Overview of Medicard Philippines
MediCard Philippines provides an array of medical insurance schemes for Individuals & Family, Group & Corporates & VIP Assistance with benefits that provide monetary cover for a wide range of medical’s needs. Founded in 1987, Medicard Foundation, Inc. is a non-profit organization headquartered in Makati City.
Health Insurance Schemes Offered by MediCard in Philippines
Following are the various programs offered under Medicard:
- Individual and Family Program
There are two plan categories offered under Individual and Family Program, they are:
- With Asian Hospital and Medical Center, St. Luke’s Medical Center – Quezon City, without St. Luke’s Medical Center - Global City, Makati Medical Center, Cardinal Santos Medical Center, and The Medical City:
- Without The Medical City, St. Luke’s Medical Center – Quezon City, Makati Medical Center, Asian Hospital and Medical Center, and Cardinal Santos Medical Center:
The limit for the dreaded disease for a ward is P100,000 and for semi-private ward it is P120,000. The annual rates are as follows:
|Principal member plus 1 dependent||P39,625||P34,133|
|Principal member plus 2 dependents||P57,428||P50,315|
|Principal member plus 3 dependents||P75,230||P66,491|
|Principal member plus 4 or more dependents||P93,031||P82,663|
The limit for the dreaded disease for a ward is P50,000 and for semi-private ward it is P60,000. The annual rates are as follows:
|Principal member plus 1 dependent||P21,828||P19,468|
|Principal member plus 2 dependents||P31,490||P28,696|
|Principal member plus 3 dependents||P41,153||P37,930|
|Principal member plus 4 or more dependents||P50,820||P47,161|
The non-PhilHealth members will have to pay the corresponding portion when confined in the hospital.
Individual and Family Program Membership Eligibility
The principal member can be a company or a self-employed individual between the ages of 18 to 60 years. Dependents eligibility is as follows:
For Married principal members:
- The principal member’s legal spouse must be 18 – 60 years old.
- Children (legitimate and/or legally adopted): 30 days to 21 years old must be unemployed, unmarried, and living with the principal member.
For Single principal members:
- Parents of principal member: up to 60 years must be unemployed and depending on the principal member.
- Sisters and brothers: 30 days – 21 years, must be unmarried, unemployed and living with the principal member.
The enrollment of dependents must follow a hierarchy. The spouse will be enrolled first followed by the eldest child, if you are a married principal member. For a single principal member, the parents will be enrolled first followed by the eldest sibling.
The dependents who meet the eligibility criteria will become members within 30 days provided all the required documents are submitted. The application can be made from 11th to 25th of a month and from 26th to 10th of a month. The effectivity date for applications submitted from 11th to 25th is 1st of the following month. The effectivity date for applications submitted from 26th to 10th is 16th of the same month. The pre-existing condition limits will be computed on a prorated basis.
With the tie-up with Assist America, the Medicard VIP members who are traveling 150 kilometers for less than 90 days can avail evaluation and consultation at the Operations Center. When you sign up for Medicard VIP Plan, you get a wider range of benefits, executive check-up, a privilege to prescribe your own doctor, coverage for pre-existing conditions, etc.
Features of VIP Program
With the VIP Program, you get the following benefits:
- You get access to 5-star hospitals such as St. Luke’s Medical Center – Quezon City, Asian Hospital in Alabang, Makati Medical Center, Cardinal Santos Medical Center, and The Medical City.
- Medicard VIP plan allows you to recommend your own doctor.
- You can save more with this program as the pre-existing conditions are covered.
- You get an executive check-up at Medicard free-standing clinic.
- You can use the facilities like conference rooms and fitness rooms. You get free services at Lifestyle Center, Surya Fitness, etc.
Benefits of VIP Program
Following are the various benefits of VIP Programs:
- The dreaded disease limit is as follows:
- The additional limit for accidents are as follows:
- The pre-existing limit for in-patient and out-patient are as follows:
- You get free consultations with the following:
|Suite up to 8,000||P500,000|
|Suite up to 8,000||P200,000|
|Suite up to 8,000||P20,000|
- Family medicine.
