ASSOCIATION OF HEALTH MAINTENANCE ORGANIZATIONS OF

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AHMOPI
ASSOCIATION OF HEALTH MAINTENANCE
ORGANIZATIONS OF THE PHILIPPINES, INC.
WITNESSETH:
WHEREAS, AHMOPI is the recognized trade organization of Health Maintenance
Organizations (HMOs) in the Philippines
WHEREAS, AHMOPI is currently composed of several HMOs which are business
entities that arranges for pre-paid health care services for their members by contracting with
hospitals, physicians, and other health professionals for their services
AHMOPI members
include, but are not limited to. the following:
BLUE CROSS HEALTHCARE, INC.
800 Makati Avenue corner Burgos Strccl
Makati City
Tel. No. 899-8001 Fax; 899-5392
Website: \wvw bluccross.com.ph
MEDICAL SERVICES MARKETING &
DEVELOPMENT CORPORATION
Penthouse. Seven East Capitol Building
East Capitol Drive. Kapitolyo. Pasig City
Tel. No. 746-5000 Fax: 632-0651
Website: wwvyjnedserve.com.ph
CARITAS HEALTH SHIELD, INC
3' k Floor Kalipuiian Building
95 E. Rodrigue/ Boulevard. Que/on City
Tel. No 7X1-6492 Fax- 732-5251
Wcdsiic: ww\\.cantashcajihshild.com.ph
MEDICARD PHILIPPINES, INC.
S/F The World Center
330 Sen Gil Puyal Avenue, Makati City
Tel No. 867-2020 Fax: 810-3855
Website w\vw.mcdicardpli11Is coin
COCOLIFE HEALTH CARE
S/F Feliza Building. V A, Rufmo Strccl
Lcgaspi Village. Makati /city
Tel. No. SI3-3000 Fax: 812-3363
Website; \v\v\h
MEDOCARE HEALTH SYSTEMS, INC
7/F EU State Tower
#30 Quc/.on Avenue. Quc/on City
Tel. No. 781-9682 Fax: 732-4415
Wcdsite: ww\v,cujj,roup net
FORTUNE MEDICARE, INC.
3/F CityStalc Centre
709 Shaw Boulevard. Pasig City
Tel. No. 706-4X47 Fax: 706-4231
Website. \vu\\.fortunccare.com.ph
METROCARE HEALTH SYSTEMS, INC.
55 Don Bcnilo Hcniandc/ Street
Jalandoui Compound. Pasay City
Tel. No 551-7764 (or 67)'Fax: 551-0911
email: admprl'd.mctrocarchealth com
HEALTH MAINTENANCE, INC.
To\verGround. Makati Cinema Square
Chino Roces Avenue. Makati Cit>
Tel. No. 8 1 1 - 1 3 1 3 Fax; 817-1377
Website: wwu.hmi com.ph
PH1LHEALTH CARE, INC.
7/F Philam Life Building
U.N. Avenue, Malatc. Manila
Tel. No. 523-6002 Fax: 528-3651
INSULAR LIFE HEALTH CARE, INC.
1-CARH Building. 167 Legaspi Street
Lcgaspi Village. 1229 Makati Cit>
Tel No 813-013! io36 Fax 813-7856
Website, \vw\v.icarccom ph
PRUDENTIAL HEALTHCARE, INC.
3f Floor Prudentialife Building
843 Amai/ Avenue. Makati City
Tel. No. 816-4976 Fax: 840-0692
email brrfl'prudentialife.com ph
INTELLICARE
7'F Fell/a Building. V A. Rufmo Street
Legaspi Village. Makati City
Tel. No 894-2120 Fax: 894-2135
Wcdbistc: www.intcilicarc.com.ph
STAR HEALTHCARE SYSTEMS, INC.
4/F Beneficial Lite Insurance Building
166 Salcedo Street. Legaspi Village. Makati Cit>
Tel. No 819-0074 Fax: 819-0072
email; sales ajslarcarc.com ph
MAXICARE HEALTHCARE CORP.
