Frequently Asked Questions

What is PhilCare ?

What is the value of an HMO ?

What are the important things to consider in choosing an HMO?

Is it a permanent insurance coverage ?

Will the member be issued a card ?

What are your advantages as a PhilCare member?

How soon can you avail of the benefits?

Is there any exclusion in coverage?

Will pre-existing illnesses be covered?

What is PhilCare?

PhilCare is a multi-service Health Maintenance Organization (HMO) which provides clients access to quality and affordable healthcare services both for their preventive and curative needs through its wide range of product lines.

What is the value of an HMO?

A Health Maintenance Organization or HMO is a pre-paid health care delivery system that finances and delivers a package of comprehensive health services such as out-patient consultations and treatments, preventive health care programs & if necessary, hospitalization for its actively enrolled members. In lieu of charging a fee for each service rendered, the company collects membership fees upon enrollment to cover a pre-determined range of medical services during the period of an enrollee's coverage.

The probability of financial loss due to illness or accident is diminished, if not entirely prevented. Medical expenditures are determinable because most of the essential services you will need are covered by the regular membership fees.

What are the important things to consider in choosing an HMO?

There are a number of health care companies in the country today and when choosing an HMO you can depend on, you need to decide wisely.

To effectively decide on your health care provider consider the following points:

a. Financial Stability and Track Record of the HMO - it should be able to meet its obligations to its service providers and suppliers promptly so they will likewise be encourage to render quality service to the HMO's members.

b. Network of Service Provider - the HMO should have a vast network of reliable and first rate service providers so it would be very convenient to you to avail your benefits.

c. Service Assurance Mechanisms - the HMO must have a dependable support system that will assist you whenever you need it. There should be a 24/7 Customer Service Hotline to handle any emergency concern, a Liaison Officer/Hospital Coordinator to help you while you are confined and also Account Officers that you can turn to whenever you have inquiries or concerns regarding your program

d. Quality Assurance Mechanisms - the HMO must ensure that its members are receiving excellent and proper care.

Is it a permanent insurance coverage?

NO. The company issues an Agreement contract which is yearly renewable term coverage.

Will the member be issued a card?

PhilCare will issue a membership card which provides data regarding the extent of health care coverage.

What are the advantages of being a PhilCare member?

1. You are assured of an excellent health care. PhilCare's winning combination is its financial strength and more than 27 years of technical expertise to back-up its commitment to deliver personalized quality customer care.

2. Convenient No Deposit admission. Absolutely no cash deposit needed when you check-in at our affiliated hospitals.

3. PhilCare offers a wide range of product lines to answer specific needs of clients. You may choose a healthcare program that suits your healthcare services needs and your requirements.

4. Guaranteed access to PhilCare network of affiliated service providers which includes over 800 affiliated hospitals and clinics and more than 16,000 accredited doctors nationwide for the whole range of medical care services that are stated in your Health Care Agreement.

6. Assurance of quality service because the Company has instituted quality assurance programs to ensure the member is provided with accepted standards of health care.

7. Dental coverage and group life and accidental death and dismemberment insurance policy can be included as optional riders to the program.

Who are eligible for PhilCare Membership?

Those who are eligible for PhilCare Membership must be 59 years old and below. If spouse is aged 59 years old and below, and is actively working, he/she can be enrolled as well. All children aged 6 months to 20 years old, with single status, may also be enrolled.

How soon can you avail of the benefits?

You may start availing of your benefits as soon as your membership contract takes effect. Validity dates of coverage in your membership contract and will be printed in your individual membership cards.

Is there any exclusion in coverage?

To keep your membership fees low, some items are not covered under your health care plan. These include treatments for pregnancy and pregnancy-related conditions, rest cures, cosmetic surgery and other exclusions. The complete list of exclusions is enumerated in your membership contract.

Will pre-existing illnesses be covered?

Pre-existing illnesses are adverse health conditions which have existed prior to the effectivity date of your membership. These illnesses (whether known or unknown, disclosed or not) are excluded from the coverage. After 12 months of continuous coverage, the Pre-existing Condition Clause shall no longer apply to illnesses or conditions which only started to develop on the second year of coverage and onwards, except for conditions or illnesses which have been permanently excluded during the first year of coverage.

Quick Links