PAYPAL PHILIPPINES, INC.
Period of Coverage February 1, 2021 to January 31, 2022 DISCUSSION POINTS
ELIGIBILITY
PLAN LIMITS
AVAILMENT
OTHER BENEFITS ELIGIBILITY
PRINCIPALS
Employees up to 65 years old.
DEPENDENTS
Eligible dependents of Employees, provided Hierarchy is followed. SINGLE PRINCIPALS
1. Parents Not over 65 years old SINGLE PARENTS PRINCIPALS
1. Children (Eldest to Youngest) Biological / Legitimate/ Legally Adopted 15 days old – 21 years old Unmarried & Unemployed 2. Parents Not over 65 years old MARRIED PRINCIPALS
1. Legal Spouse Not over 65 years old
2. Children (Eldest to Youngest) Biological / Legitimate/ Legally Adopted 15 days old – 21 years old Unmarried & Unemployed
EXTENDED DEPENDENT 3. Parents Not over 65 years old UNMARRIED PRINCIPALS
1. Children (Eldest to Youngest) Biological / Legitimate / Legally Adopted 15 days old – 21 years old Unmarried & Unemployed 2. Domestic / Common Law / Same Gender Partner Not over 65 years old
EXTENDED DEPENDENT 3. Parents Not over 65 years old UNMARRIED PRINCIPALS REQUIREMENTS FOR DOMESTIC PARTNER
Birth Certificate (proof of legal age)
Barangay Certificate of cohabitation stating that the employees are his/her partner in same address, and
Certificate of No Marriage (CENOMAR)
Partner not more than 65 years old with submission of required documents Cover domestic (same as well as opposite sex) and common law partner, policy conditions remaining same as spouse
Cooling period of 12 months in partner enrolment change
Both Partners should be single, not legally married to or the domestic partner of anyone else ENROLLMENT POINTERS
20- Calendar Day Window Period Dependents shall be enrolled within 20 days from the effectivity of coverage.
No additional enrollments except for: New born baby: 20 days from date of eligibility Spouse of a newly wed employee: 20 days from date of marriage Dependent of a new employee: 20 days from effective date of Principal member ENROLLMENT POINTERS DEPENDENTS REQUIREMENTS Parents Birth Certificate Spouse Marriage Contract Child Birth Certificate or Certificate of Live Birth Birth Certificate/ Barangay Certificate of Domestic /Common Law/ Cohabitation/ CENOMAR (Certificate of No Same Gender Partner Marriage)
Skipping of Hierarchy: Dependents with Existing Active HMO membership Dependents residing/working abroad Legally Separated Death PLAN LIMITS
ROOM AND BOARD MAXIMUM BENEFIT LIMIT (Regardless of the price) (Per type of Illness)
OPEN PRIVATE (Principals) 200,000
OPEN PRIVATE (Dependents) 200,000 *Net of PhilHealth
NOTE: WITH ACCESS TO HEALTHWAY MEDICAL CLINICS, MAKATI MEDICAL CENTER, ST. LUKE'S (QC & GLOBAL CITY), ASIAN HOSPITAL, CARDINAL SANTOS, THE MEDICAL CITY AND ITS AFFILIATED CLINICS PLAN LIMITS
ROOM AND BOARD MAXIMUM BENEFIT LIMIT (Regardless of the price) (Per type of Illness)
OPEN PRIVATE (Dependent Parents) 500,000 (Grandfathered List Only. No enrollment shall be accommodated in the middle of the contract) *Net of PhilHealth
NOTE: WITH ACCESS TO HEALTHWAY MEDICAL CLINICS, MAKATI MEDICAL CENTER, ST. LUKE'S (QC & GLOBAL CITY), ASIAN HOSPITAL, CARDINAL SANTOS, THE MEDICAL CITY AND ITS AFFILIATED CLINICS HMO PREMIUM CO-SHARE RATE Single with Domestic Single Parent with Married Single Single Parent MBL Member Partner Domestic Partner (A) (B) (C) (D) (E) PayPal - 100% PHP 200,000 per year Employee PayPal - 100% Premium PayPal - 100% Premium PayPal - 100% Premium PayPal - 100% Premium Premium PHP 200,000 per year Spouse PayPal - 100% Premium NA NA NA NA Domestic / CL PHP 200,000 per year NA NA PayPal - 100% Premium NA PayPal - 100% Premium Partner PHP 200,000 per year Children (Up to 3) PayPal - 100% Premium NA NA PayPal - 100% Premium PayPal - 100% Premium
