Benefits Re-orientation

Objectives
We will achieve the following at the end of this reorientation:
To be able to identify all benefits available to Asiapro
Members
To be able to enjoy the above benefits taking into
consideration the qualifications, requirements and
procedures
1. Medical Claim
2. Permanent Disability
3. Life Insurance
4. Interest on Share Capital
(Dividend)
5. Patronage Refund
6. Training and Development
 Life
Insurance
26 days Medical
Interest on
Claim due to
Share Capital
Accident
(Dividend)
1 year 26 days

Permanent
Patronage
Disability
Refund
1 year 26 days

Medical Training and

Claim due to Development
Sickness
3 months
6 months
1. Medical Claim

A. Due to Sickness B. Due to Accident

1. Medical Claim
This benefit is to provide financial assistance to
members who incurred expenses due to
sickness or accident.

Sources of Medical Claim:

Member Asiapro
Share Share
1. Asiapro None P
2. Employee Compensation
None P
Commission
3. Social Security System P P
1A. Medical Claim Due To Sickness
Reimbursement of non-work-related medical
expenses incurred by member due to sickness
net of PhilHealth and HMO* (if applicable)

Qualifications
At least 1,248 hours of service or approximately 6
months of membership
In-patient and at least 24 hours confinement
Coverage is P20,000 maximum per illness per year
net of PhilHealth
1A. Medical Claim Due To Sickness

Examples

Month/Year Illness Medical Claim

Jan 2015 Acute UTI 15,000
Apr 2015 - -
Aug 2015 Dengue 20,000
Nov 2015 Acute UTI 5,000
Jan 2016 Pneumonia 18,000
1A. Medical Claim Due To Sickness
How to Claim
1. Inform Member Supervisor as soon as you are in the
hospital
2. Accomplish the forms needed to avail medical claim
3. Gather documents necessary to avail medical claims
4. Submit accomplished form and attach required
documents
Original Documents Required
Doctors Prescription
Medical Certificate
Statement of Account
Hospital Receipts - itemized
1A. Medical Claim Due To Sickness
Hospital should be PhilHealth-Accredited
If unable to avail the PhilHealth benefit, member to
request PhilHealth office to compute counterpart

Asiapro Counterpart
Asiapro will deduct PhilHealth counterpart amount
from the actual medical claim of the member
Any amount exceeding Asiapros limit will be
charged to the member
1A. Medical Claim Due To Sickness
Purchased/prescribed medicines can be
reimbursed:
Within hospital confinement period
Supported by doctors prescriptions (original)
Reimbursement
Period for reimbursement is within sixty (60)
days from date of hospital discharge
If the Client advanced the hospitalization
expenses, check will be under the Clients name

*** Discharge Summary is required

Claims Not Covered
Mental disorders
Any war
Diseases arising from alcoholism or drug addiction
Cosmetic and plastic surgery
Claims Not Covered
Unnecessary care or treatment
Pregnancy including childbirth, miscarriage or
abortion and complications arising from it
Contraceptive devices, treatment of impotence or
infertility
HIV related illness
 Just Checking
Hospitalization Due to Sickness
Answer the following with
Yes or No
1. 2O,OOO is the maximum Asiapro benefit for medical
claim due to sickness.
2. Medical claim due to sickness may be availed if member is
confined for least 1 hour.
3. Medical Claim due to sickness is allowed for in-patient
cases only.

4. Cost of medicines may be reimbursed if these are

prescribed during the confinement period.
1B. Medical Claim Due To Accident
Reimbursement of non-work-related medical
expenses incurred by member due to accident
net of PhilHealth and HMO* (if applicable)

Qualifications
Coverage begins with a minimum of 208 hours of
service rendered or approximately 1 month
Work or non-work related as long as no negligence on
the part of the member
Benefit will be terminated automatically upon
withdrawal of membership from Asiapro
1B. Medical Claim Due To Accident
For Out-patient
Based on total amount of official receipts submitted
Maximum claim of P20,000
Percentage of claim will be based on number of
hours of service rendered

Required month Equivalent Percentage of

of service rendered 8-hour Day Benefits
10 months & up 235 or more 100%
7 9 months 157 234 75%
4 6 months 79 156 50%
1 3 months 26 78 25%
1B. Medical Claim Due To Accident
Amount of benefit may reach a maximum of
P40,000 given the following conditions:
At least 1,248 hours or approximately 4 to 6
months of service rendered
Confinement period of at least 24 hours
Percentage of claim will be based on number of
hours of service rendered
Required month Equivalent Percentage
of service rendered 8-hour Day of Benefits
10 months & up 235 and above 100%
7 9 months 157 234 75%
4 6 months 79 156 50%
1B. Medical Claim Due To Accident
How to Claim
1. Inform coordinator as soon as you are in the hospital
2. Accomplish the forms needed to avail medical claim
3. Gather documents necessary to avail medical claim
4. Submit accomplished forms and attach required
documents

