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IMPORTANCE OF MENTAL HEALTH IN THE WORKPLACE: AN INTERACTIVE SESSION

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ABOUT US
MISSION & VISION
 
AVEGA is the country's leader in healthcare administration.

We create customized healthcare solutions that adapt and grow with changing needs.

We provide excellent value and service to the individuals and communities we serve, giving them access to high quality, affordable healthcare.

We are committed to deliver all our services with deep sense of humanity and compassion, founded on integrity, transparency, accountability, and respect for life- cornerstones of our corporate values.

55, 900

Affiliated doctors and specialists

15

Regional and satellite offices

95%

Client retention and customer loyalty

2,800

Hospitals and clinic network


  Providers Directory

AVEGA offers:

AVEGA offers:

Healthcare Benefit Administration

We take the load off your shoulders from availment to documentation.

Healthcare Benefit Administration

We take the load off your shoulders from availment to documentation.

Utilization Review & Recommendation

We provide reportorial and data analytics that can help in employee benefit management and create tailor-fitted wellness programs for your employees. This also enables you to make necessary adjustments to your benefit package within your contract period.

Utilization Review & Recommendation

We provide reportorial and data analytics that can help in employee benefit management and create tailor-fitted wellness programs for your employees. This also enables you to make necessary adjustments to your benefit package within your contract period

Fund Proctection & Management

We offer pay-per-use program which can lead to more savings for your company because we give value for your money.

Fund Proctection & Management

We offer pay-per-use program which can lead to more savings for your company because we give value for your money.

AVAILMENT PROCEDURES
1

If recommended for admission after undergoing medical consultation or diagnostic examination, secure an admitting order from an AVEGA-affiliated doctor in an AVEGA-accreditted hospital where you will be admitted.

2

Proceed to the admitting section and present your admitting order and AVEGA card. The medical staff will swipe your card for validation of membership eligibility.

If APPROVED, In-Patient LOE will be printed. Sign the LOE.
If DECLINED, staff will call AVEGA's Customer Service for assistance.

3

Occupy allowed room or room category nearest to your plan benefit.

4

Inform AVEGA's Customer Service regarding the admission within 24 hours.

5

Patient's Relation Officer (PRO) will issue an AVEGA RCS 3 for the confinement and discuss the benefit plan. Sign the RCS 3.

6

File PhilHealth for PhilHealth-required procedures.

7

Please validate if all the charges are correct. Settle any excess and miscelaneous upon discharge.

1

Go to the POS terminal in an accredited hospital or clinic. In a hospital, the terminal is located at the AVEGA Coordinator's clinic, at the Industrial office, or at the HMO office. In a clinic, the terminal is located at the reception area or at the nurse station.

2

Present your AVEGA card to the AVEGA Coordinator or to the attending medical staff and have it swiped to validate membership eligibility.

3

If APPROVED, Out-Patient (OP) Letter of Eligibility (LOE) will be printed. Sign the LOE.

If DECLINED, attending medical staff will call AVEGA's Customer Service for assistance.

4

Present the Out-Patient LOE to the AVEGA Coordinator to secure the Referral Control Sheet (RCS) 1. Sign the RCS form and avail the consultation.

5

For laboratory and diagnostic procedures, the facility will call AVEGA hotline for approval of the procedures and tagging of availments (for limit monitoring). Sign the RCS 2 and avail the procedure.

6

File for PhilHealth for PhilHealth-required procedures.

1

Check the list of accredited dentists under AVEGA. You may refer to the guidebook or to the AVEGA website, or call 7902-3430 / 8789-4030.

2

Call the dentist to confirm schedule and to inquire if an appointment should be set or if walk-in patients can be accommodated.

3

Proceed to the dental clinic on the day of your dental availment and present your AVEGA card for validation.

4

Avail the entitled dental benefit.

5

Sign the Referral Control Sheet (RCS) 5 made available at the dental clinic.

1

Go to the Emergency Room (ER) of an accredited hospital.

2

Present your AVEGA card to the ER staff for validation of your membership status.

If APPROVED, ER LOE will be printed. Sign the LOE.
If DECLINED, staff will call AVEGA's Customer Service for assistance.

3

Undergo medical treatment.

4

If declared as an OUT-PATIENT CASE, sign the hospital bill upon charges and settle non-covered charges.

