All About ETIQA

  • General Information
  • Inpatient
  • Outpatient
  • Emergency
  • Telemedicine
  • Other Information
  • Member Portal and Smile App Guide
General Information
  • Benefit Limit: PHP100,000.00.

ETIQA ACCREDITED MEDICAL NETWORKS for NO-CASH-OUT

100% PRE-EXISTING/CONGENITAL CONDITIONS

  • Pre-Existing Conditions covered up to 100% of Maximum Benefit Limit (PHP100,000.00).

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

  • Congenital Conditions also covered up to 100% of Maximum Benefit Limit (PHP100,000.00).

100% SPECIAL PROCEDURES – NEW MODALITIES

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 (PHP100,000.00) (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

Inpatient

*updated as of 09/06/2024

BENEFITS:

  • Regular Private (with dependents) Small-private (without dependents) 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 (PHP100,000.00).
  • 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 (PHP100,000.00);
  • Chemotherapy, radiotherapy, physical therapy, speech therapy and dialysis, etc. – subject to the provisions on ‘Maximum Benefit Limit’ (PHP100,000.00) & ‘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

Outpatient

*updated as of 09/06/2024

BENEFITS:

  • 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

Emergency

*updated as of 09/06/2024

BENEFITS:

  • 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 (PHP100,000.00).

-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).


  • In NON-ACCREDITED Hospitals WORLDWIDE

-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

Telemedicine

Etiqa fully covers unlimited online video consultations with licensed doctors via the Doctor Anywhere app

Etiqa members can speak to General Practitioners 24/7, on-demand, or by appointment.

Letter of Guarantee (LOG) is not required

Visit the Doctor Anywhere website for more information : https://www.doctoranywhere.ph/etiqa-members

Other Information

*updated as of 09/06/2024

ETIQA CONTACT INFORMATION

Got a question in mind?

Find the answers to commonly asked questions here:

https://www.etiqa.com.ph/faq.aspx

ETIQA'S call center hotline is also available 24/7 to receive calls for assistance in any of your medical availment needs. See the medical information center below for their contact information.


Phone Number: +632-8895-3308

Email: mic@etiqa.com.ph

There is 1 WAY to secure a LOG for scheduled availments

Via the MEMBERS PORTAL

Please click the link here : https://portal.etiqa.com.ph/member/

Kindly note of the important reminders below:


1. Call first for an appointment. The information provided in the portal will be the basis of Etiqa in issuing LOG.

2. The LOG is valid 3 days from the date issued.

3. For laboratory tests, please attach the doctor's recommendation with diagnosis.

4. The standard turnaround time for LOG issuance (consultation and laboratory test) - within 24 hours, cut-off 2pm (Monday to Saturday).

REIMBURSEMENT PROCESS AND REQUIREMENTS

REQUIREMENTS FOR IN-PATIENT (IP) CLAIMS

•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. *

REQUIREMENTS FOR OUT-PATIENT (OP) CLAIM

•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. *

Member Portal and Smile App Guide

*updated as of 09/06/2024

MEMBER PORTAL USER GUIDE

1. On your browser, enter the member portal address https://etiqa.com.ph/portal/member/ in the URL field. Then press enter, then you will be

redirected to the home page of Etiqa Member Portal.

2. When signing up, click "Not yet Registered?" button on the Member Portal Landing Page.

  • Enter the required information
  • Read and Agree to the Data Privacy Consent.
  • Click Create account

3. Verifying your account.

  • Choose where to send your verification code.
  • It can be sent either of the two ( sms or Email )
  • Type the code you received thru email or sms. (if unable to receive a verification code. Tap resend code)
  • Click verify.
  • You’re registered!

4. Forgot Password.

  • Choose where to send your verification code.
  • It can be sent either of the two ( sms or email ).
  • Type the code you received thru email or sms. (if unable to receive a verification code. Tap resend code)
  • Click verify.
  • Type your new password
  • Re-Type
  • Click submit
  • Password change success!
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