Health Plan

The Health Plan of CFI COOP is under the Mutual Medical Assistance Fund, a program solely funded 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 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 premium 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, for a period of one (1) year,  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 twelve (12)  monthly installments. However, the member may pay in full.

•  Dependent minor children, aged 1-17 years old, may also be enrolled, provided, however, when setting up the account, it will be in the name of the member with an indication that it is for the concerned dependent minor children. For requirements, click here.

• Household helpers, drivers, and personal assistant, ages 18-59 years old, may also be enrolled, provided, however, when setting up the account, it will be in the name of the member (household employer) with an indication that it is for the concerned household. For requirements, click here.

Coverage

Every participating member who is not in default of his monthly contribution shall be entitled to a maximum healthcare coverage of P100,000.00 in a covered year based on the Tariff Schedule.

Tariff Schedule

The Fund maintains a Tariff schedule of medical and hospital expenses and procedures, which are the basis for charging 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

Accredited Hospitals

Currently, the CFI Coop is in partnership with almost 50 hospitals and diagnostic centers and is continuously pursuing accreditations with more healthcare facilities nationwide to further enhance healthcare accessibility for our CFI members.

To view the Coop’s Accredited Hospitals, click here.

 Transfer Of Coverage

The MMAF coverage may be transferred to the member’s immediate family and/or extended family, provided, however, the member’s MMAF coverage has not been used and the member must be insured with another Health Maintenance Organization (HMO) or enrolled with the company’s insurance/healthcare.

1. The immediate family members are: For requirements, click here
   • Spouse and children, ages 1-59 years old (for Married)
   • Parents and siblings, ages 1-59 years old (for Single/Unmarried)
2. The extended family members are:
   • Grandchildren, grandparents, nephews, nieces, and cousins, ages 1-59 years old.

FOR OLD MEMBERS: The request to transfer the MMAF Coverage to the immediate family member or extended family member should be executed during the months of April, May and June only.

FOR NEW MEMBERS: The request to transfer the MMAF Coverage to the immediate family member or extended family member can be executed any time after the approval of the membership application. However, the transferee has to observe the  one (1) year contestability period. For requirements, click here

Contribution

Presently, the regular annual contribution is Php7,000.00. However, for qualified members aged 60 to 69 years old, the annual contribution is Php10,000.00; for those beyond 69 years old, the annual contribution is Php13,000.00. 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 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. Members with defaulted accounts can no longer avail of the MMAF coverage and cannot claim medical reimbursement or refund. If the member is in default for more than one year, his/her MMAF account will still be automatically renewed but will be treated like a new member. Hence, the contestability period of one year will apply.

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