5

If for ADMISSION, notify AVEGA's Customer Service within 24 hours. Occupy allowed room. (NOTE: Please double check room category/plan limit to avoid paying incremental charges).

6

File PhilHealth for PhilHealth-required procedures.

7

Patient's Relation Officer (PRO) will issue an AVEGA RCS 3 for the in-patient. Sign the RCS 3. Settle any incremental and miscellaneous charges upan discharge (please validate if items charged are correct).

EMERGENCY (for non-accredited hospitals)

1. Go to the Emergency Room (ER) of an accredited hospital.
2. Avail the treatment at the Emergency Room.
3. If FOR CONFINEMENT, notify AVEGA's Customer Service within 24 hours.
4. File PhilHealth for PhilHealth-required procedures.
5. Settle hospital bill upon discharge. Secure all pertinent documentation and RECEIPTS for reimbursement.
6. File for reimbursement.

If treated in a non-accredited facility, you may file for reimbursement of your hospital bill (subject to plan coverage).

The process of reimbursement is as follows:

1. Download AVEGA Reimbursement Form from AVEGA's website or secure a copy from your HR representative.

2. Fill-out the reimbursement form completely and attach required documents (Please note: all attached receipts must be original copies).

3. Submit the form and the required documents to AVEGA within 30 days from expiration of treatment/hospital discharge.

4. AVEGA will process the request within 30 days upon receipt of complete form and documents.

1

Secure an AVEGA Reimbursement form from your HR Representative or Download Reimbursement Form.

2

Complete all the required documents and attach together with the reimbursement form. Please refer to the reimbursement form for the details of the REQUIRED documents.

3

Submit the reimbursement form and required documents to your HR not more than 30 days form the last day of treatment.

Visit our new Medical Bulletin Page!


When it comes to your well-being, the more you know, the better. Keep updated on topic about health, certain illness, tips and more.




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CONTACT US
HEAD OFFICE

14/F Phil. AXA Building, Sen. Gil Puyat Avenue cor. Tindalo Street, Brgy. San Antonio, Makati City
Trunkline: 7902-3430 / 8789-4030
EMAIL: inquire@avega.com.ph

REGIONAL OFFICE

BACOLOD CITY

Door 3, R.L. Jocson Bldg., BS Aquino Drive, Bacolod City
Trunkline: 034-707-2047 to 49

CALAMBA CITY

2nd Floor KIM KAT Building, Old National Hi-way., Brgy. Parian, Calamba City, Laguna
Trunkline: (049) 545-5081-83, 545-7958, 502-2007

CEBU CITY

Rm. 601 6Flr. Metrobank Plaza Building, Osmeña Blvd., Cebu City, Philippines 6000
Trunkline: (032) 255-1282

DAVAO CITY

Suite B205 - 206, 2/F Plaza de Luisa Bldg. R. Magsaysay Avenue, Davao City
Trunkline: (082) 222-3577 to 80

SATELLITE OFFICE

ANGELES CITY

2nd Floor Mortiz Bulding, corner B. Aquino Drive & Mc Arthur Highway, Angeles City (Ground Floor, Bank of Commerce)
Trunkline: (045) 626-2070

LEGAZPI CITY

Room 217 2nd Floor King’s Commercial Building., Peñaranda St., Legaspi City
Trunkline: (052) 480-4040

NEGROS AND PANAY

San Carlos City
Mobile No: (0925)500-5605 (SUN)

ROXAS/CAPIZ/KALIBO

Mobile No: (0925)500-5605 (SUN)

ILOILO CITY

Ground Floor Viosils Arcade, M.H. Del Pilar St., Molo, Iloilo City
Trunkline: (033)509-9440, (033) 508-0014
Mobile No: (0920)917-4128 (SMART)

CENTRAL & EASTERN VISAYAS / NORTHERN MINDANAO
CAGAYAN DE ORO CITY

Rooftop, CFI Community Cooperative Bldg. Tiano-Mabini St. Cagayan de Oro City
Trunkline: (088) 864-8900
Telefax: (088) 850-6651
Mobile Number: 09175928346 (Globe)

ORMOC CITY

Mobile No: (0936)415-0383 (GLOBE)

DUMAGUETE CITY

3F Portal West Bldg. Siliman corner Hibbard Ave., Dumaguete City
Trunkline: (035)422-7842

