Health is the way forward for your business.
Everyone counts (on you)
Because you prioritize them, your staff look to you as more than just an employer but as a leader.
Effective health benefits for every employee
this comprehensive yet affordable health care maintenance program is made specifically for small and medium entrepreneurs.
| Network of Accredited Providers | |
| 1. Hospital and Clinics | 1,019 |
| 2. Doctors | 32,000 |
| 3. Dentists | 2,071 |
| 4. Primary Care Centers | 1 |
| Customer Care | |
| 1. 24/7 Hotline | Yes |
Click here to talk to our Certified Registered Financial Planner about your health Plan today.
Our Insurance coverage are all powered by Insular Life and Health Care.
Fully Regulated by the Insurance Commission.
INHealth BiZ Comprehensive Health for SMEs
Out-Patient Benefits
This includes annual physical examination, preventive health care such as Immunization Administration and Health Education Counseling on diet or exercise, and other out-patient services like Medical Consultation and First Aid Treatment.
In-Patient Benefits
This includes services of all accredited Physicians including surgical services, room and board, general nursing service, and other services or supplies deemed medically necessary.
Emergency Care Benefits
Such as ambulance services, emergency care-related procedures in accredited and non-accredited hospitals, and room upgrade.
Program Types
Plan I (Any accredited Hospital including top 9 major Hospitals)
- Asian Hospital Medical Center (AHMC)
- Makati Medical Center (MMC)
- Cardinal Santos Medical Center (CSMC)
- St. Luke’s Medical Center – Quezon City (SLMC-QC)
- The Medical City (TMC)
- St. Luke’s Medical Center – Global (SLMC-GC)
- Cebu Doctor’s Hospital (CDH),
- Chong Hua Hospital (CHH)
- Davao Doctor’s Hospital (DDH)
(For Plan b, click here talk to our Registered Financial Planner to know more)
Plan features applicable to all plans
- For primary care (non-emergency cases), entry point to accredited/preferred hospitals SHOULD BE THE COORDINATOR’S OFFICE. During off-clinic hours, and only for genuine emergency cases (as defined in the Agreement), a member may go to the Emergency Room for treatment. Unless stipulated in the Agreement, accredited clinics are not used for health care service availments.
- During genuine emergencies (as defined in the Agreement), a member may use any hospital nearest him. If a member uses an accredited hospital, we afford him full coverage according to his benefits classification. If a member uses a non-accredited hospital, reimbursement of expenses will be governed by the Emergency Benefits provision of the Agreement.
- Some accredited Metro Manila and provincial hospitals no longer have ward and semi-private rooms or no longer admit HMO patients to ward or semi-private rooms. For members who select the ward or semi-private room accommodation plan and/or use hospitals without ward or semi-private rooms for in-patient benefits, please be advised that these hospitals will automatically admit the member to the next higher room accommodation on a step-ladder basis.
- For genuine emergency cases (as defined in the Agreement), Insular Health Care takes care of the difference in upgraded costs for the first 24 hours. After the first 24 hours, the member pays for the difference in upgraded costs prior to his discharge from the hospital.
- For elective cases, the member pays for the difference in upgraded costs from day one of his confinement prior to his discharge from the hospital. Please see provision “b” under Room and Board of In-Patient Benefits.
Maximum Benefit Limit (MBL)
The Maximum Benefit Limit (MBL) per person per illness or injury per year will depend on the member’s Room Accommodation / Plan Category (which will be established at the start of the coverage period based on the client’s requirements, e.g., Officer, Supervisory, Rank & File, with or without dependents) and shall apply to dreaded and non-dreaded diseases.MBLs may vary according to the client’s requirements. However, as much as possible, the company applies the following standard MBLs for the following Room Accommodation / Plan Categories:
Accommodation
Benefit Limit
Semi-Private 150,000
Private 80,000
Ward 70,000
DEPENDENT
Semi-Private 150,000
Private 80,000
Ward 70,000
*Note: Maximum Benefit Limit (MBL) per illness per injury per year
Provided by the Filipino Doctors Preventive Healthcare Management, Inc.
