1. Plan Coverage up to 60 yrs old and beyond

2. Basic Medical Benefits (In-Patient) – during paying/accumulation period

• Annual Benefit Limit – according to plan package
• Accredited Hospital’s Room and Board- according to plan package
• Network Access to over 500 Accredited Hospitals and over 1,000 Accredited Physicians/ Specialists/ Surgeons/ Anesthesiologist
• Hospital’s Intensive Care Unit
• Operating Room Fee
• Out-patient Benefits

Annual Physical Examination

• Physical Examination
• Chest X-ray
• Stool Examination
• Urine Analysis
• Complete Blood Count
• Electrocardiogram for Members above 35 years old

Dental Benefits

• Consultation and Dental Examinations
• Oral Prophylaxis (mild cases only) – once a year
• Unlimited Simple Tooth Extraction
• Restorative and Prosthodontic Treatment Planning
• Temporary Filling – unlimited (as needed)
• Re-cementation of Loose Crowns, inlays and onlays
• Dental Nutrition and Dietary Counseling
• Dental Health Education

***Pre-existing illnesses are not covered during the accumulation/paying period.

3. Family Assistance Program – After 1 year from accumulation, the immediate family of the plan holder could avail 20-30% discount from the total bill on accredited hospitals/clinics subject for approval by Kaiser.

4. Emergency Fund – The plan holder could use his Kaiser Healthcard for admission to the accredited hospitals and physicians instead of paying the required deposit amount. This benefit could also be extended for the plan holder’s immediate family subject for approval by Kaiser.

5. Basic Medical Benefits – during and beyond extended period, or after the 7-year paying period

• Yearly Health Benefits – A guaranteed 10% yearly accumulation based on the Long Term Care Benefit will start from 8th year and will continue accumulating as long as you have funds
• Benefits in addition to the basic medical benefits during the Accumulation Period:
  • Pre-existing illnesses are covered
  • Consultation Fee (charges for diagnosis or treatment)
  • Out-patient medicines and all illness including cosmetic and maternity are covered on the 8th year onwards
• Special & Extended Benefits
  • Magnetic Resonance Imagin (MRI)
  • Nuclear/Radioactive Isotope Scan
  • CT Scan, Dialysis, Blood Transfusion
  • Physical / Speech Therapy
  • Anti-Rabies, Venom & Tetanus Vaccine
  • Emergency Benefits (Ambulance)

6. Long Term Care Benefit – equivalent to the plan purchased

Availment: On the 20th year/maturity of the Plan or Contract

7. Long Term Care Bonus – amount for which the holder is entitled to if he has not incurred any medical claim or availed of any medical benefits other than the Annual Physical Exam and Dental Benefits during the Accumulation Period (7-year paying period). This amount is equivalent to 85% of the Total Contract Price.

Availment: On the 20th year/maturity of the Plan or Contract.

8. Total Health Benefits – The TOTAL amount of Total Accumulated Unused Health Benefits PLUS Long-Term Care Benefit PLUS Long-Term Care Bonus.

Availment: On the 20th year/maturity of the Plan or Contract.

9. Four way insurance coverage from the 1st to 20th year of the plan

If, at the time of signing the Membership Application, the Plan Holder is in good health, is at least eighteen (18) but not more than sixty-seven (67) years old and performing the normal activities of daily life, he shall be insured by Kaiser under a Group Master Insurance Contract underwritten by a reputable and duly authorized insurance company, as described below:

• Term Life – If the plan holder dies before attaining the age of sixty-seven (67) years and prior to his entitlement to the Long Term Care Benefit, his beneficiary shall be entitled to an amount equal to the sum of Long Term Care Benefit and Long Term Care Bonus upon approval of the claim by the insurance company.

• Accidental Death & Dismemberment – Should the plan holder suffer, directly and independently of all other causes, any bodily injury effected solely through external, violent and accidental means, occurring prior to the plan holder’s 67th birthday and prior to his entitlement to the Long Term Care Benefit, which result in any of the specified losses within 180 days after the accident causing the injury, the insurance company will pay the following:
  • Waiver of Installment due to Death/Credit Life Insurance – If the plan holder dies during the Accumulation Period and before exceeding the age of sixty-seven (67), the proceeds of the credit life insurance shall be applied to the balance of this Contract Price upon approval of the claim by the insurance company, if any. The difference, if any, shall be paid to his designated beneficiaries.
  • Waiver of Installment due to Total and Permanent Disability – If the plan holder becomes totally disabled during the Accumulation Period and before his 60th birthday thereby preventing him from engaging in any occupation for compensation or profit, is so disabled for life, and such disability continues for at least six (6) months, Kaiser shall waive the payment of each installment becoming due during the life, and such disability. However, pending approval of the claim, installments, should be paid as they fall due, subject to refund for approval.

10. Flexible benefit design based on the premium that a person can afford or wants to save for his long term healthcare.

11. Total Health Benefits become good as cash on the 20th year /maturity. The plan holder may choose to withdraw some of his funds, and he will still be covered as long as he has remaining funds on his account.