TAGBILARAN CITY

C/O Cebu Regional Office

SOUTHERN MINDANAO
KIDAPAWAN CITY

2nd Floor, KHAS Realty Building, Quezon Blvd. cor. Datu Ingkal Streets, Kidapawan City
Trunkline: (064) 577-1715
Mobile Number: 0920945-6734 (Smart), 0922889-3204 (Sun), 0917870-4396 (Globe)

GENERAL SANTOS CITY

Contact Person/PRO: Ms. Ruth Daryl I. Feril (PRO) and Ms. Junalyn Grace L. Cadivida (CSS)
Trunkline and Telefax: (083) 552-2351 Fax (PLDT Landline), (083) 305-0215 (Globe Landline)
Mobile Number: 09209519524 (Smart), 09178704387 (Globe), 09228893211 (Sun)

FREQUENTLY ASKED QUESTIONS (FAQs)
Q.
Where can I get a copy of the list of affiliated AVEGA Medical Providers?
A.
AVEGA consistently updates its list of affiliated doctors and medical providers. You may download the list from our website (www.AVEGA.com.ph), our Facebook Page, or request a copy from your Human Resources Department.
Q.
Are there AVEGA Coordinators available in hospitals? What should I do if they are unavailable?
A.
AVEGA may have an assigned coordinator(s) per hospital who will accommodate members for outpatient and non-emergency consultations during their specified clinic hours. For hospitals that have no coordinators but have an HMO or Industrial office, you may secure AVEGA Referral Forms from either office.

For medical emergencies, you may proceed directly to the emergency room of the hospital for immediate treatment. However, assessment of whether the case is emergency or not will depend on the Emergency Room physician.
Q.
If I am in an accredited hospital and want to use the services of my personal doctor who is not accredited, can I have the medical services reimbursed?
A.
Consultation, treatment and referral for diagnostic procedures and/or confinement coming from a non-accredited doctor is non-reimbursable. For you to enjoy the benefits of your health plan, you must avail of your benefits in an AVEGA accredited hospital or clinic and have your case managed by an AVEGA affiliated doctor, except during emergency cases.
Q.
Can I have my personal doctor/dentist accredited by AVEGA?
A.
You may write a request for accreditation to AVEGA’s Account Management Department or coordinate with your HR Representative to facilitate your request.

The doctor/dentist will be asked to submit necessary requirements to AVEGA and will be evaluated by the company’s Provider Relations Department if qualified to be part of Intellicare’s network.

The doctor may be affiliated only if he/she passes AVEGA’s evaluation and he/she agrees to the payment terms and conditions of our contract. We will give you status update through our Account Officer if your request has been approved or not.
Q.
During confinement, if I want to occupy a room category higher than what is stated in my plan, may I do so?
A.
Yes, you may occupy a room category higher than what is entitled to you. However, during voluntary upgrading (when you choose to occupy a higher room category even if you’re allowed room is available), you will pay all incremental charges. Due to socialized pricing in hospitals, the higher the room occupied - the higher the cost of services. This includes room rate, professional fees, medicines, medical supplies, hospital procedures and the like. The same charges may also apply if you are admitted in a hospital that does not provide or does not allow confinement of non-private patients in the room category corresponding to your plan. The AVEGA Patient Relations Officer shall explain and remind you to pay these charges prior to hospital discharge.
Q.
What if, during the time of my admission, all the rooms under my room category are occupied – what will I do?
A.
In this case, you may choose one of the following options:

  • Occupy a lower room category and pay no incremental charges.
  • 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, otherwise you will pay all incremental charges from day one (1) of confinement.
  • You may transfer to another accredited hospital if it is a non-emergency case.
Note: Provision on involuntary upgrading of room category may vary according to the plan of the member.
Q.
What if my illness/condition developed certain complications – will these illnesses have a separate Maximum Benefit Limit?
A.
Any and all illnesses proven to be related or is a complication of a certain illness shall share the same Maximum Benefit Limit.
Q.
Who is responsible for the filing of my Philhealth forms with the hospital? What happens if I fail to file?
A.
It is the member’s responsibility to file the Philhealth forms. If you fail to file upon hospital discharge, you will pay the amount corresponding to your Philhealth benefit and apply for reimbursement directly from the Philhealth Office afterwards.

You may coordinate with your company’s HR Representative during your confinement period to secure a signed Philhealth Claim Form 1, Philhealth contributions and Member’s Data Record (MDR) as well as a Philhealth Claim Form 2 to be signed by your attending physician prior to hospital discharge. AVEGA Patient Relation Officers (PROs) will provide assistance in reminding you to submit the said forms. They, however, will not be directly responsible for the actual filing.

