POLICY ON MEDICAL SUBSIDY

I. POLICY STATEMENT

A Medical Benefit ids provided by the company to assist its employees in their
health requirements.

II. COVERAGE OF MEDICAL BENEFITS

1. All regular employees are covered by this policy.

2. Services include the following based on the limits that are established in the
policy:

a. Outpatient consultation
b. Hospitalization and medicine cost while confined
c. Laboratory and Diagnostic services with limits as prescribed by attending
physician.

3. Outpatient medications are not covered and are therefore for the account of
the employee.

III. IMPLEMENTING GUIDELINES

1. Employees are required to consult the Accredited Physicians, Diagnostic

Clinics and Hospitals as reflected in the list to be provided by the Human
Resources Department (HRD). Fees for medical services and consultation
shall be based on the limits agreed upon with the Accredited Physicians,
Diagnostic Clinic and Hospitals.
2. Diagnostic and other tests to be undertaken must be authorized by the
Accredited Physicians.
3. For Hospitalization in the event that employee exceeds its limits for medical
consultation and services, the difference shall be for the account of the
employee concerned.
4. In the event that employee exhausts the Maximum Benefit Limit as defined
by this policy, the employee shall no longer be entitled to this benefit until
the next calendar year.
5. Confinements, unless on emergency situations must be planned and
coordinated with the Human Resource Department. This will enable the
company to prepare the funds needed by the employee so as to ensure
smooth check out. It is the responsibility of the employee to secure an
estimate of the total cost to enable the company to allocate the resources
needed.
6. In case of emergencies, the employee is allowed to go to the nearest hospital
of residence. The company shall cover expenses within the employee’s limit.
The employee’s relatives however must immediately inform the company
within 24 hours of confinement for proper assistance and transfer to affiliated
hospital, if necessary.
 7. In the event that the employee consults his/her own physician or prefers to
have tests taken at Diagnostics Clinics and preferred hospitals, the company
shall only cover up to the rates negotiated with affiliated physicians,
diagnostic clinics and hospitalization limits as reflected in the policy.
8. Work related injuries shall be completely for the account of the company.

IV. HOSPITALIZATION SERVICES AND ANNUAL MAXIMUM BENEFIT LIMITS

Employee Category Room Coverage Annual Maximum

Benefit limit
Production Workers Ward up to Php 700 50,000.00
Office Staff Semi-private up to Php 60,000.00
1,000
Supervisors and Small Private up to Php 80,000.00
Managers 1,500
Executives Large Private up to Php 100,000.00
2,000

The company shall not cover the bills for the following extra-services:
 Use of extra bed, TV, electric fan, DVD/ VCD, and other similar items
unless such appliances and items are included in the Room and Board
Accommodation.
 Extra food.
 Toilet articles like face towel soap, toothbrush and the like.
 Charges of room and board beyond the limits of the Room and Board
Accommodation, the incremental rate different for professional fees,
diagnostic and laboratory examinations, and the other ancillary medical
services brought about by the employee’s voluntary acquisition of a room
other than his Room and Board Accommodation.
 Services of a private nurse.
 All other items not medically necessary in the medical management of the
patient.

V. ANNUAL CHECK-UP

The annual check-up entitlement shall be scheduled by the company through the
Homan Resources Department.

VI. LABORATORY, DIAGNOSTIC SERVICES AND OTHER PROCEDURES

Laboratory and Diagnostic services shall be covered provided it is prescribed by

the company’s accredited physician as reflected in the Physician’s order. The
company shall have limits on the following tests and indicated in the table.
 Procedure Limit
Eye laser therapy for retinal hole, Up to Php 10,000 per eye
cataract, retinal detachment and
glaucoma, excluding eye correction
such as Lasik, PRK and the like
Physical therapy / Occupational Up to twelve (12) sessions provided
therapy excluding subspecialties such within the Maximum Benefit Limit
as cardiac rehabilitation, pulmonary
rehabilitation and the like
Allergy testing / allergy screening and Up to Php 2,500 per member per year
other related examinations.
Tuberculin test Up to Php 600
Sclerotherapy for varicose veins Up to Php 5,000 per leg
Speech therapy (for stroke patients Up to Php 10,000
only)

VII. EXCLUSIONS

The following shall not be covered by the company:

