Kaiser’s National HealthCare Shield (NHS) is a group HMO program for government groups that provides comprehensive medical benefits to principal members and qualified dependents through its network of 2,000+ hospitals and clinics nationwide. It's annual premium is ₱7,000 VAT inclusive, and has a maximum benefit limit of ₱75,000 per illness.
What is the Kaiser National HealthCare Shield?
Kaiser National HealthCare Shield is designed to cater to the needs of government employees and designed to provide benefits even for high-risk cases including pregnant women, senior citizens and persons with disabilities.
Covers monthly pre- and post-natal checkup.
Covers age 18 - 65 years
Covers pre-existing conditions
Includes access to major hospitals nationwide
Provides preventive, outpatient, inpatient, emergency, and dental care
NO DEPOSIT ON ADMISSION
Financial assistance for death or major injuries
National HealthCare Shield Details
Kaiser's NHS has a 5-point healthcare program,plus financial care program. Watch details here
What are these 5-points?
Preventive Care Annual checkups, pap smear, ECG, vaccinations, family planning counseling
Outpatient Consultations, diagnostic tests, minor surgery, EENT treatment
Inpatient Confinement in semi-private room, surgery, ICU, dialysis, chemotherapy
Emergency ER services, oxygen, IV, meds for urgent care
Once admitted, you will be advised to file your Philhealth reimbursement form.
The Philhealth reimbursement due shall be deducted from the total hospital bill.
Kaiser members without Philhealth membership, shall shoulder and pay the
Corresponding portion of Philhealth.
Pre-existing
Simple lang ang aming policy sa pre-existing.
Pre-existing conditions are covered.
asthma?
high blood?
sakit sa puso?
diabetes?
Sabi nga ng Kaiser
All pre-existing conditions shall be deemed covered immediately by KAISER, and provided that the applicable benefits shall not exceed the maximum Benefit Limit per pre- existing condition/disease per year of membership
It is understood that the foregoing benefits shall likewise be applicable to dreaded diseases
Application and payment for dependents must be made within 30 calendar days of effectivity of HMO Agreement
ELIGIBILITY FOR DEPENDENTS:
A) FOR SINGLE MEMBERS/EMPLOYEES:
Parents of the principal member, up to age 65, unemployed and dependent on the principal member.
Brothers and sisters 1 year old up to 21 years of age, unemployed and are living under the same roof as the principal member.
Enrollment of dependents must follow an order of hierarchy; the parents must be enrolled first followed by the eldest sibling and so on.
B) FOR MARRIED MEMBERS/EMPLOYEES:
The legal spouse of the principal member is at least 18 years old up to age 65.
Legitimate and/or legally adopted children 1 year old up to 21 years of age and living under the same roof as the principal member.
Enrollment of dependents must follow an order of hierarchy; the spouse must be enrolled first followed by the eldest children, second child and so on for married personnel.
Not All HMO Hospitalization Plans are Created Equal!
Hospitalization plans are good, and provide immediate relief to those requiring emergency treatment or confinement. But please learn important details of your plans: many inexpensive hospital plans are one time use only, have low benefit limits, and often limited to viral, bacterial infection and accident cases.
Lifestyle diseases not covered, like those related to high blood
pressure, heart problems, allergies. Inexpensive plans have NO ACCESS to major hospitals ( usually the most advanced medical facilities in the country).
Inexpensive hospital plans normally do not include outpatient benefits, and annual physical examination, and often expire UNUSED, because most people do not frequently need emergency care and confinement.
Comprehensive group HMO plans have slightly higher annual fees, but are frequently used for doctor consultation and annual physical exam. Given the benefits, comprehensive plans such as the Kaiser National Healthcare Shield provide much more value than limited individual HMO plans.
NHS for Informal Groups (e.g. teachers)
Here's how to implement Kaiser’s National Healthcare Shield (NHS) for unofficial groups for teachers in public schools in six easy steps
KAISER shall pay the services on hospitalization of a member for dreaded disease up to the maximum amount or limit per illness per year
Dreaded diseases are potential or life threatening conditions or illnesses which may require intensive care management or prolonged or repetitive hospitalization.
The following are considered dreaded disease:
Injuries from accidents or assaults, frustrated homicide or frustrated murder
Complications of an apparent ordinary illness including MODS and SIRS (e.g. sepsis due to pneumonia, typhoid ileitis, cerebral malaria, etc.)
Malignancies and Blood Dyscrasias (Cancer, Leukemia, Idiopathic Thrombocytopenic Purpura)
Single or multiple organ dysfunction and failure (MODS and MOF)
Conditions that may require dialysis
Chronic pain syndrome (greater than six weeks)
Any illness other than the above which would require Intensive Care Unit confinement
Any other illness that is not mentioned above and is not self-inflicted is included.