- Preventive Services
- Unlimited Consultations
- Oral Hygiene Instruction
- Oral Prophylaxis – mild to moderate (once a year)
- Annual Dental Examination
- Restorations
- Unlimited Temporary Fillings
- Light Cure Filling – 2 Surfaces
- Unlimited recementation of jacket crown inlays and onlays
- Unlimited Simple Tooth extraction except surgery for impaction
- Dentures and Orthodontics
- Adjustment of Dentures – limited to adjustment of clasp
- Orthodontic Consultation
- Aesthetic Dental Consultation
- Dental education and counselling
- Treatments
- Treatment for lesions, wounds and burns
- Treatment of Dental related pain excluding cost of prescribed medicines
- Relief and/or prescription for acute dental pain
- Emergency desensitization of hypersensitive teeth
- Gum Treatment(except gum surgery)excluding cost of prescribed medicines. This shall include the management of other dental problems excluding surgeries
ADDITIONAL BENEFITS
- Open Door Dental Benefits
- Fees for Dental benefit should be on a one-time basis only.
- Preventive Services
Group Term Life Insurance With Insular Life
A financial assistance shall be given to the principal member’s beneficiary / ies in case of natural death..
Accidental Death and Disability
If the insured individual suffers, directly and independently of all other causes, any accidental bodily injury / loss within one hundred eighty days (180) days after due date of the accident causing the injury / loss, the Company shall pay the indemnities set in the Schedule of Indemnities.
LOSS Indemnity Life The Sum Insured Both Hands The Sum Insured Both Feet The Sum Insured Sight of Both Eyes The Sum Insured One Hand and One Foot The Sum Insured Sight of One Eye and One Hand; or Sight of One Eye and One Foot The Sum Insured One Hand or One Foot or Sight of One Eye 1/2 of the Sum Insured Life (Group Term) Insurance With Insular Life
- P 20,000 or P 50,000 Life (Group Term) Insurance with AD&D for employees only.
- Fees for Life (Group Term) Insurance with AD&D should be on a one-time basis only.
- P 20,000 or P 50,000 Life (Group Term) Insurance with AD&D for employees only.
Outpatient Benefits
1. Annual Physical Examination- Taking of Medical History
- Physical Examination
- Chest X-Ray
- Routine Urinalysis
- Routine Fecalysis
- Complete Blood Count (CBC)
- Electrocardiogram (ECG) for members 35 years old and above, or if indicated
- Pap Smear for female members 35 years old and above, or if indicated
2. Preventive Health Care
- Immunization Administration (Only the 1st dose of Anti-Rabies/Anti-Venom/Anti-Tetanus Vaccines are covered – does not include the cost of vaccine and determination of susceptibility)
- Health Education Counseling on diet or exercise
- Periodic Monitoring of Health Problems
- Family Planning Counseling
- Health education and wellness program (up to 4x a year)
- Medical information dissemination through clinics, newsletters, seminars, etc.
3. Outpatient Services
- Medical Consultation during regular clinic hours including specialist evaluation
- First Aid Treatment of minor injury or illness
- Minor surgery not requiring confinement
- Necessary X-rays, laboratory examinations, routine diagnostic and therapeutic procedures
- Eye, Ear, Nose and Throat (EENT) care
- Pre and Post Natal Consultations (covered up to MBL)
- Transfusion of blood and other blood elements (except blood donor screening)
- Cauterization of Warts except Genital Warts and Condyloma Acuminata (up to 1,000 per member, per year)
- Speech Therapy (covered up to MBL)
- Physical Therapy (covered up to MBL)
- Sclerotherapy – must be medically necessary and recommended by an affiliated vascular surgeon and not for aesthetic purpose (covered up to MBL)
Services of a Physician including surgical services
Room and Board using a “step-ladder” system (lowest to highest); Room amenities (vary according to actual hospital set-up)
General Nursing service
Use of Operating Room and Recovery Room
Anesthesia and its administration
Drugs and Medications during confinement
Confinement in Intensive Care Unit
Other Services/Supplies deemed medically necessary such as but not limited to:- Oxygen and its administration
- Dressing, Sutures, Cast (Plaster of Paris or fiberglass cast ) and other medical supplies
- Laboratory Tests and other necessary diagnostic service
- Transfusion of blood and other blood elements except donor-screening services
Assistance in administrative requirements through a Liaison Officer
Admission Kit
A. An illness or condition shall be considered pre-existing if before the Effective Date of the Agreement:
Any professional advice or treatment was given for such illness or condition
Such illness or condition was in any way evident to the member
The pathogenesis of such illness or condition has already started (which the member may not be aware of).
B. PECs are not covered in the first year of coverage.
C. After the member has been continuously covered with Insular Health Care for 12 months and the agreement is renewed, the following provisions on PECs shall apply:
PECs are covered provided that the PECs are not considered part of the “Permanent Exclusions to Health Care Coverage”, and thatsuch PECs were declared by the member in the original application;
such PECs are unknown to the member (without established medical history);
Undeclared PECs with established medical history are excluded from coverage. However, said PECs may be evaluated for possible future consideration.