Children (More Employee - 100% Premium Employee - 100% Premium Employee - 100% Premium PHP 200,000 per year NA NA than 3) PHP 17,128 p.a. per child PHP 17,128 p.a. per child PHP 17,128 p.a. per child
Employee - 50% Premium PayPal - 100% Employee - 50% Premium PHP 200,000 per year Parents (Up to 2) PayPal - 100% Premium PayPal - 100% Premium PHP 15,817 p.a. per parent Premium PHP 15,817 p.a. per parent
Employee - 50% Premium Employee - Top-Up Employee - Top-Up Employee - 50% Premium Employee - Top-Up for PHP 200k MBL + Top- Premium Premium for PHP 200k MBL + Top- PHP 500,000 per year Parents (Up to 2) Premium Up Premium PHP 3,362 p.a. per PHP 3,362 p.a. per Up Premium PHP 3,362 p.a. per parent PHP 20,563 p.a. per parent parent parent PHP 20,563 p.a. per parent
Notes: • Deductions will start from March onwards. March deduction will be for 2 months (Feb and March) and April onwards it will be monthly deduction • Please contact PayPal Support (Employee Central) for any inquiries on the salary deduction • All premiums are in PHP & Vat Inclusive PLAN LIMITS PRE-EXISTING CONDITION (PEC)
Existing New Principals Dependents Dependents Up to MBL Up to MBL Up to MBL
What are PRE-EXISTING CONDITIONS (PEC)? Conditions / Illnesses existing and evident to the member prior to effective date of coverage
• Nature can be clinically determined to have started whether the member is aware or not
• E.G. Hypertension, goiter, asthma, TB, gall or kidney stones, diabetes, tumors, myoma, arthritis, hernia, prostate disorders…etc. PREVENTIVE FOR ALL MEMBERS ANNUAL PHYSICAL EXAMINATION (APE) Basic 5 • Physical Examination • CBC • Chest X-Ray • Urinalysis • Stool Exam For 35 years old and above: Pap smear and ECG HIV Testing/STD Testing for Principal members only to be availed by walk in at Aventus Clinics only. To be scheduled by your HR in coordination with Intellicare. Six (6) sessions of wellness program for the Client (counseling on health habits, diet and family planning).
Routine Immunization (except cost of vaccines)
Note: APE process for employee and dependents to be announced OUT-PATIENT
Medical Consultations with Intellicare affiliated doctors. Treatment of minor injuries such as lacerations, mild burns and minor surgery not requiring confinement performed by Intellicare affiliated doctors. Diagnostic procedures prescribed by an Intellicare accredited physician. Pre and Post Natal consultations with Intellicare affiliated OB-GYN up to Maximum Benefit limit/member/year.
NOTE: With access to Healthway Medical Clinics OUT-PATIENT
Speech (for stroke patients) up to 12 sessions/year.
Physical Therapy/ Occupational therapy excluding subspecialties such as cardiac rehabilitation, pulmonary rehabilitation and the like shall be covered as follows:
- For IP: up to PEC limit; - For OP: up to 12 sessions per member per year; subject to PEC limit
Note: Therapy of one (1) body area shall be considered as one (1) session
NOTE: With access to Healthway Medical Clinics OUT-PATIENT AVAILMENT PROCESS
Proceed to any Intellicare Accredited Facility (subject to plan’s limits).
