Health Plan
The Health Plan of CFI COOP is under the Mutual Medical Assistance Fund, a program solely funder from contributions of members of the cooperative. This fund was put up in answer to the clamor of members to be provided with a health fund facility that will augment their expenses for hospital and medical procedures in the event they will fall ill or will be required to be hospitalized.
Thus, a pooled fund was created where funds can be drawn to augment expenses for certain defined medical and hospital bills and procedures.
In order to ensure the viability and sustainability of the fund, all members below 60 years of age are required to participate in the fund by paying a fixed annual contribution for a certain maximum amount of coverage of medical and hospital expenses in a covered year.
Participants
All members below 60 years of age are required to participate in the Fund, However, members who reached the age of 60 years old but we’re already participants prior to age 60 may continue participating in the Fund but for a higher rate of the annual contribution.
Dependent minor children of members may also qualify to participate in the Fund.
Enrollment
Members below 60 years of age are automatically enrolled in the program, provided, however, pre-existing conditions at the time of enrollment are exclusions for covered medical and hospital expenses.
Payment of the required annual contributions is payable In 12 equal monthly installments. However, the member may opt for a lump-sum payment.
Dependent Minor children may also be enrolled , provided, however, when setting up the account, it will be in the name of the member parent or grandparent with an indication that it is for the concerned dependent minor children.
Coverage
Every participating member who is not in default of his monthly contribution shall be entitled to a maximum coverage of P100,000.00 in a covered year with P 50,000 life insurance .
Tariff Schedule
The Fund maintains a Tariff schedule of medical and hospital expenses and procedures which are the basis for filing claims under it.
The tariff schedule contains a list of medical procedures with their corresponding maximum amounts as limits of coverage. To download tariff schedule click here
Contribution
Presently, the regular annual contribution is P6,240.00. However, for qualified members 60 years to 69 years old, the annual contributions are increased to P9,000.00 and those beyond 69 years old, the annual contribution os P12,000.00.
The premium contributions are always subject to review by the Board of Directors of the Cooperative taking into consideration the sustainability of the Fund.
Payment
The annual contributions may be paid through the one-time payment on the due date or in 12 equal monthly payment.
A covered participating member will be considered in default if any installment payment remains unpaid for 90 days.
The member in default may only be covered again under the program if he pays the outstanding balance of his contribution in default which will remain in the bools of the COOP as the member’s unpaid obligation.
A member in default cannot claim coverage for a compensable medical or hospital expense occurring during the time before his default.
Procedure for Filing of Claims
Every claim under the fund will not be entertained unless the following documents are submitted:
Fully accomplished prescribed CFI Claims Notification Form ( downloadable in CFI website)
- Official Original receipts with a detailed breakdown of charges.
- In the case of In-Patient claim, a discharge certificate from the hospital.
- To download claim form click here
