Long Term Care

The Ultimate Kaiser Health Builder Plan is a healthcare plan that allows one to control his own health and provide for his own future.

Kaiser International Healthgroup, Inc. is an actuarially-sound, product-based business. It brings together the best features of an HMO, Health Savings Plan, and a financial investment.

- An innovative program, the first of it's kind in the country;

- Guarantees long-term care even after the age of sixty when the client has only himself to rely on;

- Healthcare coverage, savings, emergency fund, and insurance rolled into one;

- An accumulative, self-earning investment that comes with Return of Payment for non-utilization in the first seven (7) years of coverage;

- A portable account! Even if you change or lose jobs, your plan and funds stay with you;

- A four-way insurance coverage:

1. Term Life

2. Accidental death and dismemberment

3. Waiver of installment due to death

4. Waiver of installment due to permanent and total disability;

- Outpatient benefits, annual physical examinations and dental coverage;

- Coverage is for individuals but can be installed in companies as a health savings salary deduction program;

- No exclusions from 8th year onward;

- Flexible, Upgradeable within 30 days ;

- Annual lifetime healthcare benefits from years 8 to 20 accumulate with interest in a "Health Savings Account"

- "Health Savings Account" earn interest beyond 20 years.

- Benefits can be used up to any age.

- Payable in 7 years only with fixed rates for the entire paying period;

- Issue age up to 60, but coverability extends after 60; and,

- Reinstatement can be done within 2 years after lapsed policy.

INSURANCE BENEFITS

If, at the time of signing the Membership Application, the Member is in good health, is at least eighteen (18) but not more than seventy-five (75) 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 Insurance

If the Member dies before attaining the age of seventy-five (75) years and prior to entitlement to the Long-Term Care Benefit Value as indicated in the Schedule of Benefits, his beneficiary shall be entitled to an amount equal to the sum of the Long-Term Care Benefit Value (LTCBV) and the Long-Term Health Care Experience incentive Hospital Benefit Limit (LTHCEIHBL) upon approval of the claim by the insurance company.

Accidental Death & Dismemberment Insurance

Should the Member suffer, directly and independently of all other causes, any bodily injury effected solely through external, violent and accidental means, occurring prior to the Member's 75th birthday and prior to entitlement to the Long-Term Care Benefit Value (LTCBV), which result in any of the specified losses below within 180 days after the accident causing the injury, the insurance company will pay a percentage of the sum of the Long-Term Care Benefit Value (LTCBV) and the Long-Term Health Care Experience Incentive Hospital Benefit Limit (LTHCEIHBL) in accordance with the following schedule:

DESCRIPTION PERCENTAGE OF LONG-TERM CARE BENEFIT

1. Loss of Life 100%

2. Loss of both hands 100%

3. Loss of both Feet 100%

4. Loss of sight of both eyes 100%

5. Loss of one hand & one foot 100%

6. Loss of one hand and sight of one eye 100%

7. Loss of one foot and sight of one eye 100%

8. Loss of one hand or one foot 50%

9. Loss of sight of one eye 50%

- Loss shall mean the dismemberment of hands and feet by severance at or above the wrist bone or ankle joints respectively. Loss of eyesight must be total and irrecoverable.

- Any partial benefit already paid for any loss(es) shall not be carried over in the subsequent contract Year i.e., the amount of benefits to be paid in the succeeding contract year shall not be reduced by any amount paid in the preceding contract year.

- The loss of the first joint of the thumb or any other finger or of any toe shall be considered as equal to the loss of one half of the thumb or finger or toe. The loss of more than one phalanx of the thumb or of any other finger or if any toe shall be treated as loss of the entire thumb or finger or toe. Where there is loss of two or more parts of the hand, the percentage payable shall not be more than the loss of one whole hand.

- The aggregate of all percentages payable with respect to any one accident shall not exceed 100%.

Waiver of Installment Due To Death

If the Member dies during the Accumulation Period and before attaining the age of seventy-five (75), the proceeds of the credit life insurance shall be applied to the balance of total membership fees upon approval of the claim by the insurance company making the contract fully paid.