1. Psychiatric care.
2. Treatment resulting from self-inflicted injuries (including infections or
complications as a result of tattoos, piercing of the ear or in any body part,
whether self-inflicted or done by a third party) or attempted suicide or self-
destruction, whether sane or insane.
3. Development al disorders including functional disorders of the mind,
alcoholism and drug addiction or abuse.
4. Treatment of any injury received which is proved to be attributable to the
employee’s own misconduct such as negligence intemperate use of drugs or
alcoholic liquor, direct or indirect participation in the commission of a crime
whether consummated or not, violation of a law or ordinance, and
unnecessary exposure to imminent danger or hazard to health.
5. Aesthetic, cosmetic and reconstructive surgery or any consultation or
treatment for any beautification purposes except if necessary to treat a
functional defect due to accidental injury within the initial confinement.
6. Acupuncture, chirotherapy and other forms of rehabilitation therapies.
7. Routine physical examinations required for obtaining or continuing
employment, requirement in school, insurance or government licensing and
health permit (except as provided under the Annual Check-up provision).
8. Corrective appliances, artificial aids, prosthetic appliances.
9. Congenital deformities and abnormalities affecting functions of individuals
(except for hernias)
10. Treatment of injuries/ illnesses caused directly or indirectly by engaging in
any hazardous or professional sport or activity i.e. scuba diving, mountain
 climbing, parachuting etc. and injuries resulting from participating in riots,
strikes, and other civil disturbances.
11. Sexually transmitted diseases, AIDS and AIDS related diseases.
12. Pre-existing Hepatitis B and Hepatitis screening and vaccines.
13. Any disease, condition, or complication, the proximate cause of which is
animal bite or snake bite, etc.
14. Treatment of injuries or illnesses resulting from war or any combat-related
activities while in military service.
15. Weight reduction programs, surgical operation or procedure for treatment of
obesity, including gastric stapling or balloon procedures and liposuction.

VIII. PROCEDURES

 Medical Consultation and Diagnostic Tests

1. The employee is required to present from Human Resources

Department for a Letter of Authority (LOA) for consultation,
diagnostic tests, and hospitalization to the company’s accredited
physicians, diagnostic clinics and hospitals.
2. The employee is require to have a LOA filled out by the attending
physician and submit accomplished form to Human Resources. This
shall be the basis for payment of Accredited Physicians.
3. The LOA is only valid for one week, thus employees must plan their
consultation.

 Hospitalization

1. The employee is required to inform the Human Resources

Department of a scheduled hospitalization confinement to allow the
company to make arrangements for the settlement of the expenses
that will be incurred. This will also allow the accomplishment of Phil
Health and other forms needed for confinement.
2. The Human Resources representative shall make arrangements with
the hospital concerned for smooth discharge.

 Reimbursement for Medical Expense

1. An employee who availed of medical services may reimburse

expenses through accomplishing the Medical Reimbursement Form.
The Human Resource or Personnel Manager shall determine
allowable limits based on the policy.
2. Upon reimbursement, the Medical Certificate and other supporting
document, i.e., prescriptions, medical abstract and the receipts must
be submitted to the Human Resources or Personnel Manager who in
turn shall endorse the reimbursement to Accounting. Incomplete
forms and documents shall not be processed.
 3. Medical reimbursement should be filed three (3) working days from
the date of consultation and/ or release from hospital confinement.

LAMCO MEDICAL BENEFIT POLICY

What is a Medical Benefit ?

A medical benefit is an assistance extended by the company to its employees in their medical
need.

Who are covered by the benefit?

All regular employees with at least one year of service with the company are covered by benefit.

What is covered by the benefit?

The following are covered by the benefit:

 Outpatient consultation
 Hospitalization and medicine cost while in confinement
 Laboratory and diagnostic services as prescribed by the Accredited
Physician within the Maximum limit coverage

What is Maximum Benefit Limit?

Maximum Benefit Limit is the allowable limit the company can extend to an employee per year
to covered for the medical cost. The following are the limits.

Category Room Coverage Max Benefit Limit

Production Workers Ward up to 700 50,000.00
Office Staff Semi-private up to 1,000 60,000.00
Sup & Managers Small-private up to 1,500 80,000.00
Executives Large private up to 2,000 100,000.00

How can employees avail the Medical Benefit?

Employees who need to avail the benefit should do the following:

 Report to Human Resource and tell your concern

 HR will issue an LOA (Letter of Authority) through the Payroll Master.
 In the absence of HR, inform the General Manager or the Office Manager
 Present the LOA to the Accredited Physician
 Return to HR and submit Employee’s copy of LOA

What is an LOA?
An LOA or Letter of Authority is an approved official form the employee needs to present to
the Accredited Physician or Diagnostic Clinic so that medical services can be availed off.

Who is an Accredited Physicians?

An Accredited Physician is a medical practitioner that the company has tied-up with so that
employees will be when in need of medical attention.

Who are the Accredited Physicians of the Company?

Dr. Paul Lao – Cardiology

St. Lukes Medical Center Philippine Heart Center
Monday to Friday Monday to Friday
9:00 AM to 12:00 NN 2:00 PM to 6:00 PM
Tel. no. 732-0199 loc 415 Tel. no. 925-2401 loc 3614
723-0101

Dr. Patricia Tan – OB Dr. Algerich Chua - Opta

Chinese General Hospital FEU Hospital – Fairview
Monday to Saturday Monday, Tuesday, Friday
3:00 PM to 7:00 PM 2:00 PM to 5:00 PM
711-4141 local (446) Tel. no. 272-8070

Where can the medical forms (LOA) be secured?

