ahmopi ; association of health maintenance ... · physician association of health maintenance...

4
AHMOPI ; ASSOCIATION OF HEALTH MAINTENANCE / ORGANIZATIONS OF THE PHILIPPINES, INC. .& ' WITNESSETH: WHEREAS, AHMOPi is the recognized trade organization of Health Maintenance Organizations (HMOs) in the Philippines WHEREAS, AHMOPI is currently composed of several HMOs which are business entities that arranges for pre-paid health care services for their members by contracting with hospitals, physicians, and other health professionals for their services. AHMOPI members include, but are not limited to, the following: BLUE CROSS HEALTHCARE. INC. 800 Makati Avenue corner Burgos Street Makati City Tel. No. 899-8001 Fax: 899-5392 Website ww\ bluccross com.ph CARITAS HEALTH SHIELD, INC 3" Floor Katipunan Building 95 E. Rodrigue/ Boulevard. Que/on City Tel. No 7X1-6492 Fax 732-5251 Wcdsilc: ww\\.can tashealthshild.com.ph COCOLIFE HEALTH CARE 8/F Feliza Building, V A. Rufino Street Lcgaspi Village. Makati /city Tel No 813-3000 Fax: 812-3363 Website: \\-\v\v.cocolife.com.jfh FORTUNE MEDICARE, INC. 3/F CityStatc Centre 709 Shaw Boulevard. Pasig City Tel No 706-4X47 Fax' 706-4231 Website. www.foftunecaFe.com.ph HEALTH MAINTENANCE. INC. TovverGround. Makati Cinema Square Chino Roces Avenue. Makati Cit> Tel. No. 811-1313 Fax:817-1377 Website: w\vu.hmi_.cpmj?h INSULAR LIFE HEALTH CARE, INC. 1-CARE Building, 167 Legaspi Street Lcgaspi Village. 1229 Makati City Tel. No. 813-0131 to 36 Fax: 813-7856 Website: www.icare.com.pt) INTELLICARE 7/F Feti^a Building. V A. Rufino Street Legaspi Village, Makati City Tel. No. 894-2120 Fax: 894-213? Wcdbistc: www. intc 11 icarc.com. ph MAXICARE HEALTHCARE CORP. 19/F Medical Pla/a Makali. Amorsolo cor dcla Rosa Streets. Lcgaspi Village. Makati Citj Tel. No. 752-6294 Fax X13-87I3 Website www.niaxicare.com.ph MEDICAL SERVICES MARKETING & DEVELOPMENT CORPORATION Penthouse. Seven East Capitol Building East Capitol Drive, Kapitolyo. Pasig City Tel. No. 746-5000 Fax: 632-0651 Website: wv\v.medscrye.,coiiujfa MEDICARD PHILIPPINES, INC. 8/F The World Center 330 Sen Gil Puyat Avenue, Makati City Tel. No. 867-2020 Fax: 810-3855 Website: wwyy.medicardphiIs.com MEDOCARE HEALTH SYSTEMS, INC 7/F EU State Tower #30 Quc/.on Avenue. Quezon City Tel. No. 781-9682 Fax: 732-4415 Wedsitc. www .eugroup. net METROCARE HEALTH SYSTEMS, INC. 55 Don Bcnito Hcniandc/ Street Jalandoni Compound. Pasay City Tel No. 551-7764 (or 67) Fax: 551-0911 email admprlr'iwnctrocarchcalth.coni PHILHEALTH CARE, INC. 7/F Philam Life Building U-N Avenue. Malalc. Manila Tel. No. 523-6002 Fax: 528-3651 Website, www philamcarc.com ph PRUDENTIAL HEALTHCARE, INC. 3 Floor Prudentialifc Building 843 Aniai/. Avenue. Makati City Tel No. 816-4976 Fax: 840-0692 email brra;prudentialife.com ph STAR HEALTHCARE SYSTEMS, INC. 4/F Beneficial Life Insurance Building 166 Salcedo Street. Legaspi Village. Makati City Tel. No. 819-0074 Fax: 819-0072 email: salesflistarcarc-com ph VALUE CARE HEALTH SYSTEMS, INC. Unit 607-613 6/F Philippine Stock Exchange Center Exchange Road. Ortigas Centre. 1600 Pasig City Tel. No. (02)702-3388 / (02)687-0219 Fax: 637-9453/56 Website: www valucare.com

