Coverage & Benefits

Regular Private

Php 100,000/sickness

 For Virtual Assistants & Support Group including their dependents:

➢ Pre-existing condition for existing and new/ additional members (principals & dependents) shall be covered up to fifty percent (50%) of the maximum card limit.

PRE-EXISTING CONDITION. Any illness or injury shall be considered as Pre-Existing if:

a) Any professional advice or treatment has been obtained for such illness or injury; OR

b) Such illness or injury was evident upon medical examination; OR 

c) The natural history of such illness or injury can be clinically determined to have started prior to any availment whether or not the member is aware of such illness or injury.

The following are considered or deemed as PRE-EXISTING CONDITIONS, but not to the exclusion of all others 

including their complications and sequelae:

a) Hypertension;

b) Thyroid disease, Goiter;

c) Cataracts/Glaucoma/Pterigium;

d) Ear nose and/or throat conditions requiring surgery;

e) Asthma;

f) Tuberculosis;

g) Chronic cholecystitis/choletithiasis and other forms of calcification;

h) Hernia;

i) Prostate disorders;

j) Hemorrhoids and fistulae;

k) Tumors;

l) Uterine myoma, ovarian cyst, endometriosis;

m) Buergers disease;

n) Varicose veins;

o) Scoliosis; 

p) Arthritis; 

q) Chronic allergies;

r) Gastric and duodenal ulcers;

s) Dreaded diseases.

Diagnostic procedures undertaken to determine the existence of a Pre-existing Condition is a covered expense provided that the result of diagnostic procedure is negative for the existence of the pre-existing condition.

Pre-existing Condition shall only be covered after one year from Effective Date of the Member's coverage provided that there is no failure to disclose, misrepresent or conceal, Material Information in the original Application or Application for reactivation. Notwithstanding the disclosure by the Member of a pre-existing condition, Intellicare may permanently exclude from cover or limit coverage a specific medical condition, Illness or Injury upon written notice to the Member.

The maximum benefit limit per illness and pre-existing/dreaded disease limits per year for dependent members enrolled after six (6) months from effective date will be calculated pro-rata on this formula:

Total Days Remaining before expiry date: 365 days

X 

Maximum Benefit Limit: 365 days (or Pre-Existing Condition/Dreaded Disease Limit)

ROOM ACCOMMODATION

1. Voluntary Upgrading - If a member chooses and occupies a room one category higher than what he/she is entitled to

• The incremental cost for hospital expenses such as professional fees, room, and board difference, and other hospital bills (laboratory, medicines, and hospital supplies) is as follows:

  • • 30% [Net hospital bill – room/board as charged] + [Room/board charged – allowable cost of the room]

2. Involuntary Upgrading – If a member has to occupy a room one category higher than what he is entitled to because of the non-availability of a category room (except suite room), he will shoulder the difference in cost between the non-category room and the category room while Intellicare pays for the professional fees and other hospital bills (laboratory, medicines and hospital supplies). However, should a room become available, the Member is obligated to transfer to a category room, otherwise incremental charges (such as professional fees, room and board difference, and hospital bills (laboratory, medicines and other hospital supplies) shall be billed to the Member.

• For whatever reasons except during Emergency Care referred to under Benefit provisions, incremental rate difference and excess charges due to voluntary or involuntary room upgrading shall be charged to the Member.

3. Members entitled to a particular category of accommodation will pay the additional costs if confined in any hospital that does not provide that category, or allow confinement for members under that category. Categories scale down from: 

• Suite; Small Suite; Large Private; Regular Private; Small Private; Semi-Private; Ward. The hospital d definition thereof applies.

DOWNGRADING OF ROOM ACCOMMODATION. Availment of a room accommodation lower than the Member's Room and Board Accommodation can be done at the option of the Member but there shall be no refund or offsetting for the cost difference in room accommodation and other related medical benefits. 

IN-PATIENT CARE. Coverage of in-patient benefits, except for Emergency Conditions, wherein the Emergency Care 

provision of this Agreement will apply, shall be subject to the following conditions:

a) The hospital confinement must be recommended by an Accredited/affiliated Doctor and approved by the duly authorized representative of Intellicare in that Accredited Hospital prior to confinement.

b) The confinement shall be in an Accredited Hospital and in accordance with the Member's Room and Board Accommodation.

c) Professional services shall be provided only by Accredited/Affiliated Doctors.

d) As proof of conditions a, b, and c above, Intellicare shall issue the requisite Referral Control Sheet (RCS) and other necessary documents.

