How To Use Your Health Coverages
What is ER Care All-In 100 Adults
· It’s a one-time use prepaid health voucher that provides up to Php 100,000 outpatient and inpatient care coverage of emergency cases due to accidents, viral and bacterial illnesses, and specific conditions.
Coverage:
· The PHP 100,000 benefit limit covers these items
o Doctor's professional fee
o Laboratory and diagnostic procedure
o Emergency room care
o Regular private room accommodations
o Medicines as medically necessary in the emergency room and during confinement
o Surgery and surgeon's fees when medically necessary
o Use of operating room, recovery room, and ICU, as medically necessary
o Special modalities of treatment as medically required in emergency room care and confinement, and subject to PHP 5,000 standard limit.
o Hospital cash allowance of PHP 1,000 when confined
What you need to know:
· This health voucher is only applicable to adults age between 18-64 years old.
· Services can only be availed in IHC-accredited hospitals and clinics. Check http://www.insularhealthcare.com.ph/our-partners to see the list of IHC-accredited
hospitals.
· PhilHealth is required for the availment of this health voucher during hospital confinement. However, for those who do not have PhilHealth coverage, one may
just pay the PhilHealth portion of the hospital bill before discharge.
· It is valid for 12 months or up until used whichever comes first.
· It is for one-time use only, regardless if the total annual benefit limit is consumed or not.
· The final medical diagnosis shall be the basis for a member's eligibility to emergency care benefits under the agreement.
· It is accepted in all Insular Health Care accredited hospitals nationwide (excluding the following hospitals: Asian Hospital and Medical Center, Cardinal
Santos Medical Center, Makati Medical Center, St. Luke's Medical Center (QC and BGC) and The Medical City).
· The voucher is not transferable once successfully registered.
· If you have already used your ER Care All-In 100 Adults health voucher, you can get another ER Care All-In 100 Adults to be covered again. Note that a person
can only be covered by one (1) product offering emergency care benefits at any point in time.
How to use ER Care All-In 100 Adults for outpatient and/or inpatient care?
1. Present your printed health voucher with valid ID at the accredited provider.
REMINDER: THE CODES THAT WILL BE PROVIDED TO REDEEM YOUR HEALTH INSURANCE ARE ONLY VALID FOR THREE (3) MONTHS FROM THE DATE OF PURCHASE; OTHERWISE, REGISTRATION WILL BE INVALID.
What is MedConsult Adults?
· This health voucher provides a range of consultation services with IHC-accredited medical specialists and dentists. Services include face-to-face outpatient
medical consultations with IHC-accredited pediatricians nationwide.
Coverage:
· One-year unlimited telemedicine access through MyPocketDoctor.
· Up to four (4) face-to-face medical consultations to all Insular Health Care-accredited general physicians, family medicine specialists, internal medicine
specialists (with subspecialties in cardiology, gastroenterology, pulmonology, endocrinology, infectious medicine, nephrology, urology, rheumatology, oncology,
hematology, and allergology), general surgeons, orthopedic doctors, ENT, and rehabilitation medicine specialists.
· One-year unlimited dental consultations with IHC’s network of dentists and selected dental services.
· DENTAL SERVICES INCLUDE:
1. PREVENTIVE SERVICES
o Unlimited Consultations
o Oral Hygiene Instruction
o One (1) Oral Prophylaxis per year (mild to moderate only)
o Annual Dental Examination
2. RESTORATIONS
o Unlimited Temporary Fillings
o Three (3) surfaces Amalgam Filling or two (2) surfaces Light Cure Fillings
o Recementation of jacket crown inlays and onlays
o Unlimited Simple Tooth extraction
3. DENTURES & ORTHODONTICS
o Adjustment of Dentures
o Orthodontic Consultation
o Aesthetic Dental Consultation
4. TREATMENTS
o Treatment of dental-related pain (excluding cost of prescribed medicines)
o Relief and/or prescription for acute dental pain
o Treatment for lesions, wounds and burns
o Emergency desensitization of hypersensitive teeth
**** The Member can avail from 5% up to 30% discount for these services:
· Dentures, jacket crown, braces and other orthodontic appliances
· Aesthetic procedures (teeth whitening)
· Rebase/reline/repair/of dentures
· Surgical removal of impacted tooth
What you need to know:
· This health voucher is only applicable to adults age between 18-64 years old.
· The consultation health voucher is only for an outpatient consultation. The consultation health voucher covers only the consultation fee. You should not pay any
excess charges relating to the consultation service. Other services will not be paid for by IHC.
· Health voucher is valid for 12 months or up until used.
· The voucher is not transferable once successfully registered.
· You cannot avail of the consultation service without an LOA. The LOA is the document that would inform the doctor that you have been authorized by IHC to have
a consultation service.
· There is no limit on how many consultations you can avail in a day. You just need to generate separate LOAs for each consultation services you would need.
· Consultation services will be activated after three (3) calendar days from the day you registered.
· Fertility and pregnancy-related cases, aesthetic-related cases, ENT procedures, ophthalmology procedures and endoscopic procedures, and those related to all
forms of behavioral disorders, developmental or psychiatric disorder, whether acquired or congenital, will not be covered .
· Here is the link to access the accredited doctors for medical consultation: Accredited Providers.xlsx
How to use MedConsult Adults for dental consultation?