Upload: others

Post on 27-Jan-2020

16 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: AHMOPI ; ASSOCIATION OF HEALTH MAINTENANCE ... · PHYSICIAN ASSOCIATION OF HEALTH MAINTENANCE ORGANIZATIONS OF THE PHILIPPINES, INC. Printed Name & Signature CARLOS D. DA SILVA President

AHMOPI ; ASSOCIATION OF HEALTH MAINTENANCE/ ORGANIZATIONS OF THE PHILIPPINES, INC..& '

WITNESSETH:

WHEREAS, AHMOPi is the recognized trade organization of Health MaintenanceOrganizations (HMOs) in the Philippines

WHEREAS, AHMOPI is currently composed of several HMOs which are businessentities that arranges for pre-paid health care services for their members by contracting withhospitals, physicians, and other health professionals for their services. AHMOPI membersinclude, but are not limited to, the following:

BLUE CROSS HEALTHCARE. INC.800 Makati Avenue corner Burgos StreetMakati CityTel. No. 899-8001 Fax: 899-5392Website ww\ bluccross com.ph

CARITAS HEALTH SHIELD, INC3" Floor Katipunan Building95 E. Rodrigue/ Boulevard. Que/on CityTel. No 7X1-6492 Fax 732-5251Wcdsilc: ww\\.can tashealthshild.com.ph

COCOLIFE HEALTH CARE8/F Feliza Building, V A. Rufino StreetLcgaspi Village. Makati /cityTel No 813-3000 Fax: 812-3363Website: \\-\v\v.cocolife.com.jfh

FORTUNE MEDICARE, INC.3/F CityStatc Centre709 Shaw Boulevard. Pasig CityTel No 706-4X47 Fax' 706-4231Website. www.foftunecaFe.com.ph

HEALTH MAINTENANCE. INC.TovverGround. Makati Cinema SquareChino Roces Avenue. Makati Cit>Tel. No. 811-1313 Fax:817-1377Website: w\vu.hmi_.cpmj?h

INSULAR LIFE HEALTH CARE, INC.1-CARE Building, 167 Legaspi StreetLcgaspi Village. 1229 Makati CityTel. No. 813-0131 to 36 Fax: 813-7856Website: www.icare.com.pt)

INTELLICARE7/F Feti^a Building. V A. Rufino StreetLegaspi Village, Makati CityTel. No. 894-2120 Fax: 894-213?Wcdbistc: www. intc 11 icarc.com. ph

MAXICARE HEALTHCARE CORP.19/F Medical Pla/a Makali. Amorsolo cordcla Rosa Streets. Lcgaspi Village. Makati CitjTel. No. 752-6294 Fax X13-87I3Website www.niaxicare.com.ph

MEDICAL SERVICES MARKETING &DEVELOPMENT CORPORATIONPenthouse. Seven East Capitol BuildingEast Capitol Drive, Kapitolyo. Pasig CityTel. No. 746-5000 Fax: 632-0651Website: wv\v.medscrye.,coiiujfa

MEDICARD PHILIPPINES, INC.8/F The World Center330 Sen Gil Puyat Avenue, Makati CityTel. No. 867-2020 Fax: 810-3855Website: wwyy.medicardphiIs.com

MEDOCARE HEALTH SYSTEMS, INC7/F EU State Tower#30 Quc/.on Avenue. Quezon CityTel. No. 781-9682 Fax: 732-4415Wedsitc. www .eugroup. net

METROCARE HEALTH SYSTEMS, INC.55 Don Bcnito Hcniandc/ StreetJalandoni Compound. Pasay CityTel No. 551-7764 (or 67) Fax: 551-0911email admprlr'iwnctrocarchcalth.coni

PHILHEALTH CARE, INC.7/F Philam Life BuildingU-N Avenue. Malalc. ManilaTel. No. 523-6002 Fax: 528-3651Website, www philamcarc.com ph

PRUDENTIAL HEALTHCARE, INC.3 Floor Prudentialifc Building843 Aniai/. Avenue. Makati CityTel No. 816-4976 Fax: 840-0692email brra;prudentialife.com ph

