Objectives

Individual and Family memberships are designed packages for all. It helps monitor the health and
safety of each individual and family member.

Our north-star is to help each individual who are not employed but want to have health security
without breaking the budget.
Individual and Family Membership
Standard and VIP Plans
Membership Eligibility
PRINCIPAL ENROLLEES
• Salaried/Voluntary personnel at least 18 years old
up to age 65

DEPENDENT ENROLLEES
For Married Employees
• Legal spouse up to 60 years of age
• Legitimate and/or legally adopted children 30 days
old and up to 21 years of age who are not gainfully
employed and unmarried

For Single Employees

• Parents up to 60 years of age, unemployed and
dependent on the Principal Member
• Brothers and sisters 30 days old and up to 21 years
of age who are not gainfully employed and
unmarried

For Single Parent Employees

• Children 30 days old and up to 21 years of age
who are not gainfully employed and unmarried
 Requirements

Filled out application form for Principal and Dependents

1 valid ID for Principal and each Dependents. If there’s any (For 0-18 year-old dependents, we require birth
certificate as additional document)

If you and/or your dependents have an existing HMO plan, you will need to submit any proof that you
and/or your dependents have an active membership.

Signed contract conforme for (Individual/Family/VIP Plan) with printed name.

Proof of Payment
 Medical Evaluation

All applicants ages 41 years old and above under All applicants for VIP Plan,
Standard Plan are required to undergo medical
evaluation and pay a minimal fee of Php.650.00 at There’s no need for a medical evaluation for
any MediCard Stand-Alone Clinics. enrollees age 41 years old and above.

Kindly call or email the nearest MediCard clinic to

set an appointment. If there’s no MediCard clinic
near you, it can also be done in any of the
accredited hospitals, but rate may vary depending
on the facility.
Categories of Illnesses/Cases
 Ordinary Illnesses
A disease that can easily be acquired overnight due to viruses and bacteria.
(e.g Dengue Fever, Typhoid Fever, Influenza, Appendicitis, Diarrhea, UTI, Covid19, etc.)
 Pre-Existing Conditions
A disease that is asymptomatic in nature and manifest over time.
(e.g. Hypertension, Goiter, Cataract, Bronchial Asthma, Tuberculosis, Prostate Disorder,
Gallstones, Hemorrhoids, Migraine, ect.)
 Dreaded Diseases
A complication coming from the pre-existing conditions leading to ICU confinement or
death. (e.g. Cancer of any form, Cardiovascular diseases, Sepsis, Diabetes Mellitus, etc.)
 Contestability Period

Standard Plan VIP Plan

One year or twelve months of membership with Pre-existing conditions cases will be covered on the
MediCard, all pre-existing conditions are not first year of membership, depending on the chosen
covered. plan.

Continuous membership 3 years onwards with Starts at P5,000 up to P20,000 per illness per member
MediCard, without any history of acquired pre- per year.
existing conditions during or prior membership, will
be covered up to the maximum limit subject to Continuous membership 3 years onwards with
evaluation, based on the final given diagnosis. MediCard, without any history of acquired pre-existing
conditions during or prior membership, will be
All acquired pre-existing conditions prior covered up to the maximum limit subject to
membership, will not be covered all throughout of evaluation, based on the final given diagnosis.
membership
 Maximum Benefit Limit for Principal
ORDINARY ILLNESS Covered up to 100% of the
MAXIMUM BENEFIT LIMIT (MBL)
(e.g. Dengue Fever, Typhoid Fever, Influenza, per illness, per member, per year
Appendicitis, Diarrhea, UTI, etc)