Original Documents Required

Doctors Prescription
Medical Certificate
Statement of Account
Hospital Receipts - itemized
Police Report, if applicable
1B. Medical Claim Due To Accident
Hospital should be PhilHealth accredited
If unable to avail the PhilHealth benefit, member to
request PhilHealth office to compute counterpart

Asiapro Counterpart

Asiapro will deduct PhilHealth counterpart amount

from the actual hospitalization claim of the member
Any amount exceeding Asiapros counterpart will be
charged to the member
Claims Not Covered
Any injury suffered while on:
a. police duty in any military, naval or police
organization
b. any riot, civil commotion and war
c. any violation of the law by the member
d. Participation in extreme sports
Claims Not Covered
Insanity
Suicidal attempt or self-inflicted or willful
exposure to needless peril
Provoked assault or any attempted threat
Injury arising from alcoholism or drug addiction
1B. Medical Claim Due To Accident

Vehicular Accidents
Police Report is a must
Motorcycle riders and passengers without or
not properly wearing helmets shall not be
covered
 Just Checking
Medical Claim Due to Accident
Will Asiapro cover medical claims
due to non-work-related accident in
these cases?
1. A member fell in a manhole and suffered from fractured
bones.
2. A member had a vehicular accident while under the influence
of alcohol.
3. A member joined a rally and was injured during the
stampede.
4. A member accidentally fell from the stairs of his house and
suffered from body injury.
2. Permanent Disability
Monetary benefit that may be availed by member
in case he suffers from permanent disability.

Qualifications
Coverage begins with a minimum of 208 hours of
service rendered or approximately 1 month
Maximum payment of P75,000 net of EC benefit if
disability resulted from work-related incident
A member can receive his/her disability benefits after
six (6) months of such continuous condition and
when such disability prevents the member from
engaging in any other business activity
3. Life Insurance
Monetary benefit that may be availed by the
dependents of the member in case of death.

Qualifications

Coverage begins with a minimum of 208 hours

of service rendered or approximately 1 month
If due to natural cause = up to P75,000
If due to accident = up to P150,000
3. Life Insurance
How to Claim
1. Relative or representative to inform coordinator
2. Accomplish Asiapro Life Insurance Benefits Claim
Form
3. Gather documents necessary for claiming life
insurance
4. Submit accomplished form and attach required
documents
3. Life Insurance
Original Documents Required
Funeral / burial receipts
Authenticated birth and death certificate of the member
Authenticated birth certificate of members beneficiary

If married, marriage contract

For minor age beneficiary, affidavit of guardianship

Police Report if applicable
Certified True Copy if no original documents are
available
Claims Not Covered

Suicide
Death suffered while performing or attempting
the performance of unlawful act
 Eligible Beneficiaries in case of
Life Insurance or Total Permanent
Disability Claim

Principal Beneficiaries
Single - parents, siblings
Married - spouse, children

Secondary Beneficiaries
Declared guardian
First degree of consanguinity
 Percentage of Benefits for
Permanent Disability and Life Insurance
(ACTIVE Members)

Required month Equivalent Percentage of

of service rendered 8-hour Day Benefits
10 months & up 235 or more 100%
7 9 months 157 234 75%
4 6 months 79 156 50%
1 3 months 26 78 25%
 Percentage of Benefits for
Medical Claim Due to Sickness or Accident
and
Life Insurance
(INACTIVE Members)
1 month (1-30 days) 100%
2 months (31-60 days) 75%
3 months (61-90 days) 50%
4 months (91-120 days) 40%
5 months (121-150 days) 30%
6 months (151-180 days) 20%
More than 6 months (181-days) 0%
Coverage will automatically terminate on the date of the
termination of membership
4. Interest on Share Capital
(Dividend)
Annual benefit
Based on members share capital and fixed deposit
Statement of Dividend and Patronage Refund

5. Patronage Refund
Annual benefit
Based on members share in gross billings
Statement of Dividend and Patronage Refund
6. Training and Development
Offered free to Asiapro Members for their
personal and professional growth

Cooperative Membership Education

Asiapro Benefits Re-orientation
Asiapro Savings and Loan Programs Re-orientation
6. Training and Development
Major Programs
Customer Service
Salesmanship
Safety Awareness
Good Manufacturing Practices
 Just Checking
True or False
1. The maximum life insurance benefit due to natural cause is
P75,000.
2. The patronage refund of a member is based on his or her
contributed share capital and fixed deposit.
3. An Asiapro member who had more than 1 year of service is
entitled to 50% of life insurance, permanent disability or
medical claim.
4. An inactive member may still avail of Asiapro benefits such as
permanent disability and medical claims.
 Life
Insurance
26 days Medical
Interest on
Claim due to
Share Capital
Accident
(Dividend)
1 year 26 days