Dreaded Diseases which are pre-existing in accordance with this Agreement are to be governed under this provision
Exclusions and limitations
All services have exclusions and limitations, and Kaiser's National Healthcare Shield have them too. Notable exclusions
Medically unnecessary expenses such as TV, massage, extra pillows
Medically unnecessary procedures such as cosmetic surgery, treatment for aesthetic treatment
Physical exam / tests for employment purposes
Treatment for injuries attributable to own misconduct, commission of crime, gross negligence, or attributable to hazardous job-related illnesses and/ or injuries while performing such work
Treatment for injuries related to alcohol intoxication, or use of drug abuse, or drug addiction, or self inflicted
Treatment for sexually transmitted diseases
Psychiatric and psychological illnesses
Purchase of lease of durable medical equipment
Outpatient prescribed medication
Custodial, domiciliary care, convalescent, and intermediate care
Services outside the Philippines
Certain procedures (typically expensive, but covered by Philhealth) such as craniotomy, organ transplantation and heart surgeries
Certain autoimmune and neurologican diseases such as Guillain-Barre syndrome, multiple sclerosis, demyelinating disease, Parkinson’s disease, Alzheimer’s disease, Myasthenia Gravis, epilepsy, seizure disorder
etc (see memorandum of agreement)
Exclusions and limitations
All services have exclusions and limitations, and Kaiser's National Healthcare Shield have them too. Notable exclusions
Services of a private nurse or doctor, use of extra bed and or food, television, DVD, electric fan, admission fee, ID bracelet, thermometer, admission kit and all other items not directly related to the medical management of the patient.
Cost of hospitalization, medicine, medical services and other expenses
incurred as a result of a member’s decision to avail of such hospitalization,
medical services, treatment or procedure not prescribed or contrary to
what has been prescribed by the attending KAISER provider, or
without KAISER’s written report.
Hospitalization and treatment outside the Philippines is not covered.
Prescribed medicines on an out- patient basis are not provided by Kaiser Accredited Units.
Out- patient medical and healthcare services are provided only during clinic hours of Kaiser Accredited Providers.
Second opinions and cost of treatment incurred in a non-accredited provider should the member unilaterally decided to seek such recourse.
Development disorders, metabolic diseases, sleep, and eating disorders.
Dermatological care for aesthetic purposes such as electrocautery or chemical treatment for skin tags, xanthelasma, milia, keloids, scars, etc. on any exposed areas of the body.
Psoriasis, vitiligo.
Sensorineural hearing impairments except those acquired during time of membership.
Open heart surgeries, angioplasties, valvuloplasties, permanent pacemaker insertion, intra-coronary thrombolysis, balloon valvulaplasties, transvenous endocryocardial biopsy, percutaneous intraaortic, balloon pump insertion balloon atrial septostomy, previous craniotomy sequelae, organ transplantation and complication and other surgeries related to the heart
Services to diagnose and for reverse infertility or fertility and virility/ potency (erectile dysfunction).
Experimental medical procedures, acupuncture, acupressure, reflexology, and chiropractics.
Physical examinations required for obtaining or continuing employment, insurance, or government licensing.
Injuries or illnesses resulting from participation in war-like or combat operations, riots, insurrection, rebellion, strikes and other civil disturbances
Sexually-transmitted diseases such as Hepatitis B, condyloma, gonorrhea, syphilis, herpes etc. and their attendant complications.
Psychiatric and psychological illnesses including neurotic and psychotic behavior disorders.
Treatment of self-inflicted injuries or injuries attributable to the MEMBER’S own misconduct, gross negligence, use of alcohol and/or drugs, vicious or immoral habits. Participation in act of crime, violation of a law or ordinance, unnecessary exposure to imminent danger or hazard to health, and hazardous sports related injuries.
Maternity care and other conditions as a result of pregnancy unless specifically provided.
Custodial, domiciliary care, convalescent, and intermediate care.
Professional fees of medico-legal officers.
Treatment of injuries sustained in a motor vehicle accident if the member or his guardian fails or refuses to execute the deed of Subrogation.
Treatment for alcoholic intoxication and drug addiction or overdose reaction to use of prohibited drugs including illnesses directly related to it and other injuries attributed as a result of it.
Plastic and reconstructive surgery for cosmetic purposes and for physical congenital deformities and abnormalities.
Human blood products like platelets, packed RBC, plasma, gamma globulin, etc. and its processing.
Corrective appliances and artificial aids and prosthetic devices.
Purchase or lease of durable medical equipment, oxygen-dispensing equipment, and oxygen except during hospital confinement under the Hospital Confinement Benefit.
Hazardous job-related illnesses and or injuries.
Circumcision, except for correction of phimosis.
Diagnosis of unknown etiology or the absence of any organic dysfunction.
Laboratory examinations for screening sexually related illnesses and injuries.