Step 1: Search list of dentists at https://www.fildoc.org/inlife-insular.html, select a dentist of your choice and set an appointment before going to the clinic premises. Please inform the dentist that you are under Reliant formerly Filipino Doctors. You may call the following numbers for assistance:
● Landline : (02)79463418/93457595/79686449
● Mobile nos.: GLOBE 09171489890/ SMART 09399223580/ SUN 09257286830
Step 2: Upon confirmation of appointment, go to clinic where you will avail of services and present your voucher with valid ID.
For further queries, you may also send an email to fildoc01@yahoo.com or mic@insularhealthcare.com.ph. Please be reminded that the status of accreditation
of dentists may change from time to time due to terms and conditions in the Agreement.
How to use MedConsult Adults for face-to-face consultation?
1. Set an appointment with the doctor via phone call prior to the day of your visit to make sure that he will be holding his clinic on the day you desire to have your
consultation and to ensure that you will be accommodated. You may check accredited doctors here: https://www.insularhealthcare.com.ph/accredited-doctors/
2. You have to present a Letter of Authorization (LOA), personalized membership health voucher and one (1) valid ID to the doctor on the day of availment.
*Note that the consultation must be availed within the LOA validity period, which is with three (3) calendar days starting from day of issuance, and must be
provided by the doctor indicated in the LOA.
How to get LOA?
Step 1: Select doctor from here. Call doctor's clinic to confirm schedule and availability.
Step 2: Call IHC Customer Service and request for LOA. (LOA will be sent thru email).
Step 3: Print LOA.
Step 4: Present LOA to doctor (Note: LOA is valid for 3 days from date of issuance).
How to use MedConsult Adults for telemedicine?
Option 1:
1. Request a consultation via SMS to 21585760 (GLOBE/TM) or 225655760 (SMART/TNT) with the following details: IHC membership ID and full name. A medical
professional will reach out to you through a call for the consultation.
Option 2:
1. Register at MyPocketDoctor (LINK HERE).
2. Once your account is verified and activated, go to Your Medical Profile > HMO tab > enter your voucher number under IHC.
3. Inside your account, Go to My Consultations > Talk to a Medical Doctor Now. A nurse and a doctor will call you.
REMINDER: THE CODES THAT WILL BE PROVIDED TO REDEEM YOUR HEALTH INSURANCE ARE ONLY VALID FOR THREE (3) MONTHS FROM THE DATE OF PURCHASE; OTHERWISE, REGISTRATION WILL BE INVALID.
Wha is ER Vantage Plus 80?
· It’s a health plan that covers a single-use benefit up to PHP 80,000 for outpatient emergency care and hospitalization coverage for acute, bacterial, and viral
illnesses and treatment of injuries resulting from accidents (except stroke) in 500+ PhilCare accredited hospitals nationwide
Coverage:
· The PHP 80,000 benefit limit covers outpatient emergency Care and hospitalization care benefits, specifically these items:
o Room and board (Regular Private Room)
o Doctors’ fees
o Laboratory and diagnostics procedure
o Special modalities of treatment as medically necessary during ER and confinement, subject to P5,000 inner limit
o Medicines (except vaccines) as medically necessary during ER and confinement except for cases declared as non-coverable **, subject to standard inner
limits
o Diagnostic and therapeutic procedures as medically necessary during ER and confinement
Other Additional Benefits (this benefit is provide by a third party-insurance provider)
What you need to know:
· The health coverage is for age 18 to 65 years old only.
· It is valid for 1 year upon activation date. Benefits starts 7 days after activation date. The Certificate of Coverage is non-transferable once activated.
· It excludes nine (9) hospitals – Makati Medical Center, St. Luke’s Medical Center in QC and Global, Asian Hospital, The Medical City, Cardinal Santos Medical Center,
Manila Adventist Medical Center, Notre Dame de Charles Hospital and Philippine Orthopedic Institute
· Emergency cases include but are not limited to the following: (a) Massive Bleeding; (b) Acute Appendicitis; (c) Fractures/multiple injuries secondary to accidents;
(d) Convulsions; (f) illnesses or conditions resulting in moderate or severe dehydration such as diarrhea or fever; and (h) Syncope.
· Pre-existing conditions and those conditions under the general exclusions of PhilCare are not covered.
· Client may examine and cancel this health plan within a period of 15 days from receipt of the Certificate of Coverage, provided that the product hasn’t been utilized
or availed for its purpose. The membership coverage shall be terminated thereafter. Refund provisions apply in accordance to PhilCare’s Termination Policy.
Please email your request at prepaidcs@philcare.com.ph.
How to use ER Vantage Plus 80 for emergency and/or hospitalization?
1. Simply present a printed copy of your Certificate of Cover together with a valid identification to the emergency room personnel at the identified PhilCare-accredited hospital. You may check https://shop.philcare.com.ph/accredited-hospitals for the list of accredited hospitals
2. ER personnel will facilitate the approval of your availment thru reaching our contact center to verify your membership eligibility and health coverage. The final
medical diagnosis is the basis for PhilCare’s approval of coverage.
3. Once approval has been provided, request for cancellation of approval to reactivate membership is not allowed.
REMINDER: THE CODES THAT WILL BE PROVIDED TO REDEEM YOUR HEALTH INSURANCE ARE ONLY VALID FOR THREE (3) MONTHS FROM THE DATE OF PURCHASE; OTHERWISE, REGISTRATION WILL BE INVALID.