I9/F Medical PI a/a Makati. Amorsolo cor
dcla Rosa Streets. Lcgaspi Village, Makati Cit>
Tel. No. 752-6294 Fax: 813-8713
Website: w\\w.niaxicare.com.ph
VALUE CARE HEALTH SYSTEMS, INC.
Una 607-613 6/F Philippine Slock Exchange Center
Exchange Road. Ortigas Centre. 1600 Pasig Cit>
Tel. No. (02)702-3388 / (02)687-0219 Fax. 637-9453/56
Website wvnv valucare.cQm
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WHEREAS, AHMOPI has signed a Memorandum of Agreement (MOA) with the
PHILIPPINE COLLEGE OF PHYSICIANS, a private corporation duly registered and
existing in accordance with the laws of the Republic of the Philippines, with office address at
Unit 2201-2203, 22nd Floor, One San Miguel Avenue Building, San Miguel Avenue corner
Shaw Boulevard, Ortigas Centre, Pasig City, hereinafter referred to as "PCP".
WHEREAS, the PCP-AHMOPI MOA took effect on May 04, 2009 and shall expire on
May 03, 2011, after which both parties may jointly review, revise and/or modify the said MOA,
if necessary, prior to its renewal for another two (2)-year term.
WHEREAS, AHMOPI Members are desirous of entering into an arrangement with
PCP Members (the Physician) in different localities/communities all over the Philippines for the
purpose of providing medical services to its members.
WHEREAS, the PHYSICIAN is a/an (specialization)
.duly
licensed to practice medicine in the Philippines, and is a member of the PCP, and has signed his
conformity to the provisions of the MOA between the PCP and the AHMOPT dated 04 May
2009;
NOW THEREFORE, for and in consideration of the foregoing premises the parties
hereby mutually agree as follows
I.
The Physician agrees to render quality and cost - effective medical services to
patients of AHMOPI members In consideration
for the above services, the
following professional fees (exclusive of Philippine Health Insurance Corporation fees)
will be paid:
1 1
O u t - P a t i e n t Consultation Fees
The out-patient consultation fees of the Physician shall be Php 300.00 regardless
of their place of practice
Other fees are as follows
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'f
r
For routine pre-procedure medical evaluation,
in- patient and oul-patient
- P 600 00
For pre-procedure medical evaluation, in-patient and
out-patient but with medical indications
- 800.00
Intra-operative monitoring
- 1,200 00
In-Patient Daily Visits:
All professional fees (PF) for both attending physicians and co-attending
physicians shall be based on the following payment schemes:
Ward
Semi-Private
Private
Suite
ICU/CCU
450.00
55000
65000
1,000.00
1,200.00
Other fees are as follows:
For routine pre-procedure medical evaluation,
in- patient and out-patient
- P 600 00
For pre-procedure medical evaluation, in-patient^and
out-patient but with medical indications
800.00
1.20000
Intra-operative monitoring
The Physician shall not "balance-bill1' AHMOPi patients for coverable health conditions
and availments. However, for non-coverable health conditions and availments, the
Physician may bill AHMOPI patients for PFs based on the PF schedules of the AHMOPIMember concerned.
All PFs are subject to the prevailing withholding tax rates and such other tax
provisions.
The prevailing Value Added Tax (VAT) currently at 12%) shall be
shouldered by the AHMOPI-Member provided the Physician submits VAT registration
certificates to the AHMOPI Member. On the other hand, withholding taxes will be
deducted from the Physician's PFs,
For medical procedures listed in the Philippine Health Insurance Corporation
(PhilHealth) and Philippine College of Surgeons (PCS) handbook of 2001, as amended in
01 April 2009, AHMOPI Members agree to pay professional fees (PF) based on the 2009
PHIC Relative Value Scale (RVS) For those procedures not listed, the PCP-AHMOPI
Liaison Committee, in collaboration with the PCP Subspecialties concerned, shall meet
and decide on the most appropriate PF schedules
Discounts for Senior Citizens will not apply to the negotiated rates ( I t e m l ) above.