 OUT-PATIENT CARE. 

• The Out-patient benefits can be availed by the Member immediately from the effective date of Member's coverage. The benefits can be availed only through the Accredited Hospital/Clinics and Doctor of Intellicare. 

EMERGENCY CARE. In all these emergency circumstances, Intellicare reserves the right to validate whether the treatment received is emergency in nature and/ or the Illness or condition is covered under the provisions of the agreement.

• a) In an Accredited Hospital. If the emergency treatment has been administered in an Accredited Hospital and the Member still requires confinement, Intellicare shall provide the in-patient benefits subject to the provisions of the Agreement.

• b) In a Non-Intellicare Accredited Hospital

  • 1. When a principal member or his/her included dependents are in life-threatening case or finds that he/she is in immediate danger of losing a limb, eye or other part of the body, or is in severe pain that requires immediate relief, Intellicare agrees to reimburse one hundred percent (100%) of the total hospital bills including professional fees based on relative value scale (RVS) for Intellicare accredited hospitals, but not to exceed to the Maximum Benefit Limit.

  • Member should notify Intellicare within twenty-four (24) hours from time of emergency care. In case the member due to his medical condition is unable to communicate directly or through a guardian or representative, the twenty-four (24) hours notification shall be extended.

  • 2. Intellicare shall pay the said amount when it is verified that Intellicare facilities were not used because to have done so would entail a delay resulting in death, serious disability or significant jeopardy to the member’s condition or the choice of hospital was beyond the control of the member or the member’s family. Other expenses such as follow-up care are not covered in using Non-Intellicare Accredited Hospital for emergency cases.

• c) In a Foreign Territory/Country. If a member undergoes confinement while in a foreign country under circumstances considered as emergency, Intellicare shall reimburse the hospital and professional charges incurred using Intellicare’s relative value scale (RVS) as Intellicare would have paid had the member been confined and treated in a non-accredited hospital/clinic up to the Maximum Benefit Limit.

Limitations for In-patient and Out-patient services

a) All confinements and out-patient services must have a written referral from a coordinator (Prescribed referral letter RCS form No. 1, 2 or 3); Intellicare reserves the right to determine whether any illness or condition is covered, following diagnosis. If there is a subsequent contradictory diagnosis, Intellicare retains the right to re-determine whether the illness or condition is covered. If not covered, Intellicare will not pay for the cost of the tests or treatment. 

b) Successive periods of hospital confinement for Dreaded diseases shall be considered as due to one illness/disability 

and subject to the maximum benefit limit.

c) 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 or counterparts will have a maximum limit of Five Thousand pesos (Php5,000.00). When a member avails of these modalities of treatment, Intellicare will not pay for the cost of further traditional modes of treatment/diagnostics for the same illness should they be necessary.

d) Members expressly agree to waive any right to choose doctors and hereby authorize Intellicare to designate qualified doctors and reputable hospitals and clinics to render services.

• A. EXCLUSIONS Intellicare will not pay for any costs or losses arising directly or indirectly from: 

  • 1. Services rendered by Non-Intellicare doctors, except with the prior written authorization of an Intellicare coordinator, or in emergency cases; 

  • 2. Services rendered by Non-Intellicare doctors in an Accredited Hospital or Clinic; 

  • 3. Additional hospital charges and doctor’s professional fees resulting from room upgrading; 

  • 4. Additional hospital charges and Accredited/affiliated Doctor’s professional fees resulting from an extension of hospital stay despite release of discharge order from the Member’s Attending Doctor; 

  • 5. Fees of the assistant surgeons for surgeries with less than two hundred fifty (250) RUV units I resident doctors who assisted the Attending Doctor in the process of rendering the medical services shall not be chargeable to the Member and/or Intellicare except for hospitals that do not have resident doctors to assist during surgeries subject to the prior approval of Intellicare; 

  • 6. 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; Extra food; toilet articles like face towel, soap, toothbrush and the like; 

