HARTE HANKS

PHILS., INC.

Period of Coverage
May 16, 2022 to May 15, 2023
 COMPANY PROFILE
WHO WE ARE

Established in 1995

1M members &
More than 20 years of
counting
solid experience

3,000 hospital & clinic

19 offices spread network
across the country
DISCUSSION POINTS

ELIGIBILITY

PLAN LIMITS

AVAILMENT

OTHER BENEFITS
ELIGIBILITY

PRINCIPALS
Employees up to 65 years old.

DEPENDENTS
Eligible dependents of Employees,
provided Hierarchy is followed.
SINGLE
PRINCIPALS

• Parents
Not over 65 years old

Or

• Unmarried Domestic Partner/ Common Law/

Same Gender Domestic Partner
Not over 65 years old

Note: Parent/s of employees with common law/ domestic partner will automatically
be terminated upon enrollment of the common law/ domestic partner.
SINGLE PARENTS
PRINCIPALS

1. Children (Eldest to Youngest)

Biological / Legitimate/ Legally Adopted
15 days old – 23 years old
Unmarried & Unemployed

2. Parents
Not over 65 years old
Or
Unmarried Domestic Partner/ Common Law/
Same Gender Domestic Partner
Not over 65 years old
Note: Parent/s of employees with common law/ domestic partner will automatically be
terminated upon enrollment of the common law/ domestic partner.
MARRIED
PRINCIPALS

1. Legal Spouse
Not over 65 years old

2. Children (Eldest to Youngest)

Biological / Legitimate/ Legally Adopted
15 days old – 23 years old
Unmarried & Unemployed
ENROLLMENT
POINTERS

30-Day Window Period

Dependents shall be enrolled within 30 days from the
effectivity of coverage.

No additional enrollments except for:

New born baby: 30 days from date of eligibility
Spouse of a newly wed employee: 30 days from date of
marriage
Dependent of a new employee: 30 days from effective date
of Principal member
PLAN LIMITS
RANK & FILE / EMPLOYEE

ROOM AND BOARD MAXIMUM BENEFIT LIMIT

(Regardless of the price) (Per type of Illness)

SEMI-PRIVATE 62,500
*Net of PhilHealth

NOTE:
MBL will be upgraded upon regularization to Php 125,000 per type of illness.
PLAN LIMITS
RANK & FILE / DEPENDENT

ROOM AND BOARD MAXIMUM BENEFIT LIMIT

(Regardless of the price) (Per type of Illness)

SEMI-PRIVATE 85,000
*Net of PhilHealth

NOTE:
Probationary employees - may enroll dependents upon regulation.
Annual premium per dependent starts at Php 8,599.00 and will be discussed during
regularization.
PLAN LIMITS
PRE-EXISTING CONDITION (PEC)

Dependents Dependents
Principals 1st Year 2nd Year onwards

Up to MBL Php 10,000 50% of MBL

NOTE:
For probationary employees – No coverage for PEC

What are PRE-EXISTING CONDITIONS (PEC)?

Conditions / Illnesses existing and evident to the member prior to effective date of coverage

• Nature can be clinically determined to have started whether the member is aware or not

• E.G. Hypertension, goiter, asthma, TB, gall or kidney stones, diabetes, tumors, myoma, arthritis,
hernia, prostate disorders…etc.
PREVENTIVE
ANNUAL PHYSICAL EXAMINATION (APE)
Basic 5
• Physical Examination • CBC
• Chest X-Ray • Urinalysis • Stool Exam

For 35 years old and above: Pap smear and ECG

To be scheduled by your HR / in coordination with Intellicare.
For all Employees: after 6 months of continuous coverage.

Routine Immunization (except cost of vaccines)

OUT-PATIENT
Medical Consultations with Intellicare affiliated doctors.
Treatment of minor injuries such as lacerations, mild burns and minor
surgery not requiring confinement performed by Intellicare affiliated
doctors.
Diagnostic procedures prescribed by an Intellicare accredited physician.
Pre and Post Natal consultations with Intellicare affiliated OB-GYN up
to 14 consultations/year.
Speech (for stroke patients) / Physical Therapy up to 12 sessions/year.
OUT-PATIENT
AVAILMENT PROCESS

Proceed to any Intellicare Accredited Facility (subject to plan’s limits).