Note: In the case of a non-Philhealth member, member must pay the Philhealth portion of the hospital bill prior to hospital discharge.
Q.
Do I get 100% reimbursement for my emergency confinement in a non-accredited hospital?
A.
If you were treated in a non-accredited hospital for a medical emergency, AVEGA will reimburse your medical expenses based on the Relative Value Scale (RVS) or rates AVEGA has agreed upon with its accredited providers. The amount will not be exactly the same as the amount that you spent in the non-accredited facility. The same computation applies to emergency confinement cases in non-service areas or foreign countries (please refer to your Emergency Care benefits for the percentage and maximum amount of reimbursement).
Q.
What is the turn-around time for the submission and processing of reimbursement?
A.
Submission of the duly accomplished AVEGA Reimbursement form and required attachments is within 30 days from the date of hospital discharge or treatment.

AVEGA will process the request within 30 days upon receipt of the complete documents.
Q.
What should I do if I am asked to pay for medical services which I know are covered?
A.
You should call AVEGA’s Trunk line through telephone numbers 902-3430/789-4030 for assistance and verification of the service being charged.
Q.
What if the hospital has a cash basis policy for some of the procedures even if they are recommended or performed by an AVEGA-affiliated physician?
A.
You may pay for the cost of the procedure first then file for reimbursement later on. Reimbursement shall be based on the Relative Value Scale (RVS) or pre-agreed rates for laboratory and diagnostic examinations (i.e. CT scan, MRI, etc.). If you do not want to shell out the amount being asked for, you may transfer to another AVEGA-accredited facility that has no “cash basis only” policy. You may call AVEGA’s Trunk line for assistance.
Q.
Why do I need to pay for the professional fees of accredited Neurologists?
A.
The professional fees of Neurologists at the moment are on a “cash basis” policy for all HMO members. This policy is in accordance with the guidelines set by the Society of Neurologist of the Philippines. You may pay for the cost of professional fees first then file for reimbursement based on AVEGA’s Relative Value Scale (RVS). For any recommended procedures, AVEGA will cover the member immediately according to the plan benefit.
Q.
What if there is no AVEGA doctor available in any accredited hospital for the field of specialization I need or I am referred to?
A.
AVEGA will exert all its effort to negotiate for the AVEGA rate to be charged once the member is referred to a non-affiliated specialist. If the physician does not agree to the rate, you will be asked to pay the cost of their professional fee first then file for reimbursement based on the AVEGA Relative Value Scale (RVS).
Q.
What if I get into a vehicular accident – will AVEGA cover the cost of my medical expenses?
A.
In this case, you need to submit a police report and other pertinent documents for any injuries sustained in vehicular accidents and other medico-legal cases (i.e. shooting, stabbing, mauling, etc.) subject for evaluation. AVEGA will not cover injuries resulting from causes under the general exclusions and limitations.
Q.
If I resign from my company, can I still use my AVEGA Card?
A.
The member’s healthcare benefit is co-terminus with his/her stay with the company. You should surrender your card prior to resignation as this is a requirement of the clearance process. Use of the card after separation from the company is an illegal transaction and the member will be billed for any medical availment incurred after resignation/separation from the company.
Q.
If I lose my card, what should I do?
A.
You should notify your HR Representative or AVEGA’s Trunk line within 24 hours upon discovery of the loss. You need to submit an Affidavit of Loss and will be charged Php 100.00 for the replacement of the card. If you need medical care while your new card is still being processed, you may contact AVEGA’s Trunk line for endorsement to the medical facility where the procedure or consultation/treatment will be conducted.
Q.
What should I do if I want to give feedback or report any concerns?
A.
You may e-mail AVEGA at info@AVEGA.com.ph or make an incident report and submit it to your HR Representative. For urgent matters, you may call AVEGA’s Trunk line for immediate assistance. Please give all pertinent information for AVEGA to be able to address the concern/s as quickly as possible.

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LEARN MORE ACCEPT
1

If recommended for admission after undergoing medical consultation or diagnostic examination, secure an admitting order from an AVEGA-affiliated doctor in an AVEGA-accreditted hospital where you will be admitted.

2

Proceed to the admitting section and present your admitting order and AVEGA card. The medical staff will swipe your card for validation of membership eligibility.

