All About ETIQA

  • Inpatient
  • Outpatient
  • Emergency
  • Telemedicine
  • Other Information


  • Semi-private is the standard room and board benefit that enrolled employees can avail of. Accommodation is up to the benefit limit of the company’s plan for

enrolled employees (PHP60,000.00).

  • General Nursing Services;
  • Services of physician(s), specialist(s), surgeon(s) and anesthesiologist.
  • Anesthesia & its administration, dressings, sutures, casts and other medical supplies;
  • Use of Operating/Recovery Room;
  • Prescribed laboratory examinations including complex diagnostic procedures such as, but not limited to, CT scans & MRI;
  • Transfusion of blood, blood elements & other intravenous fluids;
  • ICU confinements – subject to the Maximum Benefit Limit (PHP60,000.00);
  • Chemotherapy, radiotherapy, physical therapy, speech therapy and dialysis, etc. – subject to the provisions on ‘Maximum Benefit Limit’ (PHP60,000.00) &

‘Pre-existing Conditions’;

  • All other expenses directly related to the medical management of the illness and/or injury that resulted in the enrolled employee’s confinement, including the

Admissions Kit.

Room Accommodation higher than your "Room & Board" Limit:

  • During EMERGENCY Confinement: Should the enrolled employee stay in a room higher than his/her Room & Board-limit as a result of an unavailable room equal to his Room and Board-limit, eligible expenses for the 1st 24-hours of stay will be covered. Should the enrolled employee decide to stay further once an available room equal to or less than his Room and Board-limit becomes available, the enrolled employee will have to pay for any excess costs, ineligible expenses, and/or corresponding incremental costs prior to discharge.

  • During NON-EMERGENCY Confinement: Should the enrolled employee stay in a room higher than his Room & Board-limit, the enrolled employee shall pay for any excess costs, ineligible expenses, and/or corresponding incremental costs incurred prior to discharge.

Availment Process



  • Medical consultations & follow-up consultations;
  • Referral/consultations with Specialist(s);

-including pre & post natal consultations

  • Outpatient medicines administered in the clinic (not take-home meds);
  • Administration of vaccine (not cost of vaccine);
  • Prescribed laboratory/diagnostic examinations for covered illnesses/injuries;
  • Emergency treatment and minor surgeries not requiring hospitalization;
  • Anti-rabies, anti-venom & anti-tetanus (regardless of amount, up to MBL)

Availment Process



  • Ambulance Services

-Emergency ambulance service expense involving transfer of the enrolled employee to and from anywhere, anytime, for no-cash-out or reimbursement,

shall be reimbursed up to the Maximum Benefit Limit (PHP60,000.00).

-Reimbursement of ambulance service expense is not limited to one claim per enrolled employee per policy year.

  • In Accredited Hospitals Nationwide

-All expenses directly related to the medical management of the illness and/or injury that resulted in the enrolled employee’s emergency treatment shall be

covered on a no-cash-out basis. This includes medicines & drugs administered during emergency treatment, except prescribed medicines to be taken

outside the hospital (take home medicines).


-100% of eligible medical expenses incurred in the direct medical management of the illness and/or injury that resulted in the enrolled employee’s

emergency treatment shall be covered on a reimbursement basis.

**REIMBURSEMENT will be equal to the amount ETIQA would have paid had the enrolled employee been confined in an accredited hospital.**

Availment Process


Scan the QR code below to download the Doctor Anywhere app:

Visit the Doctor Anywhere website for more information :

Other Information


ETIQA'S call center hotline is available 24 by 7 to receive calls for assistance in any of your medical availment needs.

Phone Number: +632-8895-3308


Got a question in mind? Find the answers to commonly asked questions here:


  • Pre-Existing Conditions covered up to 100% of Maximum Benefit Limit (PHP60,000.00).

-e.g. Chronic asthma, diabetes, hypertension, and heart disease.

  • Congenital Conditions also covered up to 100% of Maximum Benefit Limit (PHP60,000.00).


The following special procedures are payable and form part of the entire medical expense relating to the medical management of the sickness or accident requiring such special procedures:

Special Procedure/New Modality of Treatment 
Maximum Amount of Coverage 

a. Lithotripsy

b. arthroscopic procedures

c. laparascopic procedures

d. laser therapy (exclude use for correction of vision)

e. nuclear/radioactive isotope scans

f. cost of artificial limbs, joint prosthesis and heart valve prosthesis

g. other new modalities of treatment for condition with established etiologies and are used as an alternative to the conventional and traditional procedures.