Present your Intellicare Membership Card with two (2) valid IDs at the facility’s
reception area or HMO / Industrial office for membership status validation.

If APPROVED, the Referral Control Sheet (RCS) will be issued.

If DECLINED, the attending staff will call the Intellicare’s Customer Service Hotline
for assistance.

Accomplish the Referral Control Sheet (RCS 1 / RCS 2) then proceed with availment.

NOTE:
Process of availment for new members with no account yet shall be through manual endorsement c/o HR
Certain out-patient procedures will require filing of Philhealth.
METRO MANILA
MAKATI ALABANG
6/F Filomena Bldg., 104 Amorsolo St., Legaspi Village, 2/F Sycamore ARCS 1 Building, Buencamino St. cor.
Makati City Alabang-Zapote Road, Alabang, Muntinlupa City
☎: (02) 519-6787 / (02) 751-3108 / (02) 869-3289 ☎: (02) 556-3596 / (02) 556-3592

BGC
G/F Citibank Plaza, 34th St. Corner Lane D., Bonifacio
Global City, Taguig City
REGIONAL
☎: (02) 352-8335 CALAMBA
Unit 201-203 SQA Corporate Center, Barangay 1, National
Highway Crossing, Calamba City, Laguna
MANILA ☎: (045) 499-8417 / (045) 499-8419
5/F Times Plaza Bldg., U.N. Ave. corner Taft Ave., Ermita,
Manila City
☎: (02) 353-6807 / (02) 353-6808 STA. ROSA
2/F Carvajal Building 2, National Highway, Balibago City,
Sta. Rosa, Laguna
PASAY ☎: (049) 508-1806 / (049) 306-0397
Scape Bldg., Macapagal Avenue, cor. Pearl Drive, Central
Business Park 1, San Rafael, Brgy. 76, Pasay City
☎: (02) 541-5645 CLARK
G/F BPO Building 5, SM City Clark, M.A. Roxas
Highway,Brgy. Malabanias, Angeles City, Pampanga
ORTIGAS ☎: (045) 499-8417 / (045) 499-8419
G/F AIC Grande Tower, Sapphire St. cor. Garnet Road,
Ortigas Center, Pasig City
☎: (02) 584-2430 / (02) 584-1013 CEBU IT PARK
Unit 203 TGU Tower, Asiatown, IT Park Apas, Cebu
☎: (032) 479-9261
NORTH EDSA
2/F Philippine College of Surgeon Bldg., 992 North Edsa,
Quezon City CEBU CYBERGATE
☎: (02) 352-4676 / (02) 352-4677 L/3 Robinsons Cybergate, 2029 Don Gil Garcia & J.
Llorente St., Capitol Site, Cebu
☎: (032) 236-9028 / (032) 238-3922 / (032) 238-7672
www.medgatephilippines.com
www.medgatephilippines.com

1 2 3 4

Call Triage Teleconsultation E-treatment

www.medgatephilippines.com

Call Doc. Anywhere.

TM

Anytime. No Line.

(02) 705 0700

(032) 265 5111 (Cebu) 0917 536 2156 (Globe)
(082) 285 5111 (Davao) 0998 990 7540 (Smart)
(035) 522 5111 (Dumaguete)
0925 714 7794 (Sun)

SMS (request for a callback)

<Full name>; <Intellicare Card Number>; <Reason for Consultation>; <Contact Number>
0917 829 8469 (Globe) | 0998 843 8932 (Smart) | 0933 824 8040 (Sun)
IN-PATIENT
Room & Board accommodation within the limits of the PLAN.
Diagnostic procedures prescribed by an Intellicare accredited physician.
Standard nursing care services, admission kit & other items directly
related to the medical management of the patient.
Ambulance Service (hospital to hospital) to be covered thru
reimbursement up to Php 3,000/conduction/member/year.
IN-PATIENT
AVAILMENT PROCESS

Secure an admitting order from an Intellicare -affiliated physician.