STAR HEALTHCARE SYSTEMS, INC.4/F Beneficial Life Insurance Building166 Salcedo Street. Legaspi Village. Makati CityTel. No. 819-0074 Fax: 819-0072email: salesflistarcarc-com ph

VALUE CARE HEALTH SYSTEMS, INC.Unit 607-613 6/F Philippine Stock Exchange CenterExchange Road. Ortigas Centre. 1600 Pasig CityTel. No. (02)702-3388 / (02)687-0219 Fax: 637-9453/56Website: www valucare.com

Page 2: AHMOPI ; ASSOCIATION OF HEALTH MAINTENANCE ... · PHYSICIAN ASSOCIATION OF HEALTH MAINTENANCE ORGANIZATIONS OF THE PHILIPPINES, INC. Printed Name & Signature CARLOS D. DA SILVA President

WHEREAS, AHMOP1 has signed a Memorandum of Agreement (MOA) with thePHILIPPINE COLLEGE OF PHYSICIANS, a private corporation duly registered andexisting in accordance with the laws of the Republic of the Philippines, with office address atUnit 2201-2203, 22nd Floor, One San Miguel Avenue Building, San Miguel Avenue cornerShaw Boulevard, Ortigas Centre, Pasig City, hereinafter referred to as "PCP".

WHEREAS, the PCP-AHMOP! MOA took effect on May 04, 2009 and shall expire onMay 03, 2011, after which both parties may jointly review, revise and/or modify the said MOA,if necessary, prior to its renewal for another two (2)-year term.

WHEREAS, AHMOPI Members are desirous of entering into an arrangement withPCP Members (the Physician) in different localities/communities all over the Philippines for thepurpose of providing medical services to its members;

WHEREAS, the PHYSICIAN is a/an (specialization) _dulylicensed to practice medicine in the Philippines, and is a member of the PCP, and has signed hisconformity to the provisions of the MOA between the PCP and the AHMOPI dated 04 May2009;

NOW THEREFORE, for and in consideration of the foregoing premises the partieshereby mutually agree as follows:

I. The Physician agrees to render quality and cost - effective medical services topatients of AHMOPI members In consideration for the above services, thefollowing professional fees (exclusive of Philippine Health Insurance Corporation fees)will be paid

1 . 1 Out-Patient Consultation Fees

The out-patient consultation fees of the Physician shall be Php 300.00 regardlesof their place of practice

Other fees are as follows:

'f For routine pre-procedure medical evaluation,in- patient and out-patient - P 600.00

'r For pre-procedure medical evaluation, in-patient andout-patient but with medical indications - 800.00

> Intra-operative monitoring - 1,20000

In-Pat ient Daily Visits:

All professional fees (PF) for both attending physicians and co-attendingphysicians shall be based on the following payment schemes:

Wardr Semi-Private~r Private~r Suite

ICU/CCU

Other fees are as follows:

'r For routine pre-procedure medical evaluation,in- patient and out-patientFor pre-procedure medical evaluation, in-patient andout-patient but with medical indicationsIntra-operative monitoring

450.00550.00650.00

1,000.001,200.00

- P 600 00

800.00,200.00

Page 3: AHMOPI ; ASSOCIATION OF HEALTH MAINTENANCE ... · PHYSICIAN ASSOCIATION OF HEALTH MAINTENANCE ORGANIZATIONS OF THE PHILIPPINES, INC. Printed Name & Signature CARLOS D. DA SILVA President

10

11

12.

The Physician shall not "balance-bill" AHMOPI patients for coverable health conditionsand availments. However, for non-coverable health conditions and availments, thePhysician may bill AHMOPI patients for PFs based on the PF schedules of the AHMOP1-Member concerned

All PFs are subject to the prevailing withholding tax rates and such other taxprovisions. The prevailing Value Added Tax (VAT) currently at 12%) shall beshouldered by the AHMOPI-Member provided the Physician submits VAT registrationcertificates to the AHMOPI Member. On the other hand, withholding taxes will bededucted from the Physician's PFs,

For medical procedures listed in the Philippine Health Insurance Corporation(PhilHealth) and Philippine College of Surgeons (PCS) handbook of 2001, as amended in01 April 2009, AHMOPI Members agree to pay professional fees (PF) based on the 2009PH1C Relative Value Scale (RVS) For those procedures not listed, the PCP-AHMOPILiaison Committee, in collaboration with the PCP Subspecialties concerned, shall meetand decide on the most appropriate PF schedules

Discounts for Senior Citizens will not apply to the negotiated rates ( I t eml) above.