Present your Intellicare Membership Card with two (2) valid IDs at the facility’s reception area or HMO / Industrial office for membership status validation.
If APPROVED, the Referral Control Sheet (RCS) will be issued. If DECLINED, the attending staff will call the Intellicare’s Customer Service Hotline for assistance.
Accomplish the Referral Control Sheet (RCS 1 / RCS 2) then proceed with availment.
NOTE: Certain out-patient procedures will require filing of Philhealth. www.aventusmedical.com
CUBAO G/F Manhattan Parkview Tower One, General Romulo Ave., Araneta City, Cubao, Quezon City ☎: (02) 8245-0976 METRO MANILA NORTH EDSA MAKATI – AYALA NORTH EXCHANGE 2/F Philippine College of Surgeon Bldg., 992 North Edsa, 3/F Retail 61 & 62, Amorsolo St., Ayala Ave., Quezon City Makati City ☎: (02) 8352-4676 / (02) 8352-4677 ☎: (02) 8587-8053 ALABANG 2/F Sycamore ARCS 1 Building, Buencamino St. cor. MAKATI – FILOMENA BLDG. Alabang-Zapote Road, Alabang, Muntinlupa City 6/F Filomena Bldg., 104 Amorsolo St., Legaspi Village, ☎: (02) 8556-3596 / (02) 8556-3592 Makati City ☎: (02) 8519-6787 / (02) 8817-1464 / (02)8 869-3289
BGC REGIONAL G/F Citibank Plaza, 34th St. Corner Lane D., Bonifacio CALAMBA Global City, Taguig City Unit 201-203 SQA Corporate Center, Barangay 1, National ☎: (02) 8352-8335 / (02) 8362-0042 Highway Crossing, Calamba City, Laguna ☎: (045) 499-8417 / (045) 499-8419 MANILA 5/F Times Plaza Bldg., U.N. Ave. corner Taft Ave., Ermita, STA. ROSA Manila City 2/F Carvajal Building 2, National Highway, Balibago City, ☎: (02) 8353-6807 / (02) 8353-6808 Sta. Rosa, Laguna ☎: (049) 508-1806 / (049) 306-0397 PASAY Scape Bldg., Macapagal Avenue, cor. Pearl Drive, Central CLARK Business Park 1, San Rafael, Brgy. 76, Pasay City G/F BPO Building 5, SM City Clark, M.A. Roxas ☎: (02) 8541-5645 / (02) 8838-0627 Highway,Brgy. Malabanias, Angeles City, Pampanga ☎: (045) 499-8417 / (045) 499-8419 MANDALUYONG Lower 2/F St. Francis Square, Doña Julia Vargas Ave. cor. CEBU IT PARK Bank Drive, Ortigas Center, Mandaluyong City Unit 203 TGU Tower, Asiatown, IT Park Apas, Cebu ☎: (02) 8542-6578 / (02) 7255-8974 ☎: (032) 479-9261
ORTIGAS CEBU CYBERGATE G/F AIC Grande Tower, Sapphire St. cor. Garnet Road, L/3 Robinsons Cybergate, 2029 Don Gil Garcia & J. Ortigas Center, Pasig City Llorente St., Capitol Site, Cebu ☎: (02) 8584-2430 / (02) 8584-1013 ☎: (032) 236-9028 / (032) 238-3922 / (032) 238-7672 PREFERRED NETWORKS
5 Person Ward Emergency Daniel Mercado Medical Center – Batangas Mercado General Hospital San Jose Del Monte Inc. – San Jose Del Monte QualiMed Clinic - Fairview Terraces QualiMed Clinic - UP Town Center QualiMed Clinic - Mckinley Road QualiMed Surgery Center - Manila
Intellicare Lane Private Room PREFERRED NETWORKS
Cebu Doctor's University Hospital Mactan Doctors Hospital Cebu North General Hospital Cebu South General Hospital San Carlos Doctors Hospital PREFERRED NETWORKS
CDO Polymedic Medical Plaza CDO Polymedic General Hospital www.medgatephilippines.com www.medgatephilippines.com
1 2 3 4
Call Triage Teleconsultation E-treatment www.medgatephilippines.com
Save on travel cost Save on time 24/7 | 365 days a year Save money
Multiple touchpoints No waiting in line Optional medication No disease exposure delivery
38 pre-approved labs 3-Day unli consults www.medgatephilippines.com
Call Doc. Anywhere. Anytime. No Line.TM
(02) 8705 0700 (032) 265 5111 (Cebu) 0917 536 2156 (Globe) (082) 285 5111 (Davao) 0998 990 7540 (Smart) (035) 522 5111 (Dumaguete) 0925 714 7794 (Sun)