Present the admitting order, your Intellicare Membership Card & two (2) valid IDs
at the admitting section of the hospital for membership status validation and
scheduling of confinement. IN-PATIENT
FORM (RCS 3)

On the schedule of confinement, occupy the entitled room according to plan

benefit.

Sign the Referral Control Sheet (RCS 3) issued by the visiting Intellicare
Patient Relations Officer.
NOTE:
Process of availment for new members with no account yet shall be through manual endorsement c/o HR
File for Philhealth upon discharge.
ROOM UPGRADING
INVOLUNTARY

If the entitled room is not available, member may occupy (1) One
category higher up to 24 hours (except suite room) without
incremental charges.

After 24 hours, whether the room becomes available or not,

incremental charges will be billed to the member.

If during confinement the entitled room becomes available,

member should transfer automatically to their allowed room
category. Otherwise, member will pay all incremental charges.
ROOM UPGRADING
VOLUNTARY

The member will be charged for the excess over their entitlement
and should pay the excess upon discharge (approximately 30% of
the total hospital bill, excess room & board and doctor’s fee). All excess
bills shall be collected from the member before discharge.

Keep in mind that staying in a more expensive room also makes

the other services (i.e., medicines, professional fee, etc.) more
expensive.
EMERGENCY

ACCREDITED HOSPITAL NON-ACCREDITED FOREIGN TERRITORIES

(LEADING TO CONFINEMENT)

MAXIMUM
Up to MBL Up to MBL Up to MBL
COVERAGE thru reimbursement thru reimbursement

HOSPITAL
BILLS 100% 80% 100%

PROFESSIONAL
BILLS 100% *RVS 80% *RVS 100% *RVS

*Relative Value Scale (RVS) – HMO Rates

REIMBURSEMENT
PROCESS

1. Secure and fill out the Intellicare Reimbursement Form.

2. Submit the Reimbursement Form with the following documents:

REQUIRED DOCUMENTS
Original Official Receipt (with TIN)
Statement of Account from the Hospital
Medical Certificate
Laboratory results (if with diagnostic procedure)
Operative record with histopath (if with operation)
Police report & Medico-legal Report (if required)

NOTE:
Submit to Intellicare not more than 60 days from expiration of treatment.
Processing of the request is within 30 working days upon receipt of complete documents.
DENTAL
Dental examination & health education
Annual oral prophylaxis
Simple tooth extraction
Temporary fillings
Light cure fillings: up to 2 teeth per year
Recementation of jackets, crown, inlays / onlays
Treatment of minor gum problems, mouth lesions, wounds & burns
Orthodontic consultation (braces and malposition of teeth)
Temporo mandibular joint (clicking of jaws) consultation
Pre-natal check of teeth and gums
Emergency dental treatment for the relief of pain
DENTAL
AVAILMENT PROCESS

Set an appointment with an Intellicare-affiliated dentist.

Proceed to the dental clinic on your scheduled date and present your Intellicare DENTAL FORM
(RCS 5)
Membership Card with two (2) valid IDs for membership status validation.
d

Avail the entitled benefit and sign the Dental Form (RCS 5).

NOTE:
Process of availment for new members with no account yet shall be through manual endorsement c/o HR
Dental benefits are non-reimbursable.
ADDITIONAL BENEFITS
Chemotheraphy / Radiotheraphy / Dialysis shall be covered up to pre-existing condition limit.

Cataract Surgery (except cost of lens) will be covered up to pre-existing condition limit.

AIDS secondary to accidental blood transfusion or needle injection shall be covered up to PEC Limit
per year.

Cauterization of warts (including facial warts) may be done in designated HMO clinic/s with a limit of
Php1,000.00 per year for employees only.
ADDITIONAL BENEFITS
Allergy Testing will be covered through reimbursement up to Two Thousand Five Hundred Pesos
(Php2,500.00) per year if prescribed by Accredited Physician.

