Health Care: Intellicare

HMO BENEFIT PROGRAM
Corporate Accounts

Who is Eligible to Enroll?

• Single Proprietor / Partnership / Corporation duly registered with DTI or SEC to conduct business in the Philippines.
• Minimum of 15 regular employees and 10 dependents.

MEMBERSHIP ELIGIBILITY

1. Principal members at least eighteen (18) to sixty-five (65) years old.
2. Dependents:
   1. Married principals must enroll their spouse first, aged sixty-five (65) and below, followed by the eldest to the youngest child at fifteen (15) days old to twenty-one (21) years old;
   2. Single/unmarried members, must be acknowledged natural children first, parents aged sixty-five (65) and below, then the siblings, eldest brother/sister to the youngest child at least fifteen (15) days old to twenty-one (21) years old;

What are the benefits in enrolling under the HMO Program?

• Intellicare members have the privilege to avail of the following services at any accredited Hospitals and Clinics Nationwide.

1. ANNUAL PHYSICAL EXAM
   • Complete blood count
   • Physical Examination
   • Urinalysis
   • Fecalysis
   • Chest x-ray
   • Electrocardiogram (For members age thirty-five (35) years and above, or if indicated)
   • Pap smear (For female members age thirty-five (35) years and above, or if prescribed)
2. PREVENTIVE CARE
   • Periodic medical check-up
   • Management of health problems
   • Counseling on health habits (family planning, diet prescriptions)
   • Record keeping of medical history
   • Routine Immunization (except cost of vaccines)
3. OUT-PATIENT
   • Medical consultation during regular clinic hours, excluding prescribed medicines;
   • Emergency room care;
   • Referral to accredited specialist/s;
   • Eye, Ear, Nose, and Throat consultations;
   • Treatment of minor injuries and/or illnesses
   • Laboratory tests, x-rays, and other diagnostic exams prescribed by the Intellicare physician;
   • Minor surgery not requiring confinement;
   • Speech and physical therapy
   • Pre-natal and post-natal consultations.
4. IN-PATIENT CONFINEMENT
   • No deposit upon admission
   • Room and Board benefits specified in Schedule per category;
   • Use of operating room and recovery room facilities;
   • Standard admission kit (e.g. ID bracelet, thermometer, etc.);
   • Professional services of all attending accredited specialists, anesthesiologists;
   • Anesthesia and medications;
   • Blood transfusions and intravenous fluids;
   • Laboratory tests, x-rays, and other diagnostic examinations;
   • Administered medicines;
   • Dressings, plaster casts, sutures and other items directly related to the medical management of the patient;
   • ICU confinement/ dialysis;
   • CT scan and ultrasound (except for maternity cases);
   • Ambulance service
   • Assistance in administrative requirements through the liaison officer; and
   • All other hospital charges deemed necessary by Intellicare Accredited Physician in the treatment of the patient.
5. EMERGENCY CARE
   
   E-1. IN ACCREDITED HOSPITALS
   • Doctor’s services
   • Medicines used
   • Oxygen and intravenous fluids
   • Dressings, casts and sutures
   • Laboratory, x-ray and other diagnostic examinations directly related to the emergency management of the patient
   
   E-2. IN NON-ACCREDITED HOSPITALS
   • Intellicare agrees to reimburse up to eighty percent (80%) of the total hospital bills including professional fees using Intellicare Relative Values Scale (RVS) but not to exceed Php30,000.00.
   
   E-3. IN FOREIGN COUNTRIES
   • Confinement in foreign territory shall be treated as if the member had been confined in an non-accredited hospital facility using Intellicare Relative Values Scale (RVS) but not to exceed Php30,000.00.
   
   E-3. IN AREAS WITHOUT ACCREDITED HOSPITALS
   • Intellicare agrees to reimburse up to one hundred percent (100%) of the total hospital bills including professional fees using Intellicare Relative Values Scale (RVS) but not to exceed Php30,000.00.
6. Financial Assistance including AD&D (For principals only)
   
7. Natural death
8. Accidental death
9. Loss of both hands
10. Loss of both feet
11. Loss of sight of both eyes
12. Loss of one hand and one foot
13. Loss of one hand and sight of one eye
14. Loss of one foot and sight of one eye
15. Loss of one hand or one foot
16. Loss of sight of one eye

PHP 10,000.00 20,000.00 10,000.00 10,000.00 10,000.00 10,000.00 10,000.00 10,000.00 5,000.00 5,000.00 Dental Services (OPTIONAL BENEFIT)Dental Examination; Annual oral prophylaxis; Oral health education through chairside instruction; Orthodontic consultation (braces and malposition of teeth); Pre-natal check of teeth and gums; Temporo Mandibular Joint (TMJ) consultation (clicking of jaws); Conduct activities on dental health education (e.g. regarding AIDS); Emergency dental treatment for the relief of pain; Gum treatment for cases like inflammation or bleeding; Temporary fillings; Simple extraction of unsavable tooth; Recementation of fixed bridges, crowns, jackets, inlays/outlays.

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