- General practitioner.
- General surgeon.
- Obstetrician gynaecologist.
|Regular private||Laboratory examination – 30% discount. Maternity related laboratory and ultrasound – up to 30% discount.|
|Regular private||Laboratory examination – 30% discount. Maternity related laboratory and ultrasound – up to 30% discount.|
|Large private||Laboratory examination – 40% discount. Maternity related laboratory and ultrasound – up to 30% discount.|
|Suite up to 8,000||Laboratory examination – 50% discount. Maternity related laboratory and ultrasound – up to 30% discount.|
|Suite up to 8,000||P8,000|
|Out-patient consultation||Out-patient laboratory||In-patient approved hospital bills||Professional fees|
|Regular private||5 consultations at P250 per consultation||80% up to P5,000||80% up to P30,000||70% MRV up to dreaded disease limit|
|Regular private||10 consultations at P300 per consultation||80% up to P10,000||80% up to P50,000||75% MRV up to dreaded disease limit|
|Large private||15 consultations at P350 per consultation||80% up to P12,000||80% up to P75,000||80% MRV up to dreaded disease limit|
|Suite up to 8,000||Unlimited consultations at P350 per consultation||100% up to P20,000||80% up to P100,000||100% MRV up to dreaded disease limit|
* MRV – Medicard Relative Value
|Regular private||Primary package|
|Large private||Expanded plus the choice of 1 test for liver functions, kidney functions, diabetes functions, or thyroid functions.|
|Suite up to 8,000||Expanded plus the choice of 2 test for liver functions, diabetes functions, kidney functions, or thyroid functions.|
|Regular private||Regular private||Large private||Suite up to 8,000|
|Surya at Medicard Lifestyle Center||3 yoga sessions||5 yoga sessions||1 month unlimited yoga classes||3 months unlimited yoga classes|
|Medicard skin & body||3 diamond peel sessions||3 diamond peel sessions and 2 facial sessions||5 diamond peel sessions and 2 revitate or thermolift sessions||10 diamond peel sessions and 5 revitate or thermolift sessions|
|Coverage for slipped disc||P5,000||P10,000||P20,000||P30,000|
|Dental||Bi-annual oral prophylaxis||Light cure filling and Bi-annual oral prophylaxis||2 Light cure filling and Bi-annual oral prophylaxis||5 Light cure filling, Root canal up to P5,000 and Bi-annual oral prophylaxis|
|Regular private||One time|
|Regular private||2 times in a year|
|Large private||2 times in a year|
|Suite up to 8,000||3 times in a year|
Medical Services Available Under VIP Program
Following are the various medical services made available to you:
- You will have access to Operations Centers and you can get a medical evaluation, consultations, and referrals.
- The AAAL will pay hospital admission guarantee on your behalf, you will have to repay it within 45 days.
- When there is an inadequate medical facility in the area you are in, AAAL will arrange for an emergency evacuation.
- Repatriation is provided under medical supervision and you will have to not bear any cost for the same.
- You will be monitored by a medical personnel who will stay in regular communication with your physician and relay necessary information to your family members.
- A designated family member will be provided with a round trip to the airport closest to the place of your hospitalisation.
- AAAL will aid in replacing the prescription when possible.
- If you have minor children, they will be cared for if left unattended as a result of your medical emergency.
- AAAL will transmit and receive emergency messages from/to home.
- In the event of your death, AAAL will arrange for the return of the mortal remains.
- You will be provided with counsellors, interpreters, or legal personnels.
- You will get assistance from AAAL for the transfer of emergency cash.
- You will get assistance in locating lost documents, luggage, personal belongings, etc.
- Support assistance services will be provided.
- Identification cards will be provided by AAAL.
Services will not be provided by AAAL in the following instances:
- Attempt to suicide.
- Commission of unlawful act.
- Travel taken solely for securing medical treatment.