Similar PFs will apply to all specialists/physicians consulted to co-manage a particular
patient
7
All bills presented by the Physician with complete documentation shall be fully paid by
the .AHMOPI Member according to the negotiated rates (item 1 above) within forty-five
(45) days from receipt of out-patient claims from the Physician, and within sixty (60)
day.v from receipt of in-patient claims from the hospital
7.1,
A penalty of 3% per month shail be imposed on delays from submission of outpatient and in-patient claims (using the same 45-day and 60-day turn-around time
after providing services to the patient) to payment of claims
72
It is the responsibility of the AHMOPI-Member to remit the payments for PFs
directly to the Physician, including the certificate of tax withheld at source (Form \
2307), for both in-patient and out-patient services.
All billings pertinent to professional fees of the Physician for out-patient services
afforded Planholders of AHMOPI Members must be submitted to the individual
AHMOPI Member concerned within 60 days from date of service
All claims
submitted for processing beyond this 60-day prescription period shall be considered
void and non-payable
9.
The Physician shall extend utmost cooperation and shall coordinate with the
AHMOPI Member on all matters pertaining to the effective and efficient delivery
of health care and other support services.
10
The Physician shall comply with the policies and guidelines governing the
servicing of Planholders of AHMOPI Members such as, but not limited to,
providing medical records, operative reports, discharge summaries, etc., whenever
these shall be needed
The Physician is an independent contractor, hence he is not considered an
employee or an agent of the AHMOPI Member As such, the AHMOPI Member
shall not assume any statutory employer obligations such as, but not limited to,
Social Security, PhilHealth, and Employee's Compensation premiums
The Physician agrees to hold AHMOPI Members and its Planholders free and
harmless from any claim or liability to any third party arising out of, or related
to, any act, omission or negligence of the part of the Physician
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13.
This Agreement shall be valid and effective on the date of execution hereof and
is automatically renewable every year thereafter, unless earlier terminated/revoked
by either party by giving a thirty-day prior notice to the other party
14
Any modification/s to this Agreement shall be embodied in an Addendum to be
attached herein and considered an integral part hereof
IN WITNESS WHEREOF, the parties have set their hands on this
PHYSIC IA IS
ASSOCIATION OF HEALTH MAINTENANCE
ORGANIZATIONS OF THE PHILIPPINES, INC.
CARLOS D. DA SILVA
President
Printed Name & Signature
AHMOPI MEMBERS:
I
Blue Cross HealthCare, Inc
Noel L. Rosas, MD
2.
Caritas Health Shield, Inc
Geoffrey M. Martinez
3
Cocolife Health Care
Atty Alfredo C. Tumacder, Jr
4
Fortune Medicare, Inc.
Dorothea J. Sibal
5
Health Maintenance, Inc.
Pilar A. Adrias, MD
6.
Insular Life Health Care, Inc
Seralme L Manguni
7.
IntelliCare
Mario M Silos
8.
Maxicare Healthcare Corp
Jose Pastor Z. Puno
9
Medical Services Marketing &
Development Corporation
Vir?,ilio A. Del ValLe
10 Medicard Philippines, Inc
Nicanor S. Montoya, Jr., MD
II
Eugene L. Sagcal, MD.
Medocare Health Systems, Inc
day of
12. Metrocare Health Systems, Inc.
Jo Eileen Suzanne R Pama, MD
13 Philhealth Care. Inc
Marites L. Nepomuceno
14 Prudentialife Healthcare, Inc
Benito R. Reverente, Jr., MD
15 Star Healthcare Systems, Inc.
Jaime C Fernandez
16 Value Care Health Systems, Inc
Rosemarie U. Yu
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I N F O R M A T I O N SHFF-T ON F H F P H Y S I C I A N :
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