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DRUGS Drugs from formulary - PRIMARY LEVEL 1,250.00 2,500.00 3,750.00 5,000.00 Drugs from formulary - REFERRAL LEVEL 1,250.00 2,500.00 3,750.00 5,000.00 Drugs hypertension 8,250.00 8,250.00 8,250.00 8,250.00 Medication for asthma HEALTH PROMOTION 52,000.00 52,000.00 52,000.00 52,000.00 Health promotion: yearly check up 50+ 500.00 600.00 800.00 1,500.00 Family planning incl. condoms Maternal Health PRENATAL CARE and DELIVERY 500.00 600.00 800.00 1,500.00 Antenatal care visits & examinations 3,000.00 3,100.00 3,300.00 4,000.00 Supply of nutritional supplements / drugs 5,000.00 5,000.00 5,000.00 Normal delivery / Assisted delivery 9,000.00 9,000.00 9,000.00 9,000.00 Caesarean section delivery (in case of complications) 76,000.00 101,000.00 Admissions 5,000.00 5,000.00 5,000.00 Evacuation of retained products of conception NEONATAL SERVICES 1,000.00 16,000.00 31,000.00 46,000.00 Perinatal care 3,000.00 3,100.00 3,300.00 1,500.00 Premature care (by referral + consensus of medical board) 5,000.00 5,000.00 5,000.00 Growth monitoring & nutritional care PREVENTIVE CARE 500.00 600.00 800.00 1,500.00 Immunization HIV/AIDS Treatment, care and support 500.00 600.00 800.00 1,500.00 Voluntary counselling and testing for HIV 500.00 600.00 800.00 1,500.00 (rapid test) Laboratory investigations and diagnostics test Laboratory investigations and diagnostics test - PRIMARY LEVEL 2,000.00 2,500.00 3,000.00 4,000.00 Laboratory investigations and diagnostics test - REFERRAL LEVEL Radiology investigations 2,000.00 2,500.00 3,000.00 4,000.00 X-ray 5,000.00 5,000.00 5,000.00 5,000.00 Ultrasound Inpatient Services 10,000.00 10,000.00 10,000.00 10,000.00 Admissions Surgery 5,000.00 5,000.00 5,000.00 Wound care at Primary Level 2,000.00 2,000.00 5,000.00 10,000.00 Minor surgery after authorisation 30,000.00 45,000.00 Major surgery after authorisation - only when life threatening; at tertiary hospital 75,000.00 100,000.00 - 42 -
2. Philippines Hospital Cash Plan Table 13. Distribution of Claim Amounts Claim Amount Days in Hospital Probability Low Medium High Maxi 0 0.40% 0 0 0 0 1 12.60% 750 1,250 2,450 4,235 2 14.80% 1,250 2,250 3,650 6,970 3 23.60% 1,750 3,250 4,850 9,705 4 11.40% 2,250 4,250 6,050 12,440 5 10.10% 2,750 5,250 7,250 15,175 6 1.06% 3,250 6,250 8,450 17,910 7 1.06% 3,750 7,250 9,650 20,645 8 1.06% 4,250 8,250 10,850 23,380 9 1.06% 4,750 9,250 12,050 26,115 10 1.06% 5,250 10,250 13,250 28,850 11 1.06% 5,750 11,250 14,450 31,585 12 1.06% 6,250 12,250 15,650 34,320 13 1.06% 6,750 13,250 16,850 37,055 14 1.06% 7,250 14,250 18,050 39,790 15 1.06% 7,750 15,250 19,250 42,525 16 1.06% 8,250 16,250 20,450 45,260 17 1.06% 8,750 17,250 21,650 47,995 18 1.06% 9,250 18,250 22,850 50,730 19 1.06% 9,750 19,250 24,050 53,465 20 1.06% 10,250 20,250 25,250 56,200 21 1.06% 10,750 21,250 26,450 58,935 22 1.06% 11,250 22,250 27,650 61,670 23 1.06% 11,750 23,250 28,850 64,405 24 1.06% 12,250 24,250 30,050 67,140 25 1.06% 12,750 25,250 31,250 69,875 26 1.06% 13,250 26,250 32,450 72,610 27 1.06% 13,750 27,250 33,650 75,345 28 1.06% 14,250 28,250 34,850 78,080 29 1.06% 14,750 29,250 36,050 80,815 30 1.06% 15,250 30,250 37,250 83,550 31 0.02% 15,750 31,250 38,450 86,285 32 0.02% 16,250 32,250 39,650 89,020 33 0.02% 16,750 33,250 40,850 91,755 34 0.02% 17,250 34,250 42,050 94,490 35 0.02% 17,750 35,250 43,250 97,225 36 0.02% 18,250 36,250 44,450 99,960 37 0.02% 18,750 37,250 45,650 102,695 38 0.02% 19,250 38,250 46,850 105,430 39 0.02% 19,750 39,250 48,050 108,165 40 0.02% 20,250 40,250 49,250 110,900 41 0.02% 20,750 41,250 50,450 113,635 42 0.02% 21,250 42,250 51,650 116,370 43 0.02% 21,750 43,250 52,850 119,105 - 43 -
Page 1 and 2: Application of Standard Actuarial P
Page 3 and 4: Abstract Microinsurance is growing
Page 5 and 6: 5.1.2 Philippines Cash Plan .......
Page 7 and 8: 1 Introduction 1.1 Aim The aim of t
Page 9 and 10: 1.4 Actuarial Pricing Techniques Ac
Page 11 and 12: 2 Health Microinsurance Schemes Thi
Page 13 and 14: 2.1.3 HMIS Regulatory Environment A
Page 15 and 16: The borrower must be between the ag
Page 17 and 18: 3. Choosing an appropriate pricing
Page 19 and 20: product from which the data is bein
Page 21 and 22: Industry data tends to be unavailab
Page 23 and 24: The only sequential data that was f
Page 25 and 26: 5.1.1 KNCU Health Plan The 2006 out
Page 27 and 28: assumptions are subject to more unc
Page 29 and 30: 6 The Pricing Model This chapter de
Page 31 and 32: enewable. The cashflow approach cou
Page 33 and 34: 6.5 Office Premium Calculation The
Page 35 and 36: assumptions in the model used by Mi
Page 37 and 38: The main items of expense are staff
Page 39 and 40: 8.2 Outlook As actuaries become mor
Page 41 and 42: http://www.plosmedicine.org/article
Page 43 and 44: Appendix I - Data and assumptions u
Page 45 and 46: Proportion of married women that us
Page 47: PRENATAL CARE and DELIVERY Antenata

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