If APPROVED, In-Patient LOE will be printed. Sign the LOE.
If DECLINED, staff will call AVEGA's Customer Service for assistance.

3

Occupy allowed room or room category nearest to your plan benefit.

4

Inform AVEGA's Customer Service regarding the admission within 24 hours.

5

Patient's Relation Officer (PRO) will issue an AVEGA RCS 3 for the confinement and discuss the benefit plan. Sign the RCS 3.

6

File PhilHealth for PhilHealth-required procedures.

7

Please validate if all the charges are correct. Settle any excess and miscelaneous upon discharge.

1

Go to the POS terminal in an accredited hospital or clinic. In a hospital, the terminal is located at the AVEGA Coordinator's clinic, at the Industrial office, or at the HMO office. In a clinic, the terminal is located at the reception area or at the nurse station.

2

Present your AVEGA card to the AVEGA Coordinator or to the attending medical staff and have it swiped to validate membership eligibility.

3

If APPROVED, Out-Patient (OP) Letter of Eligibility (LOE) will be printed. Sign the LOE.

If DECLINED, attending medical staff will call AVEGA's Customer Service for assistance.

4

Present the Out-Patient LOE to the AVEGA Coordinator to secure the Referral Control Sheet (RCS) 1. Sign the RCS form and avail the consultation.

5

For laboratory and diagnostic procedures, the facility will call AVEGA hotline for approval of the procedures and tagging of availments (for limit monitoring). Sign the RCS 2 and avail the procedure.

6

File PhilHealth for PhilHealth-required procedures.

1

Check the list of accredited dentists under AVEGA. You may refer to the guidebook or to the AVEGA website, or call 902-3430 / 789-4030.

2

Present your AVEGA card to the AVEGA Coordinator or to the attending medical staff and have it swiped to validate membership eligibility.

3

Call the dentist to confirm schedule and to inquire if an appointment should be set or if walk-in patients can be accommodated.

4

Avail the entitled dental benefit.

5

Sign the Referral Control Sheet (RCS) 5 made available at the dental clinic.

1

Go to the Emergency Room (ER) of an accredited hospital.

2

If APPROVED, ER LOE will be printed. Sign the LOE.
If DECLINED, staff will call AVEGA's Customer Service for assistance.

3

Undergo medical treatment.

Present your AVEGA card to the ER staff for validation of your membership status.

If APPROVED, ER LOE will be printed. Sign the LOE.
If DECLINED, staff will call AVEGA's Customer Service for assistance.

4

If declared as an OUT-PATIENT CASE, sign the hospital bill upon charges and settle non-covered charges.

5

If for ADMISSION, notify AVEGA's Customer Service within 24 hours. Occupy allowed room.

NOTE: Please double check room category/plan limit to avoid paying incremental charges.

6

File PhilHealth for PhilHealth-required procedures.

7

Patient's Relation Officer (PRO) will issue an AVEGA RCS 3 for the in-patient. Sign the RCS 3. Settle any incremental and miscellaneous charges upan discharge (please validate if items charged are correct).

EMERGENCY (for non-accredited hospitals)

1. Go to the Emergency Room (ER) of an accredited hospital.

2. Avail the treatment at the Emergency Room.

3. If FOR CONFINEMENT, notify AVEGA's Customer Service within 24 hours.

4. File PhilHealth for PhilHealth-required procedures.

5. Settle hospital bill upon discharge. Secure all pertinent documentation and RECEIPTS for reimbursement.

6. File for reimbursement.

If treated in a non-accredited facility, you may file for reimbursement of your hospital bill (subject to plan coverage).

The process of reimbursement is as follows:

1. Download AVEGA Reimbursement Form from AVEGA's website or secure a copy from your HR representative.

2. Fill-out the reimbursement form completely and attach required documents (Please note: all attached receipts must be original copies).

3. Submit the form and the required documents to AVEGA within 30 days from expiration of treatment/hospital discharge.

4. AVEGA will process the request within 30 days upon receipt of complete form and documents.

1

Secure an AVEGA Reimbursement form from your HR Representative or Download Reimbursement Form.

2

Complete all the required documents and attach together with the reimbursement form. Please refer to the reimbursement form for the details of the REQUIRED documents.

3

Submit the reimbursement form and required documents to your HR not more than 30 days form the last day of treatment.

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