Intellicare

Established in 1995

100% wholly-Filipino owned

50M pesos paid up capitalization

473,000 membership base

Widest accreditation networkOver 650 major hospitals and first-class clinicsApproximately 10,000 reputable physicians and specialistsMore than 400 dentists nationwide

Strong manpower complement and infrastructure24/7 Customer Service assistanceHighly-personalized service of Patient Relations Officers during in-patient casesSatellite offices in key cities and provinces3 mobile clinics and 8 full service clinics

Above 90% client retention rate

• ELIGIBLE DEPENDENTS• Enrollment must follow this order

(Hierarchy Rule)

• For Single Principal Members1. Mother or father

– not over 65 years old2. Siblings

– Not over 21 years old– Unmarried– Unemployed

*For Single Parents, Biological Children may be enrolled first before the parents

• For Married Principal Members1. Legal spouse

– not over 65 years old2. Children

– Biological / Legitimate / Legally adopted– 30 days – 21 years old– Unmarried– Unemployed

• Enrollment period – 30 days windowDependents – 30 days from effectivity date of coverage

No additional dependents except for:Newly born baby – 30 days from date of birthSpouse of newly wed employees – 30 days from date of marriageDependent of a new employee – 30 days from effectivity date of Principal member

OP Availment ACCREDITED FACILITIES EXCEPT HEALTHWAY

IP Availment OPEN DOOR POLICY

Room and Board MBL Per illness/ member/ year

REGULAR PRIVATE 120,000

Pre-Existing Condition* CoverageExisting Principals New Principals Existing Dependents New Dependents

MBL MBL MBL 15,000

Philhealth Required

System Uses Electronic Eligibility Verification System (through Medilink Network Inc.’s POS Terminals)

Features and BenefitsDetermines member’s status and extent of

benefit prior to service availment

Generates an electronic approved or declined response upon swiping magnetized card

Faster transactions in terms of verification of status of membership

Efficient tracking of fraud

Dynamic data is stored in our database not in the card (no need to reprint new cards e.g. during renewals, changes in plan)

POS Terminals are accessible 24/7 (major Intellicare providers have POS terminals in place and are ideally located in –Admitting, Billing, Credit and Collection, Industrial clinics, Information, Emergency Room of the hospitals).

Refer to your directory for locations of POS terminals

For Active and Eligible Members –POS Terminal will instantly generate a 2-page LOE (Letter of Eligibility) depending on type of claim e.g. OP-Outpatient, IP-Inpatient, ER-Emergency

For Inactive and Ineligible Members – POS Terminal will display “Call IntelliCare”

When POS terminal is down –(e.g brownouts) Hospital staff will issue a Manual LOE

*For accredited clinics/hospitals without POS terminals –proceed to the IntelliCare Hospital Coordinator or call IntelliCare Customer Service for assistance

Name of ProviderName of Member

Date & Time of Availment

Line 1 Payor, LOE No.Line 2 Policy NumberLine 3 Member’s Name Line 4 Age, Plan Effectivity, CoverageLine 5 BenefitsLine 6 PHIC Required or NotLine 7 PEC Coverage or

Non Coverage Line 8 Exclusions, if anyLine 9 Instructions to Providers

Re: Procedures

Line 1 Payor, LOE No.Line 2 Policy NumberLine 3 Member’s Name Line 4 Age, Plan Effectivity, CoverageLine 5Line 6 BenefitsLine 7 Room and BoardLine 8 PhilhealthLine 9 PEC Coverage or

Non Coverage

Name of ProviderName of Member

Date & Time of Availment

Preventive CareAnnual Physical examRoutine Immunization

Outpatient careOut Patient Care Guidelines

Inpatient careIn Patient Care Guidelines

Emergency careEmergency Care GuidelinesReimbursement Guidelines

Additional BenefitsDental Care

Dental Care GuidelinesFinancial assistance

• ANNUAL PHYSICAL EXAMINATION (APE)

For Principals & Dependents

Complete Blood Count

Urinalysis

Fecalysis

Chest x-ray

Physical Examination

Pap smear (for women 35 years old and above of if prescribed by attending physician)

Electrocardiogram (for 35 years old and above or if indicated by attending physician)

-To be scheduled by your HR /

Benefits Administrator in

coordination with IntelliCare

• Routine Immunization (except cost of vaccines)• Counseling on health habits and quarterly Wellness Programs

(upon request)

• Medical Consultations with IntelliCare affiliated doctors

• Referral to IntelliCare accredited specialists

• Treatment of minor injuries such as lacerations, mild burns, sprains and the like

• Laboratory, x-ray, and other diagnostic procedures prescribed by an IntelliCare accredited physician

• Minor surgery not requiring confinement

• Pre- and post-natal consultations with any IntelliCareaffiliated OB-GYN up to 14 sessions/year.