In case an application is disapproved due to an adverse medical condition, an applicant may still avail of the Insular Health Care program by executing a “waiver” relinquishing or limiting coverage for the particular adverse condition/s (as stated in the provision on Enrollment / Approval of Application).
D. Examples of PECs: (inclusive of complications)
Hernias
All tumors and malignancies involving any body organ or system
Endometriosis, Dysfunctional Uterine Bleeding
Hemorrhoids
Diseased tonsils requiring surgery
Pathological abnormalities of the nasal septum and turbinates
Thyroid Dysfunction/Goiter
Cataract
Sinus condition requiring surgery
Asthma / Chronic Obstructive Pulmonary Disease
Cirrhosis of the liver
Tuberculosis
Anal Fistula
Cholelithiasis / Cholecystitis
Calculi of the urinary system
Gastric or Duodenal Ulcer
Hallux Valgus
Diabetes Mellitus
Hypertension
Collagen Disease / Auto Immune Disease
Cardiovascular Disease
Hormonal Dysfunction
Seizure Disorder / Cerebral Insufficiency / Stroke
E. The following health conditions may be covered (either fully or up to certain amounts) provided pre-existing conditions of an account are likewise covered:
Organ transplants and/or open-heart surgery / angioplasty and all services (e.g., coronary angiogram) related thereto (except organ donor services)
AIDS and AIDS-related diseases except when sexually transmitted
Congenital abnormalities and conditions are covered up to Php 25,000.
Chronic glomerulonephritis, gullain-barre syndrome
Scoliosis, Spinal Stenosis and Kyphosis are covered up to Php 25,000. For all other physical deformities, only consultations are covered.
For Vitiligo and Psoriasis, only consultations are covered.
Confirmatory Tests are covered up to the MBL provided the tests are done for valid diagnoses. Coverage shall be extended only up to the time the condition in question has been ruled in/out. Confirmatory tests are not applicable to health conditions listed under Permanent Exclusions.
Care by non-accredited Physician and / or in a non-preferred hospital/clinic except in emergencies wherein the emergency provision of the agreement will apply
All pregnancy related conditions requiring medical/surgical care and screen tests related thereto.
Sterilization of either sex or reversal of such, artificial insemination, sex transformations or diagnosis and treatment of infertility, and circumcision
Rest cures, custodial, domiciliary or convalescent care
Cosmetic surgery, dental/oral surgery, and dermatological procedures for the purpose of beautification except reconstructive surgery to treat a dysfunctional defect due to disease or accident
Psychiatric disorders, psychosomatic illnesses, hyperventilation syndrome, adjustment disorders, alcoholism and its complications or conditions related to substance or drug abuse, addiction and intoxication
Sexually transmitted diseases
Medical and surgical procedures which are not generally accepted as standard treatment by the medical profession
Procurement or use of corrective appliances, artificial aids, durable equipment, and orthopedic prosthesis and implants
Surcharges resulting from additional personal (luxuries/accommodation) request or service including special nursing services
Physical examination required for obtaining employment, medical certification, insurance or a government license
Injuries or illnesses due to military, paramilitary, police service, high risk activities, or suffered under conditions of war
Reimbursement of procedures obtained through government programs
Injuries or illnesses, which are self-inflicted, caused by attempt at suicide or incurred as a result of or while participating in a crime or acts involving the violation of laws or ordinances
Out-patient/take-home medicines
Valvular Heart Disease and Rheumatic Heart Disease
Medico-legal consultations
When a member is discharged against medical advice, and all 19. subsequent benefits/services related thereto.
Blood / Organ Donor screening / other screening procedures that are purely diagnostic or for screening purposes including among others, Purified Protein Derivative (PPD), and procedures conducted prior to hormonal replacement therapy
All hospital charges and professional fees after the day and time hospital discharge has been duly authorized and professional fees of Assistant Surgeons
All conditions and complications requiring dental care
Hypersensitivity/allergy tests
Diseases declared by the Department of Health (DOH) as Epidemic
Use of Emergency Room Facilities on non-emergency cases or by reason of condition/injuries not falling under the term “Emergency” as defined in the Agreement (“Emergency” shall mean the sudden, unexpected onset of illnes or injury having the potential of causing immediate disability or death, or requiring the immediate alleviation of severe pain or discomfort.) For the purpose of implementation, the final diagnosis shall be the basis for a member’s eligibility to emergency care benefits under the plan.
- Membership fees are based on a specific number of principal-enrollees that were culled from the client’s employee census.
If membership fee is employer-employee shared or employee-paid, we require at least 75% participation of employee principals.