All forms pertinent to this policy can be the Payroll Master (Ms. Nydia Ybas).

It’s an emergency and the employee has NO cash on hand, what should he do?

 Go to the nearest hospital

 The employee or his relatives should get in touch with Human Resources (Ricky
Morales 0917-248-3136) the soonest possible time.
 Company representative goes to the hospital and makes the arrangement.

It’s an emergency case, employee has cash on hand, what should he do?

 Go to the nearest hospital

 Employee initially pays for medical expense
  Employee files for a reimburses of the total amount spent through the use of
reimbursement form
 Employee receives the reimbursement within 4 working days

How does an employee reimburse?

 Submit to HR all medical documents (medical certificate, endorsement, letter, medical

transcript) and official receipts, together with an accomplished Medical Reimbursement
Form (the form can also be secured from Ms. Nydia Ybas)
 Make sure to have the form (your reimbursement) approved by your immediate
superior before submitting to HR
 HR shall determine allowable limits based on the policy and request payment

What are not covered by the benefit during hospitalization?

The company shall not cover the bills for the following extra-services:

 Use of extra bed, TV, electric fan, DVD/ VCD, and other similar items unless such
appliances and items are included in the Room and Board Accommodation.
 Extra food.
 Toiletries like face towel soap, toothbrush and the like.
 Charges of room and board beyond the limits of the Room and Board Accommodation,
the incremental rate different for professional fees, diagnostic and laboratory
examinations, and the other ancillary medical services brought about by the employee’s
voluntary acquisition of a room other than his Room and Board Accommodation.
 Services of a private nurse.
 All other items not medically necessary in the medical management of the patient.

Does the benefit cover other medical procedures?

Yes, the benefit covers all laboratory and diagnostics services prescribed by the company’s
Accredited Physicians including the following procedures listed below as long as it is within the
stated allowable amount.

Procedure Limit
Eye laser therapy for retinal hole, Up to 10K per eye
cataract, retinal detachment and
glaucoma, excluding eye correction
such as Lasik, PRK and the like
Physical therapy / Occupational Up to twelve (12) sessions provided
therapy excluding subspecialties such within the Maximum Benefit Limit
as cardiac rehabilitation, pulmonary
rehabilitation and the like
Allergy testing / allergy screening and Up to 2.5K per member per year
other related examinations.
 Tuberculin test Up to Php 600
Sclerotherapy for varicose veins Up to 5,000 per leg
Speech therapy (for stroke patients Up to 10,000
only)

What are the exclusions of the benefit?

The following shall not be covered by the benefit:

1. Psychiatric care.
2. Treatment resulting from self-inflicted injuries (including infections or
complications as a result of tattoos, piercing of the ear or in any body part,
whether self-inflicted or done by a third party) or attempted suicide or self-
destruction, whether sane or insane.
3. Development al disorders including functional disorders of the mind,
alcoholism and drug addiction or abuse.
4. Treatment of any injury received which is proved to be attributable to the
employee’s own misconduct such as negligence intemperate use of drugs or
alcoholic liquor, direct or indirect participation in the commission of a crime
whether consummated or not, violation of a law or ordinance, and
unnecessary exposure to imminent danger or hazard to health.
5. Aesthetic, cosmetic and reconstructive surgery or any consultation or
treatment for any beautification purposes except if necessary to treat a
functional defect due to accidental injury within the initial confinement.
6. Acupuncture, chirotherapy and other forms of rehabilitation therapies.
7. Routine physical examinations required for obtaining or continuing
employment, requirement in school, insurance or government licensing and
health permit (except as provided under the Annual Check-up provision).
8. Corrective appliances, artificial aids, prosthetic appliances.
9. Congenital deformities and abnormalities affecting functions of individuals
(except for hernias)
10. Treatment of injuries/ illnesses caused directly or indirectly by engaging in
any hazardous or professional sport or activity i.e. scuba diving, mountain
climbing, parachuting etc. and injuries resulting from participating in riots,
strikes, and other civil disturbances.
11. Sexually transmitted diseases, AIDS and AIDS related diseases.
12. Pre-existing Hepatitis B and Hepatitis screening and vaccines.
13. Any disease, condition, or complication, the proximate cause of which is
animal bite or snake bite, etc.
14. Treatment of injuries or illnesses resulting from war or any combat-related
activities while in military service.
15. Weight reduction programs, surgical operation or procedure for treatment of
obesity, including gastric stapling or balloon procedures and liposuction.
Are consultation fees with Employee’s Physician reimbursable?

Yes, consultation fees incurred by the employee with his Physician are reimbursable provided
the employee submits an endorsement letter signed by the Physician, together with a medical
certificate. Reimbursement will be based on rates of Accredited Physicians and Diagnostic
Clinic.

NOTE:

Annual Medical Exam will be scheduled and announced a month before actual date, thus, all
diagnostic exams prior to set schedule should be coordinated with HR.

For any question, inquiries or assistance, you may speak with HR.