Corporate Clients – Group
Medical Cover

Health insurance designed to provide affordable and cashless coverage with a wide range of benefits through our network of medical service providers.

Fullerton Health also provide the Medivac in cases of an emergency evacuation for our members.
Because the policy is based on Cashless cover, employees can attend PHA’s panel of clinics, GPs, specialist doctors (with a referral from one of our GPs) without a requirement for payment at the time of their visit.

We have also introduced biometrics at our PNG clinics and hospitals to prevent and detect fraud. This is a first for PNG and a 24 hr call centre in Port Moresby.
As an added benefit, PHA plan to allocate 5% of its net profit into the PHDF (PNG Healthcare Development Fund).

Choose the best plan for you

As a company, you can choose different levels of coverage to ensure that offering employee insurance has negligible effect on your profits and only positive impact on your bottom line.

There are 3 levels of cover:
a) PGK 25,000 Single Plan covering the Employee
b) PGK 40,000 Couple Plan covering the Employee and his/her Spouse
c) PGK 60,000 Family Plan covering the Employee, his/her Spouse and his/her Dependent Children

Who do you insure?
We insure everyone
a) Employee and Spouse: 18 – 65 years
b) Dependent Children: from 1 month to 18 years. If your dependent child is a continuing education student, they remain covered up until 25 years of age.

Deductibles
There are different options on offer for the deductibles:
a) NIL (cashless no payment required at service provider )
b) 10% – 10% of the bill to be paid to the service provider
c) 20%- 20% of the bill to be paid to the service provider

Everyone is Comprehensively Covered

We offer comprehensive protection to your employees with all policies.
a) Out-Patient Treatment (Doctor/Specialist consultation/procedure, diagnostics and prescribed medication)

b) In-Patient Treatment (Hospitalisation, including Intensive Care Unit, or Day Surgery)

c) Pre- and Post-Hospitalisation/Day Surgery Treatment (Medical Expenses incurred prior to and after Hospitalisation/Day Surgery)

d) Ambulance Cover (Emergency transportation by land, sea or air in case of a life-threatening emergency condition)

e) Medical Transfer (Return air transfer by regular airline if the Medically Necessary Treatment is not available at the patient’s location)

f) Maternity Cover (Medical Expenses, limited to PGK 5,000 per Plan per Cover Period, incurred for pregnancy, delivery, new-born baby birth check-up and vaccinations in the 2nd, 4th and 6th month)

g) Dental Expenses (Medical Expenses for dental examinations, x-rays, fillings, extractions, root canal treatments and scaling, excluding Buai stain removal and whitening/polishing of teeth)

20% Deductible each and every claim
Sub-Limits:
• Single Plan PGK 1,500 per Cover Period
• Couple Plan PGK 2,000 per Cover Period
• Family Plan PGK 3,000 per Cover Period

h) Optical Expenses (Medical Expenses for routine eye examinations and prescription glasses, excluding contact lenses, sunglasses and replacement of broken, damaged or lost glasses. Limite of 1 pair of glasses per insure per year.

20% Deductible each and every claim
Sub-Limits:
• Single Plan PGK 1,500 per Cover Period
• Couple Plan PGK 2,000 per Cover Period
• Family Plan PGK 3,000 per Cover Period

i) Funeral Benefit (payable upon Death due to Injury or Illness)
• Employee PGK 5,000
• Spouse PGK 5,000
• Child PGK 2,000

Your PHA Medical Card

Cashless Treatment within Provider Network

Access the benefits of your policy, listed above, is made easy for you. You attend one of the clinics or hospitals covered by your policy and your card will give you access to medical services without delay. (You will not pay any fees to the service provider)
Provider Network of Clinics and Hospitals throughout PNG

We are where you are!

a) Buka
b) Goroka
c) Kainantu
d) Kimbe
e) Kokopo
f) Kundiawa
g) Lae
h) Madang
i) Mt. Hagen
j) Port Moresby

The PHA Mobile App

Exclusions

Every insurance policy in the world has some things that can’t be covered but we have kept this to the bare minimum to give you the best protection available.
a) Flying in an aircraft other than as a passenger, hazardous activities such as scuba diving, parachuting, hang gliding, bungee jumping, climbing, etc.

b) Professional sports

c) War or war-like operations, invasion, acts of foreign enemies, hostilities (whether war be declared or not), terrorism, civil war, tribal fights or ethnic clashes, civil commotion

d) Any involvement in any military force, firefighting, police force, security enforcement, or any other armed forces of any country

e) Terrorism

f) Nuclear, Biological or Chemical contamination (NBC)

g) Criminal activities

h) Pandemic

i) Self-injury, suicide or attempted suicide

j) Consequences of taking Betel Nuts, drugs, alcoholic substances, intoxicants, medications without Doctor’s indication or medications for drug abuse treatment

k) More than one consultation or follow-up with a Specialist in a single day

l) Routine physical examinations

m) Corrective surgery for non-medical sight, hearing and dental defects

n) Cosmetic treatments, plastic surgery

o) Treatment of obesity, weight control programs

p) Circumcision

q) Family planning, voluntary abortion, infertility, vasectomy, hysterectomy, sterilization (except immediately after giving birth), contraceptives

r) Invitro fertilization, embryo transport, donor ovum and semen, infertility treatment

s) Birth defects, congenital anomalies, development problems

t) Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS) and AIDS related complications, syphilis, gonorrhoea, venereal diseases, and other sexual transmitted diseases

u) Donor screening and treatment, including surgery to remove organs from the donor in case of a transplant surgery

v) Senile Dementia (including Alzheimer’s disease), Parkinson’s disease, psychological and psychiatric conditions such as psychoses, neuroses, depression, anxiety, anorexia nervosa, schizophrenia, behavioural disorders, delirium, insomnia, neurasthenia, etc.

w) Charges for dentures, contact lenses, hearing aids, wheelchair, crutches, artificial limbs, belts, braces, arch supports, exercise equipment, etc.

x) Mouthwash, toothpaste, eye drops, lozenges, antiseptics, milk formulas, food supplements, multivitamins, skin care products, hair care products, sanitary supplies, etc.

y) Dental treatment of a Betel Nut user except examination and surgical extraction of wisdom teeth

Existing employees and their dependents

• No waiting periods, provided they were previously insured for at least 12 months under the Group Medical Policy of the employer and any Special Diseases, Pre-Existing Conditions and pregnancies have been declared before inception of the policy

    New employees and their dependents

• 12 months for Special Diseases (Cancer and all kinds of malignant tumors, blood pressure disease, cardiovascular disease, Gastritis, Arthritis, Hepatitis A, B or C, stones in the secretion system, chronic Sinusitis, Diabetes, Bronchial Asthma, Renal inflammation)
• 12 months for Pre-Existing Conditions (any condition, Illness, Injury, disease or physical, medical, mental or nervous condition, disorder or ailment which a person had suffered, or was or should have been aware they were suffering or for which symptoms existed that would cause an ordinary prudent person to seek diagnosis, care, or treatment, and/or were diagnosed, and/or for which medical treatment was recommended by a Doctor, irrespective of whether treatment was actually received or not, within forty-eight (48) months prior to the person being covered under this Policy)
• 3 months for Maternity Benefit

To find out more about your cover, speak to your HR department or call our customer service hotline on 321-0322 (will confirm)