Tuberculin Test will be covered through reimbursement up to Six Hundred Pesos (Php600.00) if the
member shows symptoms of Tuberculosis and if prescribed by accredited physician.

Laser therapy (excluding eye correction such as LASIK, PRK and the like) shall be covered up to 50% of
MBL, subject to the PEC Limit.

Anti-rabies, anti-tetanus and anti-venom vaccines will be covered up to Php18,000.00 per member
per year.
ADDITIONAL BENEFITS
Coverage for Congenital Illnesses / Diseases amounting to Php20,000.00 (subject to PEC Limit).

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 Php10,000.00

Work-related cases shall be covered subject to the exclusions and limitations of the contract.

Scoliosis shall be covered up to Php2,000.00 per member/year.

ADDITIONAL BENEFITS
Magnetic Resonance Imaging (MRI), Nuclear Radioactive Isotope Scan (NRIS), Neuroscan &
Perfusion Scan will be covered up to Php15,000.00.

Arthroscopic Procedure up to PEC Limit, not to exceed Php50,000.00.

Percutaneous Ultrasonic Nephrolithotomy will be covered up to PEC Limit.

Consulation for Psychological and Psychiatric Conditions shall be covered through

reimbursement up to Php 2,500.00 per session, for a maximum of Php 5,000.00 per member per
year but not to exceed Php 300,000.00 for the whole company per year.
GENERAL EXCLUSIONS AND LIMITATIONS
Out-of-network service
Miscellaneous hospital charges
Special confinements (sanitarium, convalescent home, domiciliary care, etc.)
Health check ups (pre-employment, government requirements, insurance)
Medical certificates
Professional fees in medico-legal cases
Refusal to undergo recommended treatment or demanding treatment aside
from that which the Intellicare doctors have recommended
Blood screening
Vaccines for immunization, steroid injections
Organ transplants or acquisition of an organ
GENERAL EXCLUSIONS AND LIMITATIONS
Procurement of orthotics, prosthetics, take-home medical appliances and other
durable medical equipment (DME)
Reproductive disorders, artificial insemination, circumcision, sex change
Laser eye surgery for myopia or error of refraction
Alternative medical treatment / procedures
Sleep study not due to an organic illness
Cosmetic alterations for aesthetic purposes
Out-patient medicines and medical supplies
Dental surgery, dental X-ray, impacted tooth / wisdom tooth
Hypersensitivity tests and desensitization
Pregnancy and pregnancy-related conditions
GENERAL EXCLUSIONS AND LIMITATIONS
External Forces / Activities
Exposure to imminent danger or health hazards
Violation of a law or ordinance
Extreme / hazardous sports-related injuries
Fortuitous events / disasters
Air or sea travel other than as a fare-paying passenger on a licensed aircraft / vessel

Illnesses / Conditions
Neuro-developmental & genetic disorders (which may result to mental retardation)
Developmental delay
Sexually transmitted diseases
MEMBERSHIP CARD

Always present your Intellicare

Membership Card and another
valid ID during availment.

NOTE:
LOST / DAMAGED CARDS: must be reported to Intellicare immediately.
REPLACEMENT FEE: Php100.00
WEBSITE
www.intellicare.com.ph
CONNECT WITH US

Trunk Lines: (02) 902-3400 / 789-4000

TOLL – FREE NUMBER OUTSIDE METRO MANILA: 1-800-10-789-4000

24/7 CALL SUPPORT 24/7 TEXT SUPPORT

MOBILE HOTLINE NUMBERS MOBILE HOTLINE NUMBERS
(0920) 970 – 4724 Smart (0920) 951 – 8452 Smart
(0917) 840 – 4894 Globe (0917) 805 – 2502 Globe
(0922) 891 – 3957 SUN (0922) 891 – 3925 SUN

/Intellicare @Intellicare @IntellicarePH /IntellicarePH

Thank You