SMS (request for a callback)
Room & Board accommodation within the limits of the PLAN. Diagnostic procedures prescribed by an Intellicare accredited physician. Standard nursing care services, admission kit & other items directly related to the medical management of the patient. Ambulance Service (Accredited OR Non-accredited Hospital/ Clinic to Accredited Hospital/ Clinic) shall be covered through reimbursement up to Php2,500.00 per conduction (regardless of the location within the Philippines) IN-PATIENT AVAILMENT PROCESS
Secure an admitting order from an Intellicare -affiliated physician.
Present the admitting order, your Intellicare Membership Card & two (2) valid IDs at the admitting section of the hospital for membership status validation and
scheduling of confinement. IN-PATIENT FORM (RCS 3)
d On the schedule of confinement, occupy the entitled room according to plan benefit.
Sign the Referral Control Sheet (RCS 3) issued by the visiting Intellicare Patient Relations Officer.
NOTE: File for Philhealth upon discharge. ROOM UPGRADING INVOLUNTARY
If the entitled room is not available, member may occupy (1) One category higher up to 24 hours (except suite room) without incremental charges.
After 24 hours, whether the room becomes available or not, incremental charges will be billed to the member.
If during confinement the entitled room becomes available, member should transfer automatically to their allowed room category. Otherwise, member will pay all incremental charges. ROOM UPGRADING VOLUNTARY
The member will be charged for the excess over their entitlement and should pay the excess upon discharge (approximately 30% of the total hospital bill, excess room & board and doctor’s fee). All excess bills shall be collected from the member before discharge.
Keep in mind that staying in a more expensive room also makes the other services (i.e., medicines, professional fee, etc.) more expensive. EMERGENCY
ACCREDITED HOSPITAL NON-ACCREDITED FOREIGN TERRITORIES (LEADING TO CONFINEMENT)
MAXIMUM Up to Php30,000 Up to Php30,000 COVERAGE Up to MBL thru reimbursement thru reimbursement
HOSPITAL BILLS 100% 80% 100%
PROFESSIONAL BILLS 100% *RVS 80% *RVS 100% *RVS
*Relative Value Scale (RVS) – HMO Rates REIMBURSEMENT PROCESS
1. Secure and fill out the Intellicare Reimbursement Form. 2. Submit the Reimbursement Form with the following documents:
REQUIRED DOCUMENTS Original Official Receipt (with TIN) Statement of Account from the Hospital Medical Certificate Laboratory results (if with diagnostic procedure) Operative record with histopath (if with operation) Police report & Medico-legal Report (if required) REIMBURSEMENT PROCESS
Sending of reimbursement documents (soft copy) is through Paypal's Field Customer Service Support (FCSS). Intellicare Field Customer Service Support schedule is every Monday, Wednesdays and Fridays 12:00 NOON to 9:00 PM. For initial evaluation of reimbursement, employees must send all (soft copies) of documents and requirements to FCSS at [email protected] (acknowledgment of email is during scheduled work day only.) EMAIL SUBJECT LINE: CLAIMS REQUISITION_Paypal_LAST NAME_DATE SUBMITTED. Late Filling is not allowed. Filing period of claims is 30 days from Official receipt date or availment date. REIMBURSEMENT PROCESS
