rate | Annual Rate |
1. Principal Member | P | P |
2. Dependent Spouse |
| 1, 800.00 |
3. Dependent Children |
| 1, 680.00 |
4. Dependent Parent |
| 2, 880.00 |
5. Dependent Brother or Sister | 150.00 | 1, 800.00 |