Accommodation / Benefits Plan of Principal Members must follow a uniform category (e.g., officers at Private room, rank-and-file employees at Semi-Private room, etc.) pre-established by the client at the start of the program.
A. Principal members: Regular employees at least 18 years old to less than 65 years old.
B. Dependents: (Following Hierarchy Guidelines)
- For single employees: Parent(s) first who is/are less than 65 years old and not gainfully employed; followed by the eldest sibling down to the youngest who is/are 15 days to less than 21 years old, unmarried and not gainfully employed.
- For single parent employees: Eldest child down to the youngest, 15 days to less than 21 years old, unmarried and not gainfully employed.
- For married employees: Spouse first who is less than 65 years old; followed by the eldest child down to the youngest, 15 days to less than 21 years old, unmarried and not gainfully employed.
- Ambulance Services (Hospital to Hospital Transfer Only)
- Accredited to Accredited Hospital Transfer (covered up to Php 3, 500)
- Non-Accredited to Accredited Hospital Transfer (covered up to Php 3, 500)
- Professional Fees of Attending Physicians
- Emergency Room Fees
- Medicines, blood transfusions, intravenous fluids, oxygen, dressings, sutures and casts
- X-ray, laboratory and other diagnostic examinations
- Treatment of laceration, pains and other minor injuries
- Dressing, sutures and cast (Plaster of Paris or fiberglass cast)
- First dose of anti-rabies, anti-venom and anti-tetanus vaccines.
- Reimbursable up to 80% of the Total Hospital Bills including professional fees on RVS or Php 15,000 (Php 10,000 or HB and Php 5,000 for PF), whichever is less
- Covered for the first 24 hours for genuine emergency cases only – except Suite Accommodation
- Our program is integrated with benefits under Philhealth and/or Employees Compensation Commission (ECC); therefore such Philhealth and / or ECC benefits to which the member is entitled to shall be deducted from the claim cost in the computation of benefits under our program, unless agreed otherwise through a special endorsement in the contract.
- All covered members are assumed to be Social Security System (SSS) members. In case a member and/or any dependent is not an SSS member, he shall be charged the amount equivalent to the Philhealth benefit in case he is hospitalized. Insular Health Care shall pay only all hospital bills in excess of the Philhealth benefits.
- An applicant applying for coverage is required to accomplish an enrollment form otherwise there will be no coverage despite having paid a deposit for membership fees.
- Changes in the application may be done prior to the underwriting process or the issuance of the ID card. Exceptions, if any, will be handled on a case-to-case, non-precedent setting basis.
- It is understood that Insular Health Care reserves the absolute right to approve or disapprove any application for membership. In case an application is disapproved due to an adverse medical condition, an applicant may still avail of the Insular Health Care program by executing a “waiver” relinquishing or limiting coverage for the particular adverse condition.
- Non-compliance of underwriting requirements within the prescribed period will mean the exclusion from coverage of the condition for which an underwriting requirement has been prescribed.
- In case of pre-termination of coverage or resignation/deletion of members, the client should return the ID card(s) of its members. Any misuse of the ID card by a member will be for the account of the client and / or the member.
- Membership Eligibility
- Principals – All regular employees age 18 to less than 65 years old
- Dependents
Philhealth Provision – Integrated
The following are covered up to MBL, except for some procedures, as indicated:
- Lithotripsy
- Laparoscopic Cholecystectomy (LapChole), Adrenalectomy, Hernioplasty / Herniorrhaphy / Herniotomy, Oophorectomy/ Oophorocystectomy and alll other laparoscopic procedures for diagnostic purposes
- All other laparoscopic procedures for therapeutic purposes (up to Php 20,000 per year)
- Cryosurgery
- Angiogram and/or Angioplasty/Coronary Artery Bypass Graft
- Chemotherapy/ Radiotherapy
- Dialysis
- Computed Tomography Scans (CT Scan)
- Magnetic Resonance Imaging (MRI) & Magnetic Resonance Angiogram (MRA)
- Functional Endoscopic Sinus Surgery (FESS)
- Nuclear medicine procedures
- Thyroid Scan
- Thallium Scintigraphy / Thallium Stress Test
- Sestamibi Stress Test / Hexamibi
- Radioactive Isotope Scan
- HIDA Scan
- Radionuclide Renography
- Body Metastatic Survey
- Bone Scan / Imaging / Densitometry
- Dacryoscintigraphy
- Gastric Scintigraphy
- Glomerular Filtration Rate
- Liver or Spleen Imaging
- Tetro Rest and Stress
- Thyroid Imaging / Scintigraphy
- Other nuclear medicine procedures (up to Php 5,000 per session)
- Laser eye procedures such as Laser Iridotomy /Iridectomy,Yag Laser, and Argon Laser (up to Php 5,000)
- All other Laser Eye Procedures except Photorefractive Keratectomy – one session per eye per year (up to Php 5,000)
- All other Laser procedures (up to Php 5,000)
- Mammography and Sonomammogram
- Transurethral Microwave Therapy of Prostate (up to Php 30,000 per session)
- Gamma Knife Surgery
- Heart Surgery
- Arthroscopic Procedures
- Hysteroscopic Procedures (Myomectomy, D&C and Polypectomy)
- Ultrasound (except Maternity Cases)
- Benign Prostatic Hyperplasia
- 2D Echo with Doppler
- 24 Hour Holter Monitoring
- Herniorraphy
- Electromyography
- Treadmill Stress Test
- Myelogram
- Video Gastroscopy
- Endoscopic Procedures for diagnostic purposes
- Endoscopic Procedures for therapeutic purposes (up to Php 5,000 per session)
- PET Scan (up to Php 5,000 per session)
- Percutaneous Ultrasonic Nephrolithotomy – one session per contract per year (up to Php 40,000)
- Perfusion Scan
- Stereotactic Brain Biopsy (up to Php 20,000)
Add on Benefits.