NOTE: Submit to Intellicare not more than 30 days from date of availment. Processing of the request is within 20 working days upon receipt of complete documents. Hard copies of reimbursement must be sent to 3rd F Axa Life Bldg, Sen Gil Puyat Ave cor. Tindalo St. San Antonio Makati City. Kindly address the documents to Kenneh Ke or Maques Jules Calleja for delivery of documents. Please contact our reimbursement hotline (0998-9624175) prior sending the documents to ensure availability of POC's to receive the documents. Sending of documents is every Monday to Fridays except holidays from 8:30am to 4:30pm (with lunch break 12:00nn-1:00pm. ☎: 1-800-101DENTAL (PLDT Toll-free) | (02) 8911-7777 (PLDT Trunk Line) DENTAL Thru:
Dental examination & oral health education Once a year oral prophylaxis Unlimited Simple tooth extraction Unlimited Temporary fillings Permanent Fillings - up to two (2) teeth per year Emergency out-patient dental treatment Restorative and prosthodontic treatment planning Desensitization of Hypersensitive teeth - up to two (2) teeth per year Simple adjustment of dentures ☎: 1-800-101DENTAL (PLDT Toll-free) | (02) 8911-7777 (PLDT Trunk Line) DENTAL Thru:
Recementation of jackets, crown, inlays / onlays Treatment of minor gum problems, mouth lesions, wounds & burns
Orthodontic consultation (braces and malposition of teeth)
Temporo mandibular joint (clicking of jaws) consultation Pre-natal check of teeth and gums Emergency dental treatment for the relief of pain ☎: 1-800-101DENTAL (PLDT Toll-free) | (02) 8911-7777 (PLDT Trunk Line) DENTAL Thru: AVAILMENT PROCESS
MOBILE NUMBERS: (0923) 809-5376 (Sun) (0916) 761-5277 (Globe)
Set an appointment with an affiliated Dental Network Company dentist.
Proceed to the dental clinic on your scheduled date and present your Intellicare DENTAL FORM Membership Card with two (2) valid IDs for membership status validation.
d
Avail the entitled benefit and sign the Dental Form. ADDITIONAL BENEFITS
Eye laser treatment for retinal tear, retinal hole, retinal detachment and glaucoma except for cases of myopia or correction of error of refraction (such as lasik, PRK and the likes) shall be covered up to Php10,000.00 per eye per member per year.
Electrocauterization of skin lesions such as plantar warts, flat warts, periungual warts, filiform warts and molluscum contagiosum, (from face down except genital warts and condyloma acuminata) shall be covered up to Php2,000.00 per member per year to be done at Aventus Clinics provided that an accredited physician recommends it and only for cases that affect the physiological functions of the member (not for cosmetic/aesthetic purposes). ADDITIONAL BENEFITS
Sclerotherapy for varicose veins (excluding medicines and for cosmetic purposes) shall be covered up to Php30,000 per member per year provided that it is medically necessary and recommended by an affiliated vascular surgeon (not for aesthetic purposes).
Allergy Testing/ Allergy screening shall be covered up to Php2,500.00 per member per year per member per year if prescribed by Accredited Physician.
Tuberculin Test shall be covered up to Php600.00 per member per year if the member shows symptoms of Tuberculosis and if prescribed by accredited physician. ADDITIONAL BENEFITS
Treatment for animal bites and tetanus shall be covered as follows: - Passive and active vaccines for treatment of animal bites and tetanus - up to Php20,000.00 per member per year. - Inital treatment for animal bites - up to the maximum benefit limit per member per year for the first twenty-four (24) hours from the time the member was bitten.