• Speech / Physical Therapy up to 12 sessions per year.

1. GO TO OP POS terminal in an accredited clinic or hospital.

Present your card (Hospital staff will swipe your card to validate membership status)

2. Coordinator of accredited hospitals. Present Intellicare card and LOE

3. Secure Intellicare referral slip* (RCS 1 OR RCS 2) prior to any consultations / treatment diagnostic tests/lab procedures

4. Present Intellicare card and RCS to accredited doctor or area where the procedure will be done.

5. Avail consultation / treatment or procedure (sign RCS after)

6. File Philhealth for Philhealth required procedures

OUTOUT--PATIENTPATIENT

• Room & Board Accommodation within the limits of the PLAN

• Professional fees of attending IntelliCare affiliated physicians

• Diagnostic procedures referred by the attending IntelliCare affiliated

physicians / specialists.

• Administered Medicines

either orally or intravenously

• Transfusion of blood and intravenous fluids

• Anesthesia and its administration

• Standard nursing care services, standard

admission kit, sutures, dressings, plaster

casts, and other items directly related to

the medical management of the patient

• Use of Intensive Care Unit

• Use of Operating Room & Recovery Room facilities

• Assistance in administrative requirements through the IntelliCare Patient Relation Officers

• Ambulance Service (hospital to hospital) to be covered thru reimbursement up to Php 3,000/member/year.

ININ--PATIENTPATIENT

1. GO TO (In-patient) IP POS terminal in an accredited clinic or hospital.Present your card. (Hospital staff will swipe your card to validate membership status)

2. Proceed to admitting section and present your LOEand admitting order

OCCUPY ALLOWED ROOMINVOLUNTARY UPGRADING- Member are allowed to occupy a room one level higher than whathe is entitled to due to non availability for up to 24 hours (1 day) w/o incremental charges (except suite room). After 24 hours (2nd day) whetherRoom becomes available or not, incremental charges will be billed to the account of the member.*You must transfer once your room becomes available, otherwise,pay all incremental charges *starting from the first day of confinement.VOLUNTARY UPGRADING

*Pay ALL Incremental charges from first day of confinement -30% increment in hospital services.-Room and board difference.-Professional fee difference.

3. File your Philhealth before hospital discharge*Non-filing or late filing of Philhealth AND*Non-Philhealth membersmust pay the Philhealth portion upon discharge

4. Sign RCS and hospital bill and settle miscellaneous charges upon discharge

• life-threatening situations requiring urgent medical or surgical care e.g. heart attack, stroke, poisoning, loss of consciousness or respiration and convulsion

ACCREDITED HOSPITALS

NON-ACCREDITED HOSPITALS

FOREIGN TERRITORIES

Covered up to MBL

Covered thru reimbursement

up to 30,000

Covered thru reimbursement

up to 30,000Hospital bills –

100% Intellicare

RVS

Hospital bills –80% of IntelliCare

RVS

Hospital bills –80% of IntelliCare

RVS

Professional fees – 100% IntelliCare

RVS

Professional fees – 80% of

IntelliCare RVS

Professional fees – 80% of

IntelliCare RVS

*RVS (Relative Value Scale)

EMERGENCY CARE PROCEDURESEMERGENCY CARE PROCEDURES

1. GO TO the Emergency Room of an accredited clinic or hospitalHospital staff will swipe your card to validate membership status

2. Undergo medical treatment

3. If declared as an outpatient case only, do not forget to sign RCS and hospital bill upon discharge and settle non-covered charges

4. If for admission, notify Intellicare Customer Service within 24 hours. Occupy allowed room. ( incremental charges will apply during room upgrading

5. If treated in a non-accredited hospital, you may file reimbursement of your medical bills upon discharge

1. Secure IntelliCare Reimbursement Form and fill up completely.

2. Complete the following documents and attach to the Reimbursement Form:

a. OUTPATIENT

Original Official Receipt (with TIN)

Statement of Account from the hospital

Medical Certificate*

Laboratory result (if with diagnostic procedure)

b. IN-PATIENT

Original Official Receipt (with TIN)

Medical Certificate*

Statement of Account (Itemized Hospital Bill)

Operative Record with Histopath Result (if with operation)

Police Report & Medico-Legal Report (if required)

REIMBURSEMENTS – cont….