Covered up to Maximum Benefit Limit (PHP60,000.00) (including, but not limited to, the Special Procedures listed in Section X to the left [except Lasik]).

h. Dialysis

i. Chemotherapy

j. Radiation oncology/Therapeutic radiology

k. Sclerotherapy

l. Physical and Speech therapy

m. Angiography

n. Tests involving the use of nuclear technologies

-(e.g but not limited to radionuclide ventriculography, thallium stress testing, radionuclide/thyroid scan, pyrosphosphate scintigraphy, positron emmission tomography, radio isotope scanning)

o. Thalium scintigraphy

p. CT Scan/Magnetic Resonance Imaging

q. Pulmonary perfusion scan

r. Endoscopy

s. Bone Densitometry Scan

t. Anti-Nuclear Anti-Body (ANA)

u. C-Reactive Protein (Rheumatic and its complications)

v. Lupus cell exam

w. Sleep therapy

Covered as charged and will form part of the entire expense in the medical management of the illness requiring such special procedure or new modality of treatment




1.Expenses that should be taken care of by any government programs such as PhilHealth and the like;

2.Services rendered or supplies provided free of charge;

3.Additional hospital charges and/or professional fee charges resulting from the enrolled employee taking a room accommodation more than his Room &

Board limit (excess and/or incremental costs);

4.Maternity and maternity-related conditions and/or complications except those benefits that may be provided by the (optional) Maternity Benefit, if any, of this Agreement;

5.Sterilization of either sex or reversal of such, artificial insemination, sex change, consultation/confinement regarding infertility;

6.Non-recommended confinement, convalescent/domiciliary/custodial care, rest cures;

7.Dental-related cases except those that may be provided by the (optional) Dental Benefits, if any, of this Agreement and to the extent that are necessary

for the repair or alleviation of damage caused solely by accidental injury sustained (and not caused) by the enrolled employee;

8.Circumcision, cosmetic/aesthetic procedures except re- constructive surgery to treat functional defect(s) due to a covered disease and/or accidental


9.Psychiatric disorders, psychosomatic conditions, treatment for any mental or nervous disorders, illness/injury/condition/ complication arising from the enrolled employee’s too much alcohol intake and/or use of regulated/prohibited drugs;

10.Illnesses and/or injuries arising from the enrolled employee’s participation in brawl, riots, commission of a crime, violation of ordinance and the like;

11.Illnesses/injuries resulting under conditions of war or sustained from combat-related activities;

12.Illnesses/injuries resulting from the enrolled employee’s active participation in hazardous activities such as, but not limited to, bungee jumping, hang-gliding, scuba diving, mountain/ wall climbing including professional sports;

13.Illnesses/injuries attributable to the enrolled employee’s own misconduct/ gross negligence/immoral habits, willful and unnecessary exposure to danger or hazard to health;

14.Self-inflicted injuries including and, not limited to, any form of suicide attempt;

15.Rehabilitative treatment for alcoholism or drug abuse;

16.Acquisition of prosthetic appliances, artificial aids, durable equipment, surgically implanted devices and external prosthetic devices except those that are explicitly covered and enumerated in the “Special Procedures or New Modalities of Treatment” provision of this Agreement (Standard coverage in Purple Cow);

17.Organ transplant-expense relating to organ donation of the donating party/parties (Standard coverage in Purple Cow);

18.Executive check-ups, unless explicitly provided by this Agreement, and/or confinement purely for diagnostic purposes and non-recommended confinements;

19.Take-home medicines, unless “Reimbursement of Prescribed Medicines” is provided in this Agreement, and Vaccines except first dose of either anti-venom, anti-rabies and anti-tetanus used for emergency treatment (anti-V/R/T covered to MBL in Purple Cow);

20.Medico-Legal Fees including costs of Medical Certificates that an enrolled employee may require for any purpose it may serve him;

21.Congenital disease/deformity that is evident to the enrolled employee at birth and/or can be clinically determined to be congenital (Standard coverage in Purple Cow);

22.Medical and/or surgical procedures/diagnostic tests that are experimental in nature and/or not generally accepted by the medical profession such as, but not limited to, iridology, chiropractic services, and acupuncture.



•Fully filled-up/signed IP claim form.

•Hospital Statement of Account with details of charges – photocopy is okay.

•BIR approved official receipts for hospital bills and doctors fees.

•Medicines bought outside the hospital should have the corresponding prescriptions.

•All documents except for the Statement of Account (SOA) must be original copies.

•Erasures should be countersigned by the authorized signatory

* The above is not meant to be the final/complete list of requirements. ETIQA and ia Blueprint reserve the rights to ask for additional requirements on a case to case basis. *


•Fully filled-up/signed OP claim from. Name of patient and other details must be written by the doctor.

•Medical certificate with diagnosis in-lieu of the claim form is acceptable but claim form still needs to be signed by the employee and the employer.

•BIR approved official receipts for consultation fees, medicines and laboratories.

•For lab expenses, lab request signed by the concerned doctor is required. Photocopy is okay.

•All documents must be original copies except lab request.

•Erasures on claim documents, e.g., official receipts, prescriptions, lab requests, claim form must be countersigned by the authorized person – individual

who issued the OR, prescription, lab request, claim form, etc.

* The above is not meant to be the final/complete list of requirements. ETIQA and ia Blueprint reserve the rights to ask for additional requirements on a case to case basis. *