Botox injection shall be covered up to Php5,000.00 per member per year if recommended by an accredited/ affiliated physician to be medically necessary (NOT for aesthetic/beautification purposes). ADDITIONAL BENEFITS
Work-related conditions shall be covered up to the maximum benefit limit per member per year subject to the exclusions and limitations of the contract.
Motor vehicular accidents shall be covered up to the maximum benefit limit per year subject to the exclusions and limitations of the contract and a Police report MUST be submitted to Intellicare for evaluation.
Provoked and unprovoked assault including domestic violence whether initiated by a known or unknown third party shall be covered up to the maximum benefit limit per member per year subject to the exclusions and limitations of the contract and a police report must be submitted to Intellicare for evaluation. ADDITIONAL BENEFITS
Scoliosis including necessary procedures, except physical therapy sessions, whether congenital, pre- existing, developmental or acquired shall be covered up to Php40,000.00 per member per year Note: Physical therapy sessions shall form part of the limit for Physical therapy/ Occupational therapy limit
Congenital conditions including Congnital Hernia shall be covered up to Php40,000.00 per member per year subject to pre-existing condition limit (whichever is lesser). Note: Physical therapy sessions shall form part of the limit for Physical therapy/ Occupational therapy limit. ADDITIONAL BENEFITS
Coverage for complications of congenital conditions shall form part of the limit for congenital illness
Consultation for chronic dermatoses shall be covered up to the maximum benefit limit per member per year.
Consultations and treatment for Scabies shall be covered per year.
Hepatitis B (if acquired) shall be covered up to the maximum benefit limit per member per year. ADDITIONAL BENEFITS
Rapid Antibody Test & RT-PCR Test shall be covered through reimbursement for all members without symptoms of COVID-19 to be done at any accredited facility as long as prescribed by an accredited physician/doctor.
Optical benefit which includes optical consultations, examinations, contact lens, spectacle shall be covered thru reimbursement up to Php3,500.00 for per member per year. Note: Optical procedures will be based only upon doctor’s request ADDITIONAL BENEFITS
Gender reassignment surgery benefit shall be covered up to Php200,000 for principal members who are diagnosed with Gender Dysphoria. - Consultations through accredited/non-accredited endocrinologist including prescribed hormonal treatments (through IV or injection only) shall be covered up to Php20,000 per principal per year thru reimbursement.
- Consultation reimbursement through Psychiatrist shall have a maximum of Php1,500 per consultation.
NOTE: This GRS provision of Php200,000 would be over and above the MBL. For example, if an employee X avails GRS claim worth Php120,000, his MBL for HMO would still remain Php200,000 and can be utilized for medical treatments as per HMO policy. Since PayPal is paying the GRS expenses (P120,000) plus 10% admin charge through the special fund of 5M, the MBL of the employee must not be touched. ADDITIONAL BENEFITS
INTELLICARE shall reimburse out-patient medicines up to Five Thousand Pesos (Php5,000.00) per family unit per year. Out-patient medicines must be prescribed by an accredited physician/doctor. The following items shall be reimbursed with prescription:
- Dermatological medicines and products - Medicines for psychological/psychiatric cases - Maintenance medicines - Pre and post-natal medicines - Injectible medicines (such as but not limited to chemo therapeutic drugs, vaccines ADDITIONAL BENEFITS
The following items shall be reimbursed without prescription: - Vitamins and supplements - Over-the-counter medicines
Exclusions are: Contraceptive pills and beautification/ cosmetic products, ointments, solutions, lotions for derma cases, soap/ cleanser for skin diseases. ADDITIONAL BENEFITS
Maternity Assistance: A maternity assistance program shall be made available to all enrolled female employees and legal spouse of male employees of the company and Domestic partner. The enrolled member may avail of the maternity assistance only once per contract period:
(1) Caesarean Delivery - PHP40,000.00 (2) Normal Delivery - PHP25,000.00 (3) Home Delivery - PHP10,000.00 (thru reimbursement only) (4) Miscarriage / Abortion - PHP15,000.00 (5) Threatened Abortion - PHP15,000.00 (6) Any maternity complications - PHP25,000.00 ADDITIONAL BENEFITS
INTELLICARE will only process maternity reimbursement if all originals of the following pertinent documents are submitted to INTELLICARE: - Official Receipt - Certified True Copy of Birth Certificate - Medical Certificate (stating nature of delivery: i.e. Normal, Caesarian) - Statement of Account (with itemized hospital bills)
Note: Maternity benefit may be covered outright if availed in an accredited hospital through an accredited physician. However, for hospitals with blanket authority, availment will still be on a reimbursement basis. Excess charges must be settled by the member before discharge. ADDITIONAL BENEFITS
All procedures that are not covered in the HMO Dental Plan and any prescribed dental procedure or surgery once every contract year is covered up to MBL as long as prescribed for all employees/dependents. For reimbursement filing, dental prescription with dental procedure details, original receipts and all required documents must be submitted to Intellicare for processing.
