1CoopHealth FAQ

1. Who can avail of 1CoopHealth (Ward Plan)?
   
   Ans: Enrollment to 1CoopHealth is limited to coop members. For HPPEMC, the following can enroll:
   1. Regular, Associate, and Honorary Members* aged 18-75 years old.
   2. Dependents of enrolled Members aged 12-75 years old.
      
      * Honorary Members are family/relatives of Regular or Associate Members that were endorsed to and approved by the Board.
      
      
2. I have a number of family members I plan to enroll. Can I use the Coop's Hospitalization Loan facility to pay for 1CoopHealth? 
   Ans: Yes but subject to existing Credit Policy.
   
   
3. Will pre-existing conditions be covered? 
   Ans: Pre-existing will be covered after 1 year.
   
   
4. Is it really necessary to provide an Identification Card (ID) during availment? 
   Ans: Yes it is necessary to provide a Valid ID during availment for the coordinators/customer care to validate that the person availing is the one entitled to the benefits. Ensuring that only authorized 1CoopHealth HMO Card holders avail of the benefits allow us to keep our annual premiums low.
   
   
5. If I avail at a non-accredited hospital for an elective confinement or out-patient consultation, can I reimburse? 
   Ans: Members may only avail from accredited doctors at accredited hospital and clinics. However, if there is no accredited provider in the area, members can reimburse availments subject to 1CoopHealth policy limits. 
   
   
6. How do I know if a certain diagnostic procedure requested by an affiliated doctor is covered by my healthcare program?
   Ans: For inquiries on your benefit coverage, you may call any of our Customer Care Hotlines. Your medical details and needed procedure will be assessed if covered by your plan.
   
   
7. How do I avail of my APE (Annual Physical Examination) Benefit?
   Ans: A request for an APE schedule will be needed prior to actual availment. This can be done thru calling any of the 1CoopHealth 24-hr hotlines or thru email at This email address is being protected from spambots. You need JavaScript enabled to view it..
   
   
8. What do I have to do to reimburse my bills from availments in non-affiliated hospitals during Emergency cases?
   Ans: You will need to submit the following necessary documents:
   1. Original Official Receipt/s of the hospital bill/s, including the Statement of Account (SOA) and its Charge Slips/Itemized billing.
   2. Clinical Abstract of the case if surgical intervention was performed and its hispathological report.
   3. Operative Record of the case/treatment or admission/discharge record duly signed by the attending physician.
      
      
9. What if I want to upgrade my Room and Board entitlement during elective confinement?
   Ans: It is possible and we are not refraining you to upgrade your Room and Board Accommodation as you wish, provided that you will have to shoulder the corresponding Room and Board excess fees, incremental costs of laboratory and procedures done, and the excess Professional Fees.
   
   
10. What do I do if I lose my 1CoopHealth HMO Card?
    Ans: You have to submit to the 1CoopHealth Office a request letter for a replacement of your HMO card stating the reason together with P40 as replacement cost.
    
    
11. What do I do if, during the time of my admission, all the rooms under my room category are occupied?
    Ans: In this case, you may choose one of the following options:
    1. Occupy a lower room category and pay no incremental charges.
    2. Occupy an available room one category higher than what is entitled and pay only the room and board excess. You must transfer to your designated room category once the room becomes available; othewise, you will pay all incremental charges from the first day of confinement.
    3. You may transfer to another accredited hospital if it is a non-emergency case.
       
       
12. What if my illness/condition developed certain complications – will these illnesses have a separate Maximum Benefit Limit?
    Ans: Any and all illnesses proven to be related to or is a complication of a certain illness shall share the same Maximum Benefit Limit (MBL).
    
    
13. What happens if I fail to file our PhilHealth Benefit Claim form upon discharge?
    Ans: You will have to shoulder the PhilHealth cost equivalent upon discharge.
    
    
14. I'm interested. How do we start?
    Ans: As 1CoopHealth is only available to members of cooperatives, anyone you wish to enroll needs to be a coop member. HPPEMC Regular and Associate Members may endorse their family/relatives as Honorary Members by filling up the Honorary Membership Endorsement and Enrollment Form which can be found in the HPPEMC website under MEMBERS AREA. As access is limited to members, LOGIN is required. 

Note: These exclusions should not in any way prevent any member from undergoing whatever treatment or procedures deemed necessary by attending physician.

