Individual HMO
Medical Limit:
Room and Board:
| Health Pro (MBL) | Health Luxe (MBL) | Health 360 (ABL) | |||||
|---|---|---|---|---|---|---|---|
|
Php 150,000 |
Php 300,000 |
Php 150,000 |
Php 300,000 |
Php 100,000 |
Php 150,000 |
Php 300,000 |
Php 500,000 |
|
Semi-Private |
Private Open |
Semi-Private |
Regular Private |
Ward |
Semi-Private |
Private |
Private |
Room and Board – hospital room accommodation
Maximum Benefit Limit (MBL) – limit applied to an illness per year
Annual Benefit Limit (ABL) – limit applied to all illnesses per year
Need Assistance? Request a phone call here.
Individual HMO Coverage
Benefit Limit
Health Pro
- Maximum Benefit Limit per illness (MBL) per contract year.
Health Luxe
- Maximum Benefit Limit per illness (MBL) per contract year.
Health 360
- Total Annual Benefit Limit for all illnesses (ABL) per year.
Out Patient/Clinic Access
Health Pro
- Includes the Medical City Satellite Clinics.
- Direct access to more than 600 Philcare affiliated clinics.
Health Luxe
- Direct access to more than 600 Philcare affiliated clinics.
Health 360
- Clinic based access.
- Philcare owned clinics.
- Access to more than 600 affiliated clinics by referral.Â
Hospital Access
Health Pro and Health Luxe
- More than 500 hospitals nationwide.
- Access to Asian Hospital Medical Center, St. Luke Quezon City, St. Luke Global City, Makati Medical Center, Cardinal Santos Medical Center, and the Medical City.
Health 360
- More than 500 hospitals nationwide.
- Access to St. Luke Quezon City, Makati Medical Center, Cardinal Santos Medical Center, and the Medical City.
Special Modalities of Treatment
Health Pro and Health Luxe
- Mostly up to MBL
Health 360
- Pre-set inner limit
Additional Benefits
Health Pro and Health Luxe
- Speech Therapy Php 10K/member/year
- Passive and Active Vaccines for treatment of tetanus and animal bites (including immunoglobulin) Php 20K/member/year)
- Standard Admission Kit
Health 360
- None
Emergency Care in Non Affiliated Hospital within the Philippines and Abroad
Health Pro and Heath Luxe
- 80% of hospital and professional fees based on PhilCare rates.
- Up to Php 30,000 / case
Heath Luxe
- 100% of hospital and professional fees based on PhilCare rates.
- Up to Php 15,000 / case
Travel Assist
Heath Pro and Health Luxe
- Powered by assist America, this program provides you with worldwide medical emergency services such as emergency medical evaluation, hospital admission assistance, medical monitoring and repatriation, and prescription assistance.
Health 360
- None
Coverage of Pre-existing Condition
Health Pro
- None
Health Luxe
- Php 10,000 ABL for one year
Health 360
- None
Annual Physical Examination
- Review of Medical history – Physical examination
- Chest X-Ray
- Urinalysis
- Fecalysis
- Complete Blood Count (CBC)
- ECG for members 35 years old and above or if indicated
- Pap Smear for female members 35 years old and above or if indicated
Road Ambulance Coverage
- Nationwide coverage for hospital-to-hospital transfer by ambulance
Life Insurance
- Php 100,000
Accident Death and Dismemberment
- Php 100,000
Membership
- 6 months to 65 years old (Latest age to enroll is 60 years old)
Dental Benefits
- Annual dental examination and consultations
- Emergency out-patient dental treatment
- Oral Prophylaxis once a year (light cases only)
- Simple tooth extractions
- Restorative and prosthodontics treatment planning
- Temporary fillings-unlimited as needed
- Desensitization of hypersensitive teeth
- Simple adjustment of dentures
- Recementation of loose crows, inlays and onlays
- Dental nutrition and dietary counselling
- Dental health education
- Temporo mandibular joint consultation
- Gum treatment for cases like inflammation or bleeding
- 2 surfaces light-cure dental filling
- 1 additional prophylaxis
General Exclusion and Limitations
- Pre-existing and congenital conditions/ailments are not covered. Pre-existing and congenital condition are defined as an illness or condition that prior to the first effective date or date of reinstatement of the health coverage, the pathogenesis of such illness or condition has started, whether or not the member is aware of such illness or condition.
- PhilHealth is required for Health 360, Health Pro and Health Luxe programs. Accomplished PhilHealth form needs to be submitted prior to discharge from hospital. Otherwise, the hospital will require members to pay the PhilHealth portion.
- For those without PhilHealth coverage, you may decide to get a PhilCare PhilHealth Rider upon enrolment to cover possible PhilHealth coverage. PhilHealth Rider fee Php 2,688.
- The purchase price of Health 360, Health Pro and Health Luxe packages are at a promotional discount and not eligible for combination with any other discount including Senior Citizen’s discount.
- Underwriting requirements concerning age, hierarchy, enrolment of minor, ineligible professions, BMI, will still be applied.
Terms and Conditions
- Entry age is from 6 months up to 60 years old; renewable up to 65 years old
- Medical examination is required for new enrollees 50 years old and above. Reimbursable up to Php 2,250 for approved application.
- Medical examination package: – Physical Exam / Urinalysis / ECG – Blood Tests – CBC / Sodium / Chloride / Bicarbonate / Calcium /Glucose/BUN /Potassium
- Medical examination taken in PhilCare or affiliated clinics within 6 months is accepted.