NOTES:• Submit to IntelliCare not more than 30 days from expiration of

treatment

• IntelliCare will process the request within 20 working days upon receipt of complete documents

*MEDICAL CERTIFICATE

• First dose of anti-rabies, anti-venom and anti-tetanus are covered up to PHP 15,000.00.

• Congenital illnesses shall be covered for Principal members shall be covered up to PHP 20,000.00 per illness / member / year.

• Cautery of warts up to PHP 1,000.00 / member / year.

Lithotripsy = PEC limit

Laparoscopic Procedures = PEC limit

Arthroscopic / Hysteroscopic Procedures = PEC limit

Transurethral Microwave Therapy of Prostate = maximum of 50,000

Percutaneous Ultrasonic Nephrolithotomy = PERC limit

Heart Surgery / Angiogram = up to 50,000

Neuroscan = PEC limit

Perfusion Scan = PEC limit

Magnetic Resonance Imaging (MRI) = PEC limit

Nuclear Radioactive Isotope Scan (NRIS) = PEC limit

Chemotherapy / Radiotherapy = PEC limit

Ultrasound (except maternity cases) = PEC limit

Dialysis = PEC limit

CT Scan = PEC limit

Notes on Availment of Latest Modalities of Treatment & Special Procedures

Procedures mentioned are covered up to the limits indicated or PEC limit (whichever is lesser)

Other modalities of treatment and/or diagnosis requiring sophisticated equipment and performed by highly skilled technicians or specially trained doctors for which there are no comparable conventional or traditional equivalents / counterparts will have a maximum limit of Php5,000 subject to the exclusions and limitations of the contract

Dental Examination

Bi-Annual Oral Prophylaxis

Simple tooth extraction

Temporary fillings

Two (2) teeth permanent lightcure fillings

Recementation of jackets, crown, inlays and onlays

Treatment of minor gum problems, mouth lesions, wounds and burns

Orthodontic consultations (braces and malposition of teeth)

Temporo mandibular joint consultation (clicking of jaws)

Pre-natal check of teeth and gums

Emergency dental treatment for the relief of pain

Dental health education

Check out list of IntelliCare Accredited Dentists

Call dentist to find out if they implement FIRST-COME , FIRST-SERVED or BY APPOINTMENT policy

Go to the ACCREDITED DENTAL CLINIC

Present IntelliCare Card

Avail of Dental treatment/ consultation

Sign-off dental referral control sheet after consultation / treatment

DENTALDENTAL

Natural Death - Php 10,000.00Death due to Accident - Php 20,000.00Loss of both hands - Php 10,000.00Loss of both feet - Php 10,000.00Loss of sight (both eyes) - Php 10,000.00Loss of one hand and one foot - Php 10,000.00Loss of one hand and sight on one eye - Php 10,000.00Loss of one foot and sight on one eye - Php 10,000.00Loss of one hand or one foot or sight on one eye - Php 5,000.00

NOTE: Provided, that the death or injury results from causes that are covered and not under the exclusions provision.

PROCEDURES FOR AVAILMENT (Financial Assistance)

1. Secure IntelliCare Reimbursement Form and fill up completely.

2. Complete the ff: documents and attach to Reimbursement Form:a. Filled up Internment Assistance Form

b. Attending Physician’s Certification

c. Certified original copy of Death Certificate

d. Certified original copy of the deceased and the beneficiary’s Birth Certificates

e. Certified original copy of Marriage Contract

f. Latest DTR (Daily Time Record)

g. Police Report and Autopsy (if accidental death)

NOTE:IntelliCare will process the request within 30 days upon receipt of complete documents

1. Services rendered by non-accredited doctors, except with the prior written authorization of an IntelliCareCoordinator, or in Emergency cases