1. Long-term rehabilitation and psychiatric care and/or psychological illnesses and conditions including neurotic and psychotic behavior disorders; anxiety disorders.
   
2. Developmental disorders including functional disorders of the mind, such as but not limited to Attention-Deficit Disorder (ADD) or Attention-Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorders, Bipolar Disorders, Central Auditory Processing Disorder (CAPD), Cerebral Palsy, Down Syndrome, Neural Tube Defects, and Mental Retardation.
3. Congenital, genetic and hereditary diseases and their complications affecting functions of individuals.
4. Sexually transmitted diseases including genital warts.
5. Injuries resulting from direct participation in riots, strikes, and other civil disturbances.
6. Infectious diseases (i.e. Avian Flu, Meningococcemia, etc.) that are declared epidemic or pandemic by the Department of Health, World Health Organization or any recognized health authority.
7. 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.
8. Maternity care and all other conditions, including pre and post natal consultations, related to and/or resulting from pregnancy and/or delivery which affect the conditions of the principal Member and the unborn child.
9. Circumcision (except for treatment of urological conditions), sex transformation, diagnosis, treatment and procedures related to fertility or infertility, artificial insemination, sterilization or reversal of such procedures and their complications.
10. Experimental medical procedures and its complications.
11. Acupuncture, acupressure, chirotheraphy and other forms of alternative medicine and their complications.
12. Routine physical examinations required for obtaining or continuing employment, requirement in school, insurance, government licensing, health permit and other similar purposes.
13. All screening tests
14. Treatment for injury and its complications resulting from self-inflicted injuries including infections 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.
15. Treatment of any injury received wherein there is negligence, unauthorized use of prohibited or regulated drugs, alcoholic liquor intake, direct or indirect participation in the commission of a crime whether consummated or not, violation of a law or ordinance or unnecessary exposure to imminent danger, knowingly or unknowingly, or hazard to health, by the Member.
16. Treatment of injuries or illnesses caused directly or indirectly by engaging in any professional sport or hazardous activity such as but not limited to scuba diving, surfing, water skiing, mountain climbing, rock climbing, mountaineering, parachuting, airsoft, drag racing, paintballing, wakeboarding and bungee jumping.
17. Treatment of injuries or illnesses resulting from war and any combat-related activities while in military service.
18. Treatment for Chronic Dermatoses
19. Services obtained for non-emergency conditions from physicians and hospitals in any of the following circumstances:
    1. non-Affiliated Physicians in non-Affiliated Hospitals or non-Affiliated Clinics
    2. non-Affiliated Physicians in Affiliated Hospitals or Affiliated Clinics
    3. Affiliated Physicians in non-Affiliated Hospitals or non-affiliated Clinics or other healthcare facility.
20. Additional hospital charges and physician's professional fees resulting from:
    1. room-upgrading beyond twenty-four (24) hours during Emergency Conditions;
    2. extension of hospital stay despite release of discharge order from Member's Attending Physician;
    3. fees of the assistant surgeons for surgeries with less than 250 RUV units / resident doctors who assisted the Attending Physician in the process of rendering the medical services shall not be chargeable to the Member and/or COOPHEALTH except for hospitals that do not have resident physicians to assist during surgeries subject to the prior approval of COOPHEALTH;
    4. use of extra bed, TV, electric fan, DVD/ VCD, and other similar items unless such appliances and items are necessarily and ordinarily included in the Member's Room and Board Accommodation;
    5. extra food; toilet articles like face towel, soap, toothbrush and the like;
    6. difference in Room and Board Accommodation, the incremental rate differences for professional fees, diagnostic and laboratory examinations, and other ancillary medical services brought about by obtaining a room and board accommodation higher than the Member's Room and Board Accommodation limit;
    7. services of a private or a special nurse;
    8. all other items not medically necessary in the medical management of the Member.
21. Routine physical examinations required for obtaining or continuing employment, requirement in school, insurance/travel or government licensing, health permit and other similar purposes.
22. Custodial, Domiciliary, Convalescent and lntermediate care.
23. Medical certificates.
24. Professional fees of medico-legal officer/s.
25. All expenses incurred in the process of organ donation and transplantation if the Member is the donor, and its complications.
26. Benefits covered by PhilHealth and all other government funded healthcare entitlements as provided for by law.
27. Cost of the medical services and professional fees in excess of the MBL.
28. Purchase or lease of any Durable Medical Equipment, oxygen dispensing equipment, and oxygen except during covered in-patient care.