  • 7. Difference in Room and Board Accommodation, the incremental rate differences for professional fees, diagnostic and laboratory examinations, and other ancillary medical services brought about by obtaining a room and board accommodation higher than the Member's Room and Board Accommodation limit; 

  • 8. Routine Health/Annual/Pre-employment check-ups required for school and/or employment, for other companies, Government requirements, insurance purposes, or travel abroad, health permit and other similar services; 

  • 9. Recuperation such as confinement in a sanitarium or convalescent home, rehabilitation medicines (including work-ups), custodial, domiciliary care, Government imposed quarantines; 

  • 10. Medical certificates; 

  • 11. Professional fees in medico-legal cases; 

  • 12. Refusal to undergo recommended treatment or demanding treatment for which Intellicare doctors believe a professionally acceptable alternative exists; 

  • 13. Blood screening; 

  • 14. Vaccines for immunization, anti-rabies, anti-venom, steroid injections (NOTE: Refer to SCHEDULE “A” [Additional Benefits/Endorsements], item 3 for the coverage of anti-rabies and anti-venom); 

  • 15. Organ transplants or acquisition of an organ; All expenses incurred in the process of organ donation and transplantation if the Member is the donor, and its complications (NOTE: Refer to SCHEDULE “A” [Additional Benefits/Endorsements], item 4 for the coverage of organ transplant); 

  • 16. Benefits covered by PhilHealth and all other government funded healthcare entitlements as provided for by law. 

  • 17. Cost of the medical services and professional fees in excess of the MBL. 

  • 18. Procurement, Purchase of any Durable Medical Equipment, oxygen dispensing equipment, Lease of oxygen, except during covered in-patient care. or use of eyeglasses, special braces, steel implants, buckles for retinal detachment, 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; 

  • 19. Determining/ruling out of PEC during the first twelve (12) months of membership if result is positive; 

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

TREATMENT / PROCEDURES 

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

  • 2. Laser eye surgery for myopia or error of refraction; 

  • 3. Acupuncture, chiropractic treatment, iridology, chelation; cell implant therapy; 

  • 4. Speech or physical therapy in excess of twelve (12) sessions; 

  • 5. Sleep Study, unless directly related to an organic illness and the maximum limit is PHP5,000.00; 

  • 6. 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, sclerotherapy (NOTE: Refer to SCHEDULE “A” [Additional Benefits/Endorsements], item 5 for the coverage of cauterization of warts); 

  • 7. Out-patient medicines and medical supplies except in emergency cases; 

  • 8. All other treatments, laboratory examinations, diagnostic procedures and surgical procedures not specifically defined in this Agreement are considered not covered (Example but not limited to the following: Dental Surgery, Dental XRay, etc.).

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 or not, serving in military, naval, or air forces of any country or international authority, unnecessary exposure to imminent danger or hazard, active participation in setting off 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 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, indirect hernia, hemangioma, phimosis, harelip, clubfoot, cerebral palsy, renal diseases such as medullary sponge kidney, pediatric cardiovascular work-up and the like; 

2. Developmental delay; 

3. Neuro-developmental disorders such as ADHD – Attention Deficit Hyperactive Disorder, Autism; Genetic Disorder which may result to Mental Retardation (e.g. Down Syndrome); and other condition which may require speech/ physical and other related therapies; 

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

5. 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; 

6. Guillaine-Barre Syndrome; 

7. PEC during the first twelve (12) months of cover; 

8. Hypersensitivity tests to check for allergies and desensitization (NOTE: Refer to SCHEDULE “A” [Additional Benefits/Endorsements], item 6 for the coverage of allergy testing/screening); 

9. Any disability which may have affected a Dependent prior to the thirtieth (30th) day after birth; 

10. Pregnancy, complications due to abnormal pregnancies such as but not limited to ectopic pregnancy, tube pregnancy, h-mole, abruptio placenta, placenta previa etc., childbirth, miscarriage, abortion. 