Intellicare shall cover flu vaccine (Influenza Trivalent) for all employees per year through ASO program, to be availed at Aventus Clinics only. Administration of flu vaccine to be scheduled by Intellicare (minimum of 200 vials). (Flu vaccines process will be shared by HR). ADDITIONAL BENEFITS
FLU VACCINE PROCESS: 1. Employee to select any preferred aventus clinic branch for the flu vaccine.
2. Employee will e-mail below details to order the vaccine in advance at least 2 months prior target date to Intellicare Representative for consolidation of orders and endorsement to Intellicare/Aventus (PayPal to provide email address to employees). Template for stock reservation stated below: Name of Employee: Clinic/Aventus Branch: Date Preferred: Type of Vaccine: Flu vaccine ADDITIONAL BENEFITS
FLU VACCINE PROCESS: 3. Intellicare representative will send the order request the vaccine to Intellicare/Aventus. Sending of orders to Intellicare representative can no longer be cancelled as we advance the ordering of vials for proper coordination of stock availability.
4. Intellicare Representative will advise the employee once vaccine is already available and schedule must be facilitated before going to the clinic - no appointment no schedule of vaccine (Tentative: April onwards)
5. Employee must bring their HMO card or valid ID during the availment date. ADDITIONAL BENEFITS
POS Coverage effective July 1, 2021. Point of Service (POS) for All Members: Members are allowed to avail of services from non-accredited doctors and non-accredited hospitals for in-patient which shall be covered through reimbursement provided originals of all pertinent documents are submitted to INTELLICARE. Reimbursement shall be up to eighty percent (80%) of hospital bills and eighty percent (80%) of professional fees based on INTELLICARE relative value scale (RVS).
The Point of Service (POS) shall not apply to the following services/facilities: - Dental services; - Accredited hospitals or facilities that are specifically excluded in the group corporate agreement. www.fwd.com.ph ✉: [email protected] LIFE INSURANCE Thru: FOR PRINCIPAL MEMBERS ONLY
Sum Assured: Php 10,000.00
Group Life Insurance (GLI) - Php 10,000.00
Family Assistance Benefit (advanced from GLI) - Php 1,000.00
Terminal Illness Benefit (advanced from GLI) - Php 10,000.00
Accidental Death, Dismemberment - Php 10,000.00 and Disability Benefit (ADDD) *Double Indemnity shall apply if the cause of death is due to accident
NOTE: Group Life Insurance shall be provided for members up to sixty-five (65) years old www.fwd.com.ph ✉: [email protected] LIFE INSURANCE Thru: FOR PRINCIPAL MEMBERS ONLY
SCHEDULE OF INJURIES PERCENTAGE SCHEDULE OF INJURIES PERCENTAGE Both hands or feet 100% One ear 50% One hand and one foot 100% Thumb (both phalanges) 25% Either one hand or one foot and 100% Thumb (one phalanx) 10% sight of one eye Fractured leg or patella with 10% Arm at above elbow 70% established non-union Leg at or above knee 70% Shortening of leg by at least 5cm 7.5% Arm between elbow & wrist 60% Great toe 5% Leg between knee & foot 60% Finger(s) (per phalanx) 3.5% Loss of Speech 50% First or second Metacarpals 3% Loss of Hearing 50% Toe, other than Great toe (one phalanx) 1% Either one hand or one foot or one eye 50% Third, fourth, or fifth Metacarpals 1% GENERAL EXCLUSIONS AND LIMITATIONS