2. Hospital charges for special or private nursing services, supplemental foods and medicines like vitamins and minerals (unless prescribed), extra accommodation and non-medical personal appliances such as radio, television, telephone, computer and refrigerator

3. Health / Annual / Pre-employment check-ups for other companies, government requirements, insurance purposes or travel abroad

4. Recuperation such as confinement in a sanitarium or convalescent home, rehabilitation medicines, custodial, domiciliary care, government imposed quarantines

GENERAL EXCLUSIONS / LIMITATIONS – cont…

5. Medical Certificates

6. Professional fees in medico-legal cases

7. Refusal to undergo recommended treatment or demanding treatment for which IntelliCare doctors believe a professionally acceptable alternative exists

8. Vaccines for immunization, anti-rabies, anti-venom, steroid injection

9. Out patient medicines and medical supplies except in emergency cases

10. Procurement or use of eye glasses, special braces, steel implants, wheelchairs or prosthetic appliances including but not limited to items such as artificial limbs, hearing aids, crutches, intra-ocular lens, contact lenses, artificial hips or joints, pacemakers, mesh (for hernia), stents and ventilating tubes

TREATMENT AND PROCEDURES

1. Determining / Ruling out PEC during the first 12 months of membership if result is positive

2. Determining / ruling out of hepatitis or tuberculosis if result is negative

3. Circumcision, infertility or fertility and virility/potency (erectile dysfunctions), artificial insemination, sex change

4. Laser eye surgery for myopia or error of refraction

5. Acupuncture, chiropractic treatment, iridology, chelation, cell implant theraphy

6. Speech or Physical therapy in excess of 12 sessions


7. Reconstructive surgery (except to treat a functional defect directly caused by accident or illness covered herein), cautery of warts, milia, xyringoma, facial moles, aesthetic, cosmetic or beautification alterations

8. Hypersensitivity tests to check for allergies and desensitization

9. Sleep study (unless directly related to an organic illness covered up to 5,000)

10. Blood screening

11. Organ transplants or acquisition of an organ


EXTERNAL FORCES / ACTIVITIES

1. War-like or combat operations, government declared acts of rebellion, active participation in riots or demonstrations, strikes or labor disputes, terrorism, provoked criminal acts, violation of a law or ordinance, commission of a crime whether consummated of not, serving in the military, naval or air forces of any country or international authority, unnecessary exposure to imminent danger of hazard, active participation in setting of and/or handling pyrotechnic materials, attempted suicide, self-inflicted injuries

2. Participation in hazardous activities such as skydiving, motor sports, judo, karate, taekwondo, boxing, wrestling, bungee jumping, scuba diving, snorkeling, horseback riding, polo, hunting, mountain climbing, rock climbing, hang gliding, spelunking, ballooning, gymnastics or partaking as a paid professional or semi-professional in any sport


3. Government declared epidemics, complete or partial destruction of hospital by fire, flood, or other perils, earthquake, tsunami, volcanic eruption, acts or order of Government, brownouts

4. Aviation or aeronautics use or sea travel other than as a fare-paying passenger on a licensed aircraft/vessel operated by a recognized airline/operator

ILLNESSES / CONDITIONS

1. Congenital abnormalities such as neonatal hernia, indirecthernia, hemangioma, phimosis, harelip, clubfoot, cerebral palsy, renal diseases such as medullary sponge kidney, pediatric cardiovascular work-up and the like

2. Neuro-developmental disorders such as ADHD (attention Deficit Hyperactivity Disorder) Autism, Genetic disorder, which may result to mental retardation (e.g. Down Syndrome) and other conditions which may require speech/physical and other related therapies


3. Sexually-transmitted diseases, AIDS and AIDS-related complex or condition

4. Substance addiction or reaction to use of prohibited drugs, alcoholism, alcohol intake, anxiety reaction, psychiatric and psychological illnesses,neurotic and psychiatric behavior disorders, or accidents arising from these conditions

5. Guillain-Barre syndrome

6. Developmental delay

7. Any illness or disability which may have affected a dependent prior to the 30th day after birth

8. Pregnancy, childbirth, miscarriage, pregnancy-related illnesses, abortion, post-natal care


Always present your IntelliCare Membership Card and another valid ID during availment.