- Incidents that involve drugs unless they were prescribed by a physician.
- Injuries resulting from participating in war or insurrection.
- Transfer of patient from one medical facility to the other which provides the similar level of care.
- AAAL will not repatriate or evacuate without medical authorisation.
|Dreaded disease limit||Additional limit for accidents||In-patient & Out-patient|
|Suite up to 8,000||P500,000||P200,000||P20,000|
|Regular private||Regular private||Large private||Suite up to 8,000|
|Principal member plus 1 dependent||P45,908||P54,391||P82,493||P120,666|
|Principal member plus 2 dependents||P67,649||P75,224||P99,287||P136,697|
|Principal member plus 3 dependents||P88,266||P94,982||P115,212||P151,896|
|Principal member plus 4 dependents||P111,131||P116,839||P132,875||P168,756|
|Excess of 4 dependents||P22,517||P23,542||P25,841||P26,566|
Annual premium for members between 61 – 65 years:
|Suite up to 8,000||P104,432|
Straight charge is at 5% discount. You get 0% installment with your BDO cards. Non-Philhealth members will have to pay the Philhealth portion of the total bill when confined. Executive check-ups are provided for principal member plus one dependent. Medical evaluation for those above 41 years is waived.
The cut-off date for effectivity date assigning is as follows:
- Receipt of an application made from 11th to 25th of a month – 1st of the following month.
- Receipt of an application made from 26th to 10th of a month – 16th of the same month.
If you have lost your contract or ID, you must report the same immediately. The charges for lost ID is P150 and P100 for lost contract.
The group plan applies for SMEs with coverage for 5 to 10 members between the age of 18 to 60 years. On the other hand, the Corporate Program requires at least 11 principal members between the same age band. This plan provides coverage for hospitalization due to accident or illness. Services such as Outpatient care, Emergency care, Preventive health care, financial assistance and Dental care are available based on the coverage chosen by the employer.
Following are the various benefits offered by Medicard Philippines:
- Hospital Confinement Benefits
- Incremental Costs and Excess Charges
- Outpatient Care
- Preventive Healthcare
- Emergency Care
- Dental Care
- Member’s Financial Assistance
- Medicard Perks
Hospital Confinement Benefits
The non-emergency confinement will be subject to review and approval of the board of Medicard. Medicard has the right to direct the physicians to more opinions, if needed. The following services apply when the Medicard physician prescribes hospitalisation:
- There is no deposit to be paid at the time of admission.
- Members of Medicard will have access to Operation Theatre and Recovery room.
- Members will have access to room and board as per the type of enrolment.
- Services of the anaesthesiologist, surgeons, internist, etc. can be availed.
- Medications for anaesthesia that are necessary for a surgical procedure.
- Whole blood transfusions.
- Administered medicines.
- Laboratory examinations and x-ray.
- Plaster casts, dressing, sutures, and other items that are related to medical management.
- Chemotherapy, dialysis, radiotherapy, and ICU confinements are covered.
- Pre-existing conditions are covered.
- MRI, CT Scan, and ultrasound cover offered are up to P5,000 per year per member.
- Interventional surgical procedures and modern therapeutic modalities are covered up to P20,000 per year.
- Assistance for administrative requirements.
- The following procedures and examinations will be covered up to P5,000 each per year per member:
- Pulmonary perfusion scan.
- Tests involving the use of Nuclear Technologies.
- Nerve Conduction Velocity Studies.
- 2-D Echo and Doppler.
- 24-Hour Holter Monitoring.
- Treadmill Stress Test.
- Plasma/Urinary Cortisol.
- Adrenocortical Function.
- Mammography and Sonomammogram.
- Plasma Aldosterone.
- Anti-nuclear antibody.
- Bone densitometry scan.
- C-Reactive protein.
- Laboratory/ancillary services.
- Lupus cell exam.
- Radioactive Iodine therapy.
- Genetic or Immunologic studies.
- New modalities and/or diagnostic and treatment procedure for conditions that have established etiologies and the only alternative left are the conventional methods.
