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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 were 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, that pre-existing conditions at the time of enrollment are excluded from 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 the tariff schedule click here


Contribution

Presently, the regular annual contribution is P6,240.00. However, for qualified members aged 60 to 69 years old, the annual contributions are increased to P9,240.00; for those beyond 69 years old, the annual contribution is P12,240.00.

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 a one-time payment on the due date or in 12 equal monthly payments.

If a member requests a reimbursement or refund within the first six (6) months from the set-up date of their MMAF coverage, their outstanding MMAF premium should be settled before the member can file the claims.

Defaulted Payments

If no payments are made for more than six (6) months from the set-up date, the member is considered in default and can no longer avail of the MMAF coverage.

If the member is in default for more than one year, their account will be suspended. If the member wants to reinstate the MMAF program, they must settle their existing MMAF payables and submit a request letter to reinstate their MMAF coverage. A successful renewal of a member’s MMAF account will be treated like a new member, and the one-year contestability period will apply.

Lastly, 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
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