1. What is PhilamCare ?

2. What is a Health Maintenance Organization or HMO ?

3. Is it a permanent insurance coverage ?

4. Will the member be issued a card ?

6. What are your advantages as a PhilamCare member ?

7. What are the limitations of the health care plan ?

8. Who are eligible for Philamcare Membership?

9. How soon can you avail of the benefits?

10. Are there any exclusions in coverage?

11. Will pre-existing illnesses be covered?

What is PhilamCare ?

PhilamCare is a Health Maintenance Organization (HMO)

What is a Health Maintenance Organization or HMO ?

A Health Maintenance Organization or HMO is a pre-paid health care delivery system that delivers a package of comprehensive health services such as out-patient treatments, preventive health care programs & if necessary, hospitalization for its actively enrolled members. In lieu of charging a fee for each service rendered, the company collects regular membership fees from its members upon enrollment or membership and at fixed intervals thereafter.

Is it a permanent insurance coverage ?

NO. The company issues an Agreement contract which is a yearly renewable term coverage.

Will the member be issued a card ?

PhilamCare will issue a data and information membership card which provides health care benefits with the convenience of a "no-cash-outlay" arrangement. At the same time, the membership card allows the enrollee to access the PhilamCare network of affiliated service providers which includes over 3,000 affiliated specialists, 153 affiliated hospitals and 19 out-patient clinics nationwide.

What are your advantages as a PhilamCare member ?

1. The probability of financial loss due to illness or accident is diminished , if not entirely prevented.

2. Medical expenditures are determinable because most of the essential services you will be needing are covered by the regular membership fees.

3. Guaranteed access to a team of primary physicians as well as medical specialists for the whole range of medical care services are stated in your Health Care Agreement. Likewise, assurance of quality service because the Company has instituted quality assurance programs to ensure the member is provided with accepted standards of health care.

4. Coverage for a P 10,000 group life and accidental death and dismemberment insurance policy.

What are the limitations of the health care plan ?

Just like other HMOs, PhilamCare carries with it certain limitations which are necessary in order to maintain high quality medical services at affordable membership fee rates for our members.

The following are the limitations of the plan:

1. Non-coverage of Pre-existing Conditions
An illness or condition shall be considered Pre-existing if, during the effective date of your health care coverage, Non-coverage of Pre-existing Conditions.

Who are eligible for Philamcare Membership?

IThose who are eligible for PhilamCare Membership must be 59 years old and below. If spouse is aged 59 years old and below, and is actively working, he/she can be enrolled as well. All children aged 6 months to 20 years old, with single status, may also be enrolled.

How soon can you avail of the benefits?

You may start availing of your benefits as soon as your membership contract takes effect. Validity dates of coverage in your membership contract and will be printed in your individual membership cards.

Are there any exclusions in coverage?

To keep your membership fees low, some items are not covered under your health care plan. These include treatments for pregnancy and pregnancy-related conditions, rest cures, cosmetic surgery, dental treatments and other exclusions. The complete list of exclusions is enumerated in your membership contract.

Will pre-existing illnesses be covered?

Pre-existing illnesses are adverse health conditions which have existed prior to the effectivity date of your membership. These illnesses (whether known or unknown, disclosed or not) are excluded from the coverage. After 12 months of continuous coverage, the Pre-existing Condition Clause shall no longer apply to illnesses or conditions which only started to develop on the second year of coverage and onwards, except for conditions or illnesses which have been permanently excluded during the first year of coverage.