B. DREADED DISEASES. The following are deemed as such: 

1. Cerebrovascular accident (Stroke) Paralysis, Epilepsy; 

2. Central nervous system lesions (Poliomyelitis, Meningitis/Encephalitis/Neurosurgical conditions); 

3.Cardiovascular disease (Coronary/Valvular/Hypertensive Heart Disease); 

4. Chronic obstructive pulmonary disease (Asthma / Bronchitis / Emphysema); 

5. Liver parenchymal disease (Cirrhosis, Hepatitis, Newgrowth); 

6. Chronic kidney/Urological disease (Urolithiasis, Obstructive Uropathies, etc.); 

7. Chronic gastrointestinal tract disease; 

8. Collagen diseases (Rheumatoid arthritis, Systemic lupus erythematosus); 

9. Diabetes; 

10. Malignancies and blood dyscrasia (Cancers, Leukemia, Idiopathic Thrombocytopenic Purpora); 

11. Burns (if occurring prior to enrollment); 

12. Single or multiple organ failure requiring dialysis; and 

13. Any illness other than the above, which would require intensive care unit confinement. 

Dental Coverage

• Dental examination;

• b) Twice (2x) a year oral prophylaxis;

• c) Oral health education through chairside instruction;

• d) Orthodontic consultation (braces and malposition of teeth);

• e) Pre-natal check of teeth and gums;

• f) Temporomandibular joint consultation (clicking of jaws);

• g) Conduct activities on dental health education (e.g. regarding AIDS);

• h) Emergency dental treatment for the relief of pain;

• i) Gum treatment for cases like inflammation or bleeding;

• j) Temporary fillings; up to 2 teeth per member per year

• k) Simple extraction of unsavable tooth; unlimited tooth extraction of unsavable tooth

• l) Recementation of fixed bridges, crowns, jackets, inlays/outlays-kindly call our Customer Service hotline at (02)87894000 for this benefit

• m) Desensitization of hypersensitive teeth – up to two (2) teeth per member per year;

• n) Permanent light cure fillings – up to two (2) teeth per member per year.

(For principal members only)

A. Annual Physical Examination: To be done at any Aventus Clinics rendered to principal members after six (6) months

of continuous coverage, and which includes:

a) Complete blood count 

b) Physical examination

c) Urinalysis 

d) Fecalysis

e) Chest x-ray

f) Electrocardiogram (For members age thirty-five [35] years and above, or if indicated)

g) Pap smear (For female members age thirty-five [35] years and above, or if prescribed)

h) Evaluative doctor’s consultation

Members may also avail of the APE Package at assigned Intellicare Accredited Clinics provided that there is no Aventus Clinic available in the area

B. APE Process Flow

1. Independent Contractor sends APE Request email to HR (rghr@revaglobal.com)

   • Email request should be sent at least 7 business days prior to the target date

   • Email request should contain the following information

     • 1. Preferred clinic/Branch (at least 3)

          1. Metro Manila (Aventus Clinics only)

          2. Outside Metro Manila (Click here to check clinics close to member location)

       2. Preferred Date (provide at least 3 dates)

       3. Delivery address of hard copy of results

       4. Email address for online results access

       5. Additional procedures (if any)

       6. Where to bill the additional procedure (if applicable)

2. Turn Around Time of processing of the APE confirmation letter: 10 working days upon receipt.  

One Hundred Pesos (Php100.00) + shipping fee shall be charged for each replacement of identification cards. 

Note: Please report lost or stolen cards immediately. 

Common law partner/ same gender domestic partner (up to 65 years old) may be enrolled as dependent within the enrollment period.

Eligibility for common law partner/ same gender domestic partner shall be as follows:

UNMARRIED PRINCIPAL WITH COMMON LAW PARTNER/ SAME GENDER DOMESTIC PARTNER

 First (1st) Priority - Legitimate, legally adopted or legitimized children who are unmarried, unemployed, wholly dependent financially upon the member at least thirty (30) days old and not more than twenty-one (21) years old.

Second (2nd) Priority - Unmarried Common law partner/ same gender domestic partner (up to 65 years old)

To get coverage, the below qualifiers should be present:

1. Member is symptomatic (has signs and symptoms like fever, cough, colds, loss of smell, body weakness, etc.

2. Requested by an Intellecare accredited doctor

3. Facility wherein the test will be done should also be accredited with Intellicare

Click here to view answers to frequently asked questions regarding Covid-19 availments.