- Get the same low price with added services
- Access to International Certified Wealth Managers to help you review your investments, assets and other financial concerns.
- Access to exclusive market reports, promos,
- Access to Life counseling and Financial Counseling
- Assistance for Life Insurance claim
- Free online membership to San Jose & partners portal to manage your finances.
- Access to Exclusive events
- Future Discounts and Priveledges with our partner stores.
Click here to view SJ&P other services.
- Guaranteed room upgrade for the first 24 hours.
- Standard program provisions for In Health Biz effective 1 February 2017 shall apply.
- Above rates are inclusive of 12% VAT.
- Type of payment for Principals is Non-contributory (subject to 100% enrollment by all eligible employees).
- Eligibility Requirement for Principal:
- All regular employees of THE COMPANY at least 18 years to less than 65 years old.
- Benefits include coverage for Basic Annual Physical Examination (APE).
- Plan and benefits should be uniform or according to Rank/Position/Classification. Dependent’s plan shall in no way be superior over their respective principal.
- Applicable for accounts with less than 10% field based, non-office based employees only.
- Coverage may only be activated 5 working days from date of payment.
- Program shall be subject to the following provisions:
- Extra-ordinary inflation
- Imposition of new government tax
- Extra-ordinary increase of hospital costs (more than 30%
- Waiver of application form subject to submission of electronic data (E-data)
- Non-Philhealth integrated benefits for non-philhealth members only. (Members should be declared prior to start of coverage).
- Without access to Healthway Medical Clinics, Inc. and American Eye Center.
- Insular Health Care, Inc. exclusions shall apply.
- Applicable for group of 20 – 99 enrollees.
Motor Vehicular Accidents
Coverage for newer modalities (up to Php 5,000 per member, per year)
Unprovoked Assault (Up to MBL)
Work-related Illnesses or Injuries – ECC Cases (Up to MBL)
Congenital Conditions (Up to Php 25,000 per member, per year)
Coverage is as follows:
1. Gullaine-Barre Syndrome Up to MBL/PEC Limit 2. Scoliosis, Spinal Stenosis and Kyphosis Up to Php 25,000 3. All other physical deformities Consultations only 4. Chronic Dermatoses Up to MBL/PEC Limit 5. Chronic Glomerulonephritis and Pyelonephritis Up to MBL/PEC Limit 6. Poliomyelitis Up to MBL/PEC Limit 7. Slipped Disc Up to MBL/PEC Limit 8. Neurologic Diseases and Spinal Stenosis Up to MBL/PEC Limit 9. Diabetes and its Complications Up to MBL/PEC Limit 10. Malignant Tumor Up to MBL/PEC Limit 11. Sleep Study directly related to an organic illness Up to PHP 5,000 12. Vitiligo and Psoriasis Consultations only 13. Pain Management Up to P 3,000 per year 14. Post-operative Analgesia Up to P 3,000 per operation 15. Insular Health Care Mobile App (IMA) Covered 16. VIP Program Covered 17. FREE Clinic Vouchers Covered (1 Clinic Voucher for every 25 members) 18. Access to Lifestyle Partners (Discount) Covered 19. Waiver of Application Form Covered (if applicable) 20. Experience Discount Benefit Covered (if applicable) 21. HMO Card Released within 7 Working Days