1st Year: PEC up to P5,000 per illness, per

PRE-EXISTING CONDITIONS member, per year
(e.g. Hypertension, Goiter, Cataract, Bronchial
Asthma, Tuberculosis, Prostate Disorder,
Hemorrhoids, Varicose Veins, Migraine, etc.) 2nd Year: PEC up to P5,000 per illness, per
member, per year provided that the
pathogenesis or onset of such illness, injury, or
adverse medical condition started prior to or
during the contestability period; otherwise up
to MBL
DREADED DISEASES
(e.g. Cancer of any form, Cardiovascular
Diseases, Diabetes Mellitus, Sepsis, Any illness
that requires ICU confinement, etc.)
 Plan Entitlement for Standard Plan
MBL PER ILLNESS, PER
YEAR ORDINARY ILLNESS PRE-EXISTING
ROOM & BOARD (SUBJECT TO THE
CATEGORY OF COVERAGE CONDITION COVERAGE
ILLNESS)

1st year of
Ward 50,000 Up to Maximum membership PEC
Benefit Limit cases are not covered

Standard program room plan:

Ward P50,000
Semiprivate P60,000
Semiprivate without AHMC P100,000

Small Private with AHMC P120,00 including MMC, SLMC (Quezon City and Global City) TMC, CSMC:
 Plan Entitlement for VIP Plan
MBL PER ILLNESS, PER
YEAR ORDINARY ILLNESS PRE-EXISTING
ROOM & BOARD (SUBJECT TO THE
CATEGORY OF COVERAGE CONDITION COVERAGE
ILLNESS)

Regular Private 200,000 Up to Maximum Up to 5,000

Benefit Limit

VIP program room plan with access to AHMC, MMC, SLMC (Quezon City and Global City) TMC, CSMC:

Regular Private P200,000 with PEC 5,000

Regular Private P250,000 with PEC 10,000
Large Private P300,000 with PEC P15,000
Suite Room P500,00 with PEC P20,000
 Comprehensive Healthcare

• Hospitalization Care
• Outpatient Care
• Preventive Health Care
• Emergency Care
• Dental Care
 Hospitalization Care
COVERAGE
BENEFIT All limits are subject to PEC

No deposit upon admission Covered

Room and board Covered according to type of plan enrollment
Use of operating theatre and Recovery Room
X-ray and laboratory examinations
Services of MEDICard specialists
Surgery and anesthesia
Covered within the MBL/ PEC Limit
Administered medicines
Dressings, sutures and plaster casts, etc.

Fresh whole blood (including screening/

processing), and intravenous fluids
 Hospitalization Care
COVERAGE
BENEFIT All limits are subject to PEC

Human Blood Products (including screening/ Covered within the MBL

processing) Except Gamma Globulin

Chemotherapy

Radiotherapy
-Intensified Modulated Radiotherapy
-Three Dimensional Conformal Up to 10 sessions within the MBL
Radiotherapy (3DCRT)
-Tomotherapy
-Brachytherapy

Dialysis (Continuous Renal Replacement

Therapy CRRT)
 Hospitalization Care
COVERAGE
BENEFIT All limits are subject to PEC

Slipped Disc Up to P5,000

Additional Limit for Accidents Up to P50,000

Admission kit including wee bag

All other items directly related to the Covered

management of the case

Assistance from Liaison Officer

 Hospitalization Care
BENEFIT COVERAGE
All limits are subject to PEC
Complex Diagnostic Procedures such as, but Up to P5,000
not limited to MRI, CT Scan and Ultrasound

Modern Therapeutic Modalities and

interventional surgical procedures such as, but
not limited to Laparoscopic surgery and
lithotripsy (once a year)
Up to P20,000
Arthroscopically and Endoscopically guided
procedures guided procedures/excisions/
treatments
CT Scan, MRI and Ultrasound guided procedure

New Diagnostic & Therapeutic Modalities; New

modalities and/or diagnostic and treatment
procedures for conditions with established Up to P5,000
etiologies and its use is only as alternative to
the conventional methods.
 20

Outpatient Care
 Outpatient Care
BENEFIT COVERAGE
(All limits are subject to PEC)
Regular Consultation & Treatment Covered
except prescribed medicines
Referral to specialists
Treatment of minor injuries and surgery not
requiring confinement
Covered within the MBL
X-ray and laboratory examinations
Eye, Ear, Nose & Throat treatment
Physical / Speech Therapy Up to 10 sessions within the MBL
Laser treatment of Glaucoma & Retinal
Detachment Up to P20,000