Similar PFs will apply to all specialists/physicians consulted to co-manage a particularpatient

All bills presented by the Physician with complete documentation shall be fully paid bythe AHMOPI Member according to the negotiated rates (item f above) within forty-five(45) days from receipt of out-patient claims from the Physician, and within sixty (60)days from receipt of in-patient claims from the hospital.

7.1

7.2.

A penalty of 3% per month shall be imposed on delays from submission of out-patient and in-patient claims (using the same 45-day and 60-day turn-around timeafter providing services to the patient) to payment of claims-

It is the responsibility of the AHMOPI-Member to remit the payments for PFs « \y to the Physician, including the certificate of tax withheld at source (Form \kj^

2307), for both in-patient and out-patient services

All billings pertinent to professional fees of the Physician for out-patient servicesafforded Planholders of AHMOPI Members must be submitted to the individualAHMOPI Member concerned within 60 days from date of service. All claimssubmitted for processing beyond this 60-day prescription period shall be consideredvoid and non-payable.

The Physician shall extend utmost cooperation and shall coordinate with theAHMOPI Member on all matters pertaining to the effective and efficient deliveryof health care and other support services.

The Physician shall comply with the policies and guidelines governing theservicing of Planholders of AHMOPI Members such as, but not limited to,providing medical records, operative reports, discharge summaries, etc., wheneverthese shall be needed.

The Physician is an independent contractor, hence he is not considered anemployee or an agent of the AHMOP1 Member. As such, the AHMOPI Membershall not assume any statutory employer obligations such as, but not limited to.Social Security, PhilHealth, and Employee's Compensation premiums

The Physician agrees to hold AHMOPI Members and its Planholders free andharmless from any claim or liability to any third party arising out of, or relatedto, any act, omission or negligence of the part of the Physician.

*c

Page 4: AHMOPI ; ASSOCIATION OF HEALTH MAINTENANCE ... · PHYSICIAN ASSOCIATION OF HEALTH MAINTENANCE ORGANIZATIONS OF THE PHILIPPINES, INC. Printed Name & Signature CARLOS D. DA SILVA President

14.

This Agreement shall be valid and effective on the date of execution hereof andis automatically renewable every year thereafter, unless earlier terminated/revokedby either parly by giving a thirty-day prior notice to the other party

Any modification/s to this Agreement shall be embodied in an Addendum to beattached herein and considered an integral part hereof

IN WITNESS WHEREOF, the parties have set their hands on this day of

PHYSICIAN ASSOCIATION OF HEALTH MAINTENANCEORGANIZATIONS OF THE PHILIPPINES, INC.

Printed Name & SignatureCARLOS D. DA SILVAPresident

AHMOPI MEMBERS:

1. Blue Cross HealthCare, Inc.

2. Caritas Health Shield. Inc

3 Cocolife Health Care

4 Fortune Medicare, Inc.

5. Health Maintenance, Inc.

6. Insular Life Health Care, Inc.

7. IntelliCYire

8 Maxicare Healthcare Corp

9. Medical Services Marketing &Development Corporation

10. Medicard Philippines, Inc.

11 Medocare Health Systems, Inc

12, Metrocare Health Systems, Inc.

13. Philhealth Care, Inc

14 Prudentialife Healthcare, Inc

15. Star Healthcare Systems, Inc.

16 Value Care Health Systems, Inc

Noel L. Rosas, MD

Geoffrey M Martinez

Atty. Alfredo C Tumacder, Jr

Dorothea J Sibal

Pilar A Adrias, MD.

Seralme L. Manguni "

Mario M. Silos

Jose Pastor Z. Puno

V i r g i L i o A. Del Val le

Nicanor S. Montoya, Jr , MD.

Eugene L. Sagcal, MD

Jo Eileen Suzanne R. Pama. MD

Mantes L. Nepomuceno

Benito R. Reverente, Jr., MD

Jaime C Fernandez

Rosemarie U, Yu