Out-of-network service Miscellaneous hospital charges Special confinements (sanitarium, convalescent home, domiciliary care, etc.) Health check ups (pre-employment, government requirements, insurance) Medical certificates Professional fees in medico-legal cases Refusal to undergo recommended treatment or demanding treatment aside from that which the Intellicare doctors have recommended Blood screening Vaccines for immunization, anti-rabies, anti-venom, steroid injections Organ transplants or acquisition of an organ Procurement of orthotics, prosthetics, take-home medical appliances and other durable medical equipment (DME) GENERAL EXCLUSIONS AND LIMITATIONS
Determining / ruling out PEC during the first 12 months of membership if result is positive Reproductive disorders, artificial insemination, circumcision, sex change Laser eye surgery for myopia or error of refraction Alternative medical treatment / procedures Sleep study not due to an organic illness Cosmetic alterations for aesthetic purposes Out-patient medicines and medical supplies Hypersensitivity tests to check for allergies and desensitization Any disability which may have affected a dependent prior to the 30th day after birth Pregnancy and pregnancy-related conditions GENERAL EXCLUSIONS AND LIMITATIONS
External Forces / Activities Exposure to imminent danger or health hazards Violation of a law or ordinance Extreme / hazardous sports-related injuries Fortuitous events / disasters Air or sea travel other than as a fare-paying passenger on a licensed aircraft / vessel
Illnesses / Conditions Congenital abnormalities Neuro-developmental & genetic disorders (which may result to mental retardation) Developmental delay Sexually transmitted diseases Psychiatric and psychological illnesses MEMBERSHIP CARD
Always present your Intellicare Membership Card and another valid ID during availment.
NOTE: LOST / DAMAGED CARDS: must be reported to Intellicare immediately. REPLACEMENT FEE: Php100.00 CERTIFICATE OF COVER
NOTE: In the absence of the membership card, member may present the Certificate of Cover (COC) signed by an HR representative. WEBSITE
www.intellicare.com.ph CONNECT WITH US
Trunk Lines: (02) 7902-3400 / 8789-4000 TOLL – FREE NUMBER OUTSIDE METRO MANILA: 1-800-10-789-4000
24/7 CALL SUPPORT 24/7 TEXT SUPPORT MOBILE HOTLINE NUMBERS MOBILE HOTLINE NUMBERS (0920) 970 – 4724 Smart (0920) 951 – 8452 Smart (0917) 840 – 4894 Globe (0917) 805 – 2502 Globe (0922) 891 – 3957 SUN (0922) 891 – 3925 SUN
/Intellicare @Intellicare @Intellicare @Intellicare Intellicare-PH CONNECT WITH US
Trunk Lines: (02) 7902-3400 / 8789-4000 TOLL – FREE NUMBER OUTSIDE METRO MANILA: 1-800-10-789-4000
24/7 CALL SUPPORT 24/7 TEXT SUPPORT MOBILE HOTLINE NUMBERS MOBILE HOTLINE NUMBERS (0920) 970 – 4724 Smart (0920) 951 – 8452 Smart (0917) 840 – 4894 Globe (0917) 805 – 2502 Globe (0922) 891 – 3957 SUN (0922) 891 – 3925 SUN
/Intellicare @Intellicare @IntellicarePH /IntellicarePH /Intellicare-PH
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