Cataract Extraction (excluding cost of lens) Covered within the MBL

 Outpatient Care
BENEFIT COVERAGE
(All limits are subject to PEC)
Cauterization of warts (including facial warts) Up to P1,000

First dose of Anti-tetanus Up to P1,000

Tuberculin Test (except screening) Up to P800

Consultations for chronic dermatoses Covered
(except Psoriasis)

Consultations for scabies Covered at MediCard clinics only

Out-Patient Medicines Covered up to P3,000

Discount for Laboratory Examinations Up to 30% discount

 23

Preventive Health Care

 Preventive Health Care
BENEFIT COVERAGE

 Medical Consult
 Medical History
 Physical Examination
 Pelvic Examination (Female)
 Digital Rectal Examination
 Complete Blood Count, Platelet
 Urinalysis
 Stool Examination
 With Fecal Occult Blood Covered
 Blood Chemistry
 Fasting Blood Sugar
 Serum Creatinine
 SGPT
 Serum Uric Acid
 Lipid Profile
 Total Cholesterol
 Serum Triglycerides
 Preventive Health Care
BENEFIT COVERAGE
 Serum HDL, LDL
 Imaging
 Chest X-ray
 Whole Abdominal Ultrasound
 Cardio - respiratory
 12 Lead ECG Covered
 Treadmill Stress Test
 Special Consultation
 Ophthalmology
 Consult
 Visual
Acuity
 Pap smear (Female)
Management of Health Problems Covered
Routine Immunization Covered; except administered vaccine
Counseling on Health habits, diets and Planning Covered
Record keeping of medical history Covered
 26

Emergency Care
 Emergency Care
What is considered an emergency condition?
Any life threatening condition caused by an illness or injury

Examples:
Heart attack, coma, stroke, poisoning, loss of consciousness or respiration, convulsion, acute appendicitis
severe asthma attacks, etc.

BENEFIT COVERAGE
In MediCard-accredited hospitals
Doctor’s services
Medicines used during treatment or for
immediate relief Covered within MBL
Oxygen and intravenous fluids
Dressings, plaster casts and sutures

Laboratory, X-ray and other diagnostic Covered within the MBL,

examinations directly related to the emergency
management of the
patient
 Emergency Care
In non-accredited hospitals

BENEFIT COVERAGE
All limits are subject to PEC
Approved Hospital Bills
Reimbursement Basis:
100% based on MediCard Relative Value (MRV)* up
Doctor’s Professional Fees to MBL

In foreign countries

BENEFIT COVERAGE
All limits are subject to PEC
Approved Hospital Bills
Reimbursement Basis:
100% based on MediCard Relative Value (MRV)* up
Doctor’s Professional Fees to P30,000; converted to Philippine Currency (PhP)

*Medicard Relative Value

Schedule of charges as agreed between the Association of Health Maintenance Organizations in the Philippines and
various recognized Medical Societies using the Philippine College of Surgeons (PCS) Book
 How to file for reimbursement?
Submit the following documents to MediCard Claims and Reimbursement Section,
15F The World Centre Bldg., 330 Sen. Gil Puyat Avenue, Salcedo Village, Belair, Makati City
30 days after medical treatment/discharge:
Outpatient In Patient

• Fully accomplished Reimbursement Claim Form

• Cover letter/Incident report (stating the reason
• Fully accomplished Reimbursement Claim Form for filing of reimbursement)
• Cover letter / Incident report (stating the • History of Present Illness
reason for filing of reimbursement) • Clinical Abstract
• Medical Certificate stating chief • Discharge Summary
complaint and • Original Official Receipt of Hospital bills and/or
final diagnosis Prof. fees
• Emergency room record • Statement of account
• Original Official Receipts • Itemized breakdown of charges or charged
• Results of laboratory/diagnostic slips
examination • Operative Technique (for surgical cases)
• Operative Technique (for surgical cases) • Police Report (for accidents)
• Police report (for accidents) • Certificate of Live birth and/or Marriage Contract
• Itemized breakdown of charges (for maternity claim)
• Subrogation Form (for accidents) • Results of laboratory/diagnostic examinations
• Subrogation Form (for accidents)
How to file for reimbursement?
Receive reimbursements faster with MediCard’s E-Payout