Waiver of Installment Due To Total And Permanent Disability

If the Member becomes totally disabled during the Accumulation Period and before 75th birthday thereby preventing from engaging in any occupation for compensation or profit, is so disabled for life, and such disability continues for at least six (6) months, KIH shall waive the payment of each membership fee becoming due during the period of disability. However, pending approval of the claim, membership fees should be paid as they fall due, subject to refund upon approval.

- All claims under the above Insurance Coverage shall be subject to two (2) years contestability period as provided for by law from the date of issue or reinstatement of this Contract.

- If the Member dies during the Accumulation Period, the Principal Beneficiary named herein shall be substituted as the new Member, but no longer with insurance benefits and subject to the provisions on Pre-existing illness or Injury (Art. II).

Designated Hospitals

During an emergency case, a member who is in a critical condition caused by an illness or injury, the following benefits are:

- Physician's services

- Medicines utilized during treatment or for immediate relief

- Casts, dressing and sutures

- Oxygen and intravenous fluids

- X-Ray, laboratory and other diagnostic examinations directly related to the emergency management of the patient

Non-Designated Hospitals

- KAISER will reimburse 80% of the total hospital bills inclusive of professional fees based on KAISER Accredited Units (KAU) but exceed Php5,000

- KAISER shall only pay the said amount (80% but not to exceed Php5,000) when it is verified that the use of a KAISER non-designated provider would entail a delay resulting in death, serious disability and significant jeopardy to the member's condition or the choice of hospital was beyond the control of the member or member's family

- The member is required to submit all billings relative to such admission to the Kaiser office for the reimbursement of compensable expenditures within a period of 15 days form the date of discharge

FEATURES AND HEALTH CARE BENEFITS

Basic Medical Benefits

- Accredited Hospital's Room & Board Services of Accredited Physician/Specialist/Surgeon/Anesthesiologist
- Hospital's Intensive Care Unit
- Operating Room Fee

Accredited Hospitals

- Over 500 Accredited Hospitals, Hospital's Intensive Care Unit & Operating Room

Accredited Doctors and Specialists

- Over 1,000 accredited Physicians/Specialists/Surgeons/Anesthesiologists

Dental Benefits

- Unlimited dental check-ups, once a year free dental prophylaxis, unlimited simple tooth extraction

Special and Extended Benefits

- Magnetic Resonance Imagine (MRI)
- Nuclear/Radioactive Isotope Scan
- CT Scan, Dialysis, Blood Transfusion
- Physical/ Speech Theraphy
- Anti-Rabies, Venom & Tenanus Vaccine
- Emergency Benefits (Ambulance)

Long-Term Care Benefits (LTCBV)

- Guaranteed health benefits as shown in the Schedule of Benefits which can be used at the end of 20th year as part of the Hospital Benefit Limit (HBL) until fully utilized or can be converted into cash on the 20th year.Guaranteed health benefits as shown in the Schedule of Benefits which can be used at the end of 20th year as part of the Hospital Benefit Limit (HBL) until fully utilized or can be converted into cash on the 20th year.

Yearly Health Care Hospital Benefit Limit (YHCHBL)

- 10% of the LONG TERM CARE BENEFIT VALUE (LTCBV) earned starting from end of the accumulation period and every year thereafter up to the 20th year.

Long Term Health Care Experience Incentive Hospital Benefit Limit (LTHCEIHBL)

- Approximately 85% of the total membership fees which can be converted into cash or be part of the Hospital Benefit Limit (HBL) from the 20th year until fully utilized.

Lifetime Network Access

- Lifetime access to over 1,000 doctors, over 500 hospitals as long as you have funds available in your health benefits

Cost Free Health Benefits

- With return of Membership Fee for Non-Utilization

Additional Yearly Health Care Hospital Benefit Limit (AYHCHBL)

- A benefit other than the YEARLY HEALTH CARE HOSPITAL BENEFIT LIMIT (YHCBL) at the end of the accumulation period and every year thereafter up to the 20th year, provided that Kaiser's investment earnings is higher than 6% per annum.