Permanent
Patronage
Disability
Refund
1 year 26 days

Medical Training and

Claim due to Development
Sickness
3 months
6 months
 HMO Program
for
Asiapro Members
 First Global Pro
Health Care
Management, Inc.
Unit 1510 Cityland 10 Tower II 154 H.V. dela Costa,
Salcedo Village, Makati City
Telefax No. (02) 753-1363/ Tel nos. 753-4971/409-8387
 About First Global

Incorporated on September 27, 2006

Registered with Philippine Securities and Exchange

Commission (SEC) under Management Services Industry
 HMO Service
Provider

Asiapro Members
 Voluntary
Coverage includes Principal Member plus up to 3 qualified
dependents or family members
Four (4) plans to choose from
No cash out for confinement in accredited hospitals
Members are allowed full reimbursement up to the limits
of the plan for confinement in non-accredited hospitals
Coverage includes pre-existing condition
Coverage shall be for one year from the date of
enrolment.
PRINCIPAL MEMBER
Asiapro member who is Active at the time of enrollment
Below 65 years of age at the time of enrollment

What if an Asiapro Member is inactive?

He/she cannot enroll because he/she is not receiving payout.
Payment of HMO premium is through payout deduction.
DEPENDENTS (Up to 3)

If Principal Member is Single

1. Parents - Below 65 years of age
2. Siblings 90 days old up to 21 years of age

If Principal Member is Married

1. Spouse - Below 65 years of age
2. Children - 90 days old up to 21 years of age
DEPENDENTS (Up to 3)

If Principal Member is a Single Parent

1. Parents - Below 65 years of age
2. Children - 90 days old up to 21 years of age
HMO PLANS
 PLAN A

PREMIUM P2,062.00 or P171.80/month

or P5.70/day
SPOUSE/
Benefits PRINCIPAL
PARENT
CHILDREN

Hospital Daily Income Allowance 1,500 1,500

* Maximum of 60 days per year shared by principal member and dependents.

Hospital Daily Income Allowance

1. Pays each day of hospital confinement starting from the first full day up to 60
days due to illness or accident.
2. Paid through ATM.
3. Paid in addition to PhilHealth and other health and medical insurance.
**Release period of HDIA will depend on the assessment of Medasia
and Prudential Guarantee.
 PLAN B

PREMIUM P6,285.00 or P523.75/month

or P17.50/day

SPOUSE/ CHILD/
Benefits PRINCIPAL
PARENT SIBLING

Room and Board Open Open Open

Maximum Benefit Limit per illness/year 40,000 20,000 20,000

Burial Assistance (Natural and Accident

20,000 10,000 10,000
Related)
Pre-existing conditions Waived Waived Waived
 PLAN C

PREMIUM P9,093.00 or P757.75/month

or P25.30/day
SPOUSE/ CHILD/
Benefits PRINCIPAL
PARENT SIBLING
Room and Board Open Open Open

Maximum Benefit Limit per illness/year 40,000 20,000 20,000

Annual Physical Examination 500 250 250

Outpatient consultation and laboratory 5,000 2,500 2,500

Burial Assistance (Natural and Accident

20,000 10,000 10,000
Related)
Pre-existing conditions Waived Waived Waived
 PLAN D

PREMIUM P19,407.00 or P1,617.25/month

or P53.95/day
SPOUSE/
Benefits PRINCIPAL CHILD/ SIBLING
PARENT
Room and Board Open Open Open
Maximum Benefit Limit per illness/year 40,000 20,000 20,000
Emergency Care Treatment 30,000 15,000 15,000
Emergency Confinement in non-accredited
30,000 15,000 15,000
hospitals(reimbursement)
Non-Emergency Confinement in non-
25,000 10,000 10,000
accredited hospitals (reimbursement)
Annual Physical Examination 500 250 250
Outpatient consultation and laboratory 5,000 2,500 2,500
Dental Care Basic prophylaxis prophylaxis
Burial Assistance (Natural and Accident 20,000 10,000 10,000
Related)
Pre-existing conditions Waived Waived Waived
 SUMMARY OF PLANS
With a small amount of Daily Premium, your health and 3 of your
family members health are now secured.

HMO PLANS
A B C D
Net Premium
2,062.00 6,285.00 9,093.00 19,407.00

Daily Premium 5.70 17.50 25.30 53.95