Incremental Costs and Excess Charges
There is an excess charge if there is a surplus in the board and room charges payable to the hospital, if the confined room rate is higher than the actual coverage, but it is within the same category. Incremental costs incur when the insured is confined to a higher category room than the one he or she is entitled to.
If you are a member of more than one group healthcare and the premiums are paid by the employer, you can avail the benefits from one healthcare only. At the time of confinement, you must choose the healthcare. The maximum benefit limit includes hospitalisation, diagnostic procedures, and consultations. The in-patient coverage depends on the final diagnosis. If the results are within the agreement inclusions, all the diagnostic procedures will be included. If there are charges that are not included in the policy, you will have to pay the excess amount.
The following outpatient care services are provided:
- Regular consultations and treatments.
- Referral to specialists.
- Throat, nose, ear, and eye treatment.
- Laboratory examination and x-ray which is prescribed by Medicard physician.
- Minor surgeries for which confinement is not required.
- Treatment for minor surgeries.
You can go to the primary physician of any accredited clinic or hospital for the outpatient consultations and avail the services. The primary physician can request for diagnostic examinations, laboratory tests, and can refer you to a specialist.
Preventive healthcare is provided so that you can be assured that your health status is monitored regularly and properly. The following benefits and privileges are provided:
- Annual physical examination will include urinalysis, complete blood count, chest x-ray, fecalysis, pap smear (if you are above 40 years), and electrocardiogram (if you are above 40 years).
- Routine immunization.
- Record of medical history.
- Management of health.
- Counselling on family planning, diets, and health habits.
*Annual physical examination can be availed at any Medicard Lifestyle Center.
Medicard provides the following emergency services in the event of a life-threatening condition:
- The following will be provided for free of charge at a Medicard accredited hospital or clinic:
- Medicines used for immediate relief.
- Doctor’s services.
- Casts, dressings, and sutures.
- Intravenous fluids and oxygen.
- X-ray, laboratory tests, and diagnostic examinations.
- If you are in immediate danger of losing an eye, limb, or other body part, Medicard will reimburse 80% of the total hospital bills. The amount will not exceed P5,000.
- If the Medicard facilities were not used because it was out of your control, the said amount will be paid.
- Expenses that aren’t covered are transportation to Medicard facility and follow-up care.
- If you are getting emergency medical service at a non-accredited medical facility, you will have to settle the payments first and then file for reimbursement. Medicard will reimburse 80% of the total medical bills. The amount will not exceed P5,000. While filing for reimbursement, you must submit the following documents within 30 days from the date of discharge:
- Official receipt.
- Duly filled out application form.
- Charge slip, which has breakdown of the charges.
- Itemised statement of account.
- Medical certificate.
- Original professional fee receipt.
- Incident report.
- Hospital report.
- Surgical report, if any procedure was done.
- If it was an accident or a medico-legal case, police report has to be submitted.
- Prescription of the attending physician for the medicines that were purchased.
- Photocopy of your Medicard ID.
The following dental care services are offered to you at the accredited dental clinics:
- Temporary fillings.
- Oral examinations and consultations.
- Tooth extractions except for surgery for the impacted tooth.
- Oral prophylaxis once a year after the first annual premium has been paid.
- Treatment of mouth burns, wounds, and lesions.
- Adjustment of dentures.
- Gum treatment.
- Recementation of crown on-lays and in-lays, and of loose jackets.
To avail the dental care services, you must:
- Call a dentist from the list of dentists provided and set up for an appointment.
- You must visit the dentist and present your Medicard ID to avail his or her services.
- You must then sign all the documents and forms after the procedure or treatment was done.