Lost card – report to IntelliCare immediately

PHP 100.00 – replacement fee for lost card

E-MAIL ADDRESS:[email protected]

MANILA(0920) 951-8452 – Smart(0917) 805-2502 - Globe

BRANCH OFFICES

CEBU (032) 255-1282 (0920)-9073708BACOLOD (034) 433-1984 (0920) 926-8649CDO (08822) 726327 (0920) 951-9526DAVAO (082) 227-4697 (082) 227-4621

(0920) 951-9523

Intellicare Makati ClinicClinic Hours: Monday-Saturday / 8am to 5pm

2nd floor PNB Beneficial Bldg.,166 Salcedo St., Legaspi Village, Makati CityTel. 888-5556 / 830-2320 / 818-8671 local 200

Intellicare Alabang ClinicClinic Hours: Monday-Saturday / 8am to 5pm

Unit 53-10 to 20 Green Bldg. – South StationAlabang-Zapote Road, Alabang, Muntinlupa City

Tel 386-6435

Intellicare Ortigas ClinicClinic Hours: Monday-Saturday / 8am to 5pm

Ground Floor, AIC Grande Tower,Sapphire St., Ortigas Center

Tel. 706-3844

Intellicare Cebu ClinicClinic Hours: Monday-Saturday / 8am to 5pm

Unit 203 2/F TGU Tower I.T. Park Asiatolon, Apas, Cebu City

Tel. 231-0660/61/62/63

Intellicare Calamba ClinicClinic Hours: Monday-Saturday / 8am to 5pm

Unit S-5, S– 9 to 10 Daniel Commercial Complex, Old National Hi-Way, Brgy. Parian, Calamba, Laguna

Tel (049) 545-4446/(049) 545-5183

Intellicare Sta. Rosa ClinicClinic Hours: Monday-Saturday / 8am to 5mUnit 26 & 27 Sta. Rosa Commercial Complex,

Balibago, Sta Rosa City Laguna

Intellicare U.N. Avenue Clinic801 United Nations Ave., Ermita, Manila

Tel 521-8108 / 536-3906

Intellicare PCS Clinic2nd Floor Philippine College of Surgeon Bldg.,

992 North Edsa, Quezon CityClinic Hours: M-Sat 8:00am-5:00pm

Tel. # (02) 929-5127 / 929-5412

Illnesses diagnosed or pathogenesis has started before enrollment or during the first year of membership with IntelliCare,with or without the member’s knowledge.

Includes Dreaded Diseases, which are chronic or irreversible illnesses present prior to enrolment.

Hemorrhoids and anal fistulae

Tumors

Uterine myoma, ovarian cyst, endometriosis

Buerger’s disease

Varicose veins

Scoliosis

Arthritis

Chronic allergies

Gastric and Duodenal ulcers

The following are considered as PECs:Hypertension

Thyroid disease, Goiter (hypo / hyperthyroidism)

Cataracts / Glaucoma / Pterygium

ENT conditions requiring surgery

Bronchial asthma

Tuberculosis

Chronic cholecystitis, cholelithiasis (gallbladder stones) and other forms of calcification

Hernia

Prostate disorders

The following are classified as dreaded diseases:

Rheumatoid arthritis, systemic lupus erythematosus

Injuries from previous accidents

Single or multiple organ failure requiring dialysis

Burns (if occuring prior to enrollment)

Cancers, Leukemia, Idiopathic Thrombocytopenic Purpura

Diabetes mellitus, diabetes insipidus

ICU confinement and other illnesses requiring an extended stay in the hospital for an uninterrupted period of 15 days

Stroke, Paralysis, Epilepsy

Poliomyelitis, Meningitis, Encephalitis and other neurosurgical conditions

Coronary, Valvular and Hypertensive Heart Diseases

Asthma, Chronic Bronchitis, Emphysema

Cirrhosis, Hepatitis, Newgrowth

Urolithiasis, Obstructive Uropathies

Chronic gastrointestinal tract diseases requiring bowel resection and/or anastomosis

For any concerns or questions regarding Philhealth:

Benefits & Coverage

Eligibility

Membership/Payments/Requirements

Please consult your Human Resource Department or visit their

website at www.philhealth.gov.ph

Documents

Intellicare