Account secures Account submits

• Principal member
consent from their both enrolment
name and Account
employees in summary in Excel
providing their MediCard ID consolidates and
file with the
personal info to number fills-out enrolment
enrolment forms
MediCard (in • Bank name / summary in Excel
to MediCard
compliance to Data branch format
Privacy Act) by Reimbursement
• Bank account
accomplishing Section
number
MediCard E-Payout • Full account
Online • name
Reimbursement
• Email address
Enrolment Form
Mobile number
Receive reimbursements faster with MediCard’s E-Payout

Member may
check details of
Approved claims Employees will be their
will be credited thru notified via email if reimbursement
fund transfer to the payment has been claims at
following banks: credited already eMediCard. Simply
visit
https://webportal.
medicardphils.com
/eMedicard/Login.
aspx
 Emergency Care
BENEFIT COVERAGE

1. Accredited to accredited hospital:

Up to MBL per year
Reimbursement Basis
Ambulance Services (Land Transport)
2. Non-accredited to accredited hospital:
Up to P2,500 per conduction
Reimbursement basis

Hotline: 16-911
Apply ambulance benefit limit to cost
LIFELINE 16-911 MEDICAL, INC. of ambulance service
Emergency Quick Response () Service
COVERAGE : Metro and adjacent provinces: Inter-Facility Transfer (IFT) Service
Antipolo, Cainta & Taytay, Rizal; Bacoor, ;
Meycauayan, Obando & San Jose del Monte, 20% discount on regular rate of Air Evacuation
Bulacan; San Pedro, Laguna. & Airlift Services *
20% discount on regular rate of Provincial Land
Conduction *
15% discount on regular rate of Home
Care Services*
 34

Dental Care
 Dental Care
BENEFIT COVERAGE
Oral prophylaxis Twice a year
Consultations and oral examinations Covered

Simple tooth extractions Excluding surgery for impacted

or ankylosed tooth, etc.
Temporary fillings Covered
Emergency out-patient dental treatment
Gum treatments for cases like inflammation
or bleeding
Recementation of loose jackets, crowns, in- Covered
lays and on-lays
Treatment of mouth lesions, wounds and
burns
Adjustment of dentures
 Dental Care
BENEFIT COVERAGE

Temporo-mandibular Joint consultations

Restorative and Prosthodontic consultations

Covered
Dental nutrition and dietary counseling

Dental health education

 Point of Service
Benefits
BENEFIT COVERAGE
(All limits are subject to PEC)

Out-patient Consultation 5 consultation at P250 per consultation

Out-patient laboratory/ diagnostic 80% up to P5,000

In-patient: Approved Hospital Bills 80% up to P30,000

Professional Fees 70% based on MRV up to MBL

Executive Check-up at Medicard Clinics Primary Package

*MRV-MediCard Relative Value - based on what it would have cost MediCard if an accredited physician rendered
the service in an accredited hospital.
** As if prescribed by the MediCard physician.

Note: The above benefits are subject to the provisions on room accommodation, claims and reimbursement
provision of this Agreement.
 Other Benefits
BENEFIT COVERAGE
(All limits are subject to PEC)

Medicard Skin & Body Diamond Peel (3 sessions)

Surya at Medicard Lifestyle center Yoga Classes Up to 3 sessions

Weight Management/ Nutrition Program Covered in Medicard Lifestyle Center

Use of Medicard Lifestyle center- Fitness

Center (provided they have own personal
trainer; if not personal trainer will be Covered
provided with charge)

Use of Medicard Lifestyle Center- One-time

conference room (maximum of 4 hours)
Assist America Covered
Exclusions and Limitations
 Exclusions and Limitations
Hospitalization Care