Member’s Financial Assistance
Apart from the healthcare benefits provided, the surviving member will also get financial assistance in the event of death or injury due to an accident or natural causes. The following financial assistance is offered:
|Loss of sight of one eye||P5,000|
|Loss of one foot or one hand||P5,000|
|Loss of sight of one eye and loss of one foot||P10,000|
|Loss of one foot and one hand||P10,000|
|Loss of sight of both eyes||P10,000|
|Loss of both hands||P10,000|
|Death due to an accident||P20,000|
|Death due to natural causes||P10,000|
You get financial assistance if the injury or death has resulted from causes which are not covered under the pre-existing conditions or exclusions. To avail the financial assistance, the total premium for the year should’ve been paid. If you haven’t paid the total premiums, the unpaid annual premiums will be deducted from the assistance amount.
When the survived member is submitting the Medicard claims, the following documents are to be submitted within 60 days from the date of accident or death:
- Original Death Certificate.
- Affidavit of marriage agreement or next of kin.
- Medicard membership card.
- Police report in case of an accident.
- Certificate of employment of the principal member.
- Notarized copy of the attending physician’s statement.
With your Medicard, you get food, hotel and beach resorts, special services, health and beauty, and optical perks.
- Detoxify Bar: You get a free organic garden fresh salad with your Medicard when you make a minimum dine in purchase of P1,000. This offer is valid until 15th July, 2017.
- IHOP: You get a free monster mozzarella stick when you make a minimum purchase of P800. You must present your Medicard to avail this offer. The offer is valid until 15th October, 2017.
- Chef Tony’s: You get 10% discount on popcorn products when you present your Medicard. This offer is valid until 31st December, 2017.
- Kenny Rogers Roasters: You get 15% discount on food and beverages when you present your Medicard when you dine-in. The offer is valid until 15th December, 2017.
- Mrs. Fields: You get 10% discount or 6 free cookie nibblers when you present your Medicard. The offer is available when you have made a minimum purchase of P400. The offer is valid until 1st October, 2017.
- Manang’s Chicken: You get 5% discount on a minimum purchase of P100. The offer is available when you present your Medicard. The offer is valid until 1st October, 2017.
- J Cuppacakes: You get 10% off when you buy a box of 12 or 6 cupcakes. You get a free iced tea when you make a minimum purchase of P500 while you are dining in. You also get 20% discount on customised cupcakes that cost P10,000 and up. 5% discount is offered on events that gross P30,000 and up. The offer is valid until 1st April, 2017.
Hotel and Beach Resort Perks
- Camayan Beach Resort and Hotel: When you present your Medicard, you get 10% discount on beach admission, 10% off on superior and deluxe room. The offer is valid until 15th December, 2017.
- Mandala Spa and Resort Villas: you get 10% discount on spa and resort. You have to make prior reservation for the spa and resort. To avail this discount, you must present your Medicard. The offer is valid until 20th June, 2017.
- Berjaya Makati Hotel: When you present your Medicard, you get 60% discount on room accommodation. The offer is valid until 20th June, 2017.
- Best Western Boracay Tropics: When you present your Medicard, you get 25% discount on the room rates and 10% discount on food and beverages when you spend a minimum of P1,500. The offer is valid until 15th September, 2017.
- Astoria Hotels and Resorts: When you present your Medicard, you get 45% discount on the room accommodation and 10% discount on social functions. The offer is valid until 1st August, 2017.
- Siglo Suites: You get 60% off on the room rates when you present your Medicard. The offer is valid until 7th October, 2017.
- Boracay Grand Vista: You get to stay in the Honeymoon Suite with breakfast for P4,500 per night when you present your Medicard. The offer is valid until 31st March, 2017.
- Hotel Celeste: When you present your Medicard, you get 45% discount on the room rates. The offer is valid until 15th September, 2017.
- Misibis Bay: You get Standard Pacific View room for P15,700 and Standard Garden View room for P11,600 when you present your Medicard. The offer is valid until 15th October, 2017.
Special Services Perks
- Trampoline Park: When you present your Medicard, you get 45% discount on the tickets, 25% discount on fitness membership, and 25% discount on parties. The offer is valid until 31st December, 2017.
- HMR Philippines: You get 5% discount on purchases at HMR and SOS stores when you present your Medicard. The offer is valid until 11th July, 2017.
