Georgia

Hospitalization Assistance

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Hospitalization Assistance

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Product Description
  • Any regular member of SMTCDC who possesses the following qualifications:
    • Has been a member of the Cooperative for at least one year prior to claim of services.
    • Must have a minimum of P5,000.00 in share capital and at least P500.00 in savings deposit for the past six months.
    • Must be tagged as active member.
    • Must have no outstanding past-due loan, or at least, the outstanding loan is not more than thirty days past-due in the last six months.
    • If loan is restructured, must have maintained GP rating for a minimum of twelve months.

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  • Any one of Gold Member’s immediate family, to with:
    • Member’s children aged 7 to 17 years of age; or
    • Spouse; or
    • Parents up to 65 years old only. 

  • Claims must be files with complete requirements within 45 days from the last confinement date or out-patient procedure undergone by member or his/her immediate family beneficiary; otherwise, the medical assistance is forfeited.

    Further, the basis of entitlement to medical assistance benefit is the date of confinement and not the date when the claim is made.

  • Should the member prefer to transfer his/her entitlement to medical assistance, he/she must choose only one from his/her immediate family provided that he/she still has remaining medical assistance benefit during the year.
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Documentary Requirement

Hospital bill, official receipts, hospital record and/ or medical certificate are required.

1. Maternity Claim Limitations

1.1. Three (3) availments of normal delivery upon membership to the Cooperative.

1.2. Three (3) availments for caesarian section upon membership to the Cooperative.

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2. Exclusions

Hospitalization confinement due to any of the following reasons does not entitle the member to a claim on medical assistance benefit:

2.1 Executive check-up

2.2 Self-inflicted and/or provoked injuries

2.3 Plastic surgery

2.4 Induced abortion

2.5 Injuries sustained in the commission of a crime

2.6 Sickness/injuries caused by illegal business

2.7 Sickness/ injuries due to drug/alcohol abuse

2.8 Sickness/ injuries due to attempted suicide

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