Hospitalization and services a member receives from a non-accredited physician and/or from
a non-accredited hospital except during emergency cases

Miscellaneous hospital charges such as but not limited to:

 Special or private nursing services
 Supplemental foods like vitamins; maintenance medicines
 Non-medical personal appliances (e.g. T.V., computer, refrigerator)
 Telephone charges

Health check ups such as but not limited to:

 Pre-employment check-ups for other companies
 Annual check-ups for government requirements
 Physical exams for insurance purposes or travel abroad

Hospitalization and treatment outside the Philippines except in emergency cases only
 Exclusions and Limitations
Others
Reconstructive surgery (e.g. liposuction, nose job, bust lift, etc.) – except to treat a functional
defect directly caused by an accident or illness herein

Cosmetic alterations for aesthetic purposes / Dermatological care for aesthetic purposes such
as chemical treatment for skin tags, xanthelasma, milia, keloids, scars, etc.

Reproductive disorders (e.g. infertility, reversal of fertility, impotence, erectile

dysfunction), artificial insemination, sex change

Experimental medical procedures such as acupuncture, acupressure, reflexology,

iridology, chelation therapy, cell implant therapy and chiropractics

Vaccines / Shots:
 For active and passive immunization
 Steroid injections
 Exclusions and Limitations
Others

Psychiatric and psychological illnesses and any accidents arising from these conditions:
 Substance addiction or reaction to use of prohibited drugs
 Alcoholism, alcohol intake
 Anxiety reaction, neurotic and psychiatric behavior disorders

Neuro-developmental disorders which may result to mental retardation and other conditions
which may require specialized speech/physical and other related therapies:
 ADHD
 Autism
 Down Syndrome
 Exclusions and Limitations
Others
Sexually-transmitted diseases, AIDS, Hepatitis B, Condyloma, Gonorrhea, Syphilis, Herpes and
their attendant complications
Laboratory exams for screening sexually related illnesses and injuries
Corrective laser eye surgery (e.g. for error of refraction - myopia, hypermyopia)

Orthodontics, Prosthetics, take-home medical appliances and other durable

medical equipment such as but not limited to:
 Intra-ocular lens
 Pacemaker, special braces, stents
 Wheelchairs, crutches, walkers

Special Confinements such as but not limited to:

 Recuperation in sanitariums or convalescent home
 Rehabilitation including medicines
 Custodial, domiciliary care
 Exclusions and Limitations
Others

Exposure to imminent danger or health hazards such as:

 Serving in military, navy, air force of any country or international authority
 War-like or combat operations, government declared acts of rebellion, terrorism
 Active participation in strikes, riots, demonstrations and labor disputes
 Provoked criminal acts
 Violation of a law / ordinance
 Commission of a crime (whether consummated or not)
 Setting off / Handling pyrotechnic materials
 Attempted suicide, self-inflicted injuries

Sports-related injuries such as:

 Participating in extreme or dangerous sports/hazardous activities (e.g. skydiving, motor
sports, judo, karate, taekwondo, boxing, wrestling, bungee jumping, scuba
diving, horseback riding, polo, hunting, etc.)
 Exclusions and Limitations
Others

Maternity care and other conditions as a result of pregnancy unless specifically provided
 Ultrasound
 Laboratory examinations related to maternity
 Maternity Complications

Circumcision

Oral surgery for purposes of beautification, temporomandibular joint disease (TMJ)

surgery done by dental practitioner

Professional fees of medico-legal officers

Diagnosis of unknown etiology or the absence of any organic dysfunction

Shop with MediCard

With MediCard, you get healthcare

benefits plus more!
Just present your MediCard ID to any of our
partner hotels, restaurants, optical shops and
others to get exclusive discounts and perks!
 ., BEST WESTERN
.,

JUICE

@ GEOeGE ‹CA
0 L

This list may change without prior notice. Please visit www.m
edicard
hits.com.
THANK YOU