- Center for Pop: You get 10% discount on stage performance course and Starborne premium voice course when you present your Medicard. You will get 12 sessions which are 2 hours long. The offer is valid until 3rd November, 2017.
- Ocean Adventure: When you present your Medicard, you get 10% on admission and Encounter Programs. The offer is valid until 15th December, 2017.
- Savio Staff Travel: You get 50% off and you get P50,000 virtual money to book flight and hotel tickets when you register at Savio Staff Travel.
Health and Beauty Perks
- Asian Massage: When you present your Medicard, you get 10% discount on all services and 15% discount on all Asian Skymall health and beauty products. The offer is valid until 1st October, 2017.
- Bangs Tony and Jackey Salon: You get 5% discount on packages when you present your Medicard. The offer is valid until 1st August, 2017.
- Toccare Spa: You get 20% discount when you spend P3,000. You have to present your Medicard to avail this discount. The offer is valid until 15th April, 2017.
- Celestial Wellness: When you present your Medicard, you get 20% discount on services. The offer is valid until 15th October, 2017.
- Fifth Season Spa: You get 20% discount on services and a complimentary hand paraffin when you spend P3,000. To avail this discount, you must present your Medicard. The offer is valid until 15th April, 2017.
- The Optical Shop: You get 50% off on aspheric lens and single vision multi-coated lens when you purchase any brand of frames that are regularly priced. You get 20% discount on other lenses. The offer is valid until 1st September, 2017.
- The Opticians: When you present your Medicard, you get 10% off on Sofclear contact lens and Belcon, 10% off on Ophthalmic lens, and 30% off on house brands prescription frames. The offer is valid until 31st May, 2017.
- Perez Optical: When you present your Medicard, you get 10% off on select signature sunglasses and frames, minor repairs, free eyeglass cleaning, frame adjustment, and free comprehensive eye check-up. You also get 205 discount on house brand sunglasses and frames. The offer is valid until 15th august, 2017.
- George Optical: You get 10% off on Sofclear contact lens and Belcon, 30% off on house brands prescription frames and 10% off on Ophthalmic lens. The offer is valid until 31st May, 2017.
You can reach Medicard Philippines at (02) 884-9999.
Toll Free: 1-800-1-888-9001
Sales and Business Development Group I:
Direct Lines: (02) 810-02-05, (02) 843-38-21 , (02) 810-02-10
Fax No.: (02) 848-6454
Sales and Business Development Group II:
Direct Lines: (02) 810-2775, (02) 750-0598, (02) 894-5741
Fax No.: (02) 894-5720
- What is the coverage amount for Modern therapeutic modalities and interventional surgical procedure?
- Please provide a complete list of outpatient care services provided by MediCard.
Not limited to laparoscopic surgery and lithotripsy, the coverage amount is up to P20,000 each year subject to pre-existing conditions coverage.
The following services are provided by MediCard at accredited hospitals and clinics.
- Specialist referrals
- Routine consultation and treatment. Medication prescribed is not covered.
- Ear, Eye, Nose & Throat Treatment which do not require surgical intervention leading to hospitalization.
- Treatment of injuries and surgeries that do not require hospitalization.
- Lab examination & X-Ray as prescribed by the consulting Physician.
- I am planning to avail the Annual Physical Examination (APE) in the next few weeks. Please provide a list of services provided under this service.
- Complete blood count
- Chest X-ray
- Pap Smear
- Some of the tests above are only provided if indicated to a certain age group and sex.
Any individual who travels frequently can avail this plan as it secures medical assistance, treatment and reimbursement at network hospitals. To extend the convenience of accessing top notch medical facilities in various countries, MediCard has tied up with America Assist, a leading emergency service provider for travellers around the globe.
The following documents are required as a part of the claims process.
- MediCard membership details(card)
- Death Certificate(Original)
- Affidavit of next of kin/marriage agreement
- Notarised Physician's statement
- Police report in case of accident
- Principal member’s employment certificate