PAYPAL PHILIPPINES, INC.

PAYPAL PHILIPPINES, INC.

Period of Coverage

February 1, 2021 to January 31, 2022

DISCUSSION POINTS

ELIGIBILITY

PLAN LIMITS

AVAILMENT

OTHER BENEFITS

PRINCIPALS

Employees up to 65 years old.

DEPENDENTS

Eligible dependents of Employees,

provided Hierarchy is followed.

ELIGIBILITY

SINGLE

1. ParentsNot over 65 years old

PRINCIPALS

SINGLE PARENTS

1. Children (Eldest to Youngest)

Biological / Legitimate/ Legally Adopted15 days old – 21 years oldUnmarried & Unemployed


PRINCIPALS

MARRIED

1. Legal SpouseNot over 65 years old


Biological / Legitimate/ Legally Adopted15 days old – 21 years oldUnmarried & Unemployed

EXTENDED DEPENDENT


PRINCIPALS

UNMARRIED


Biological / Legitimate / Legally Adopted15 days old – 21 years oldUnmarried & Unemployed

2. Domestic / Common Law / Same Gender Partner

Not over 65 years old

EXTENDED DEPENDENT


PRINCIPALS

UNMARRIEDREQUIREMENTS FOR DOMESTIC PARTNER

Birth Certificate (proof of legal age)

Barangay Certificate of cohabitation stating that the employees are his/her partner in same address, and

Certificate of No Marriage (CENOMAR)

Partner not more than 65 years old with submission of required documents Cover domestic (same as well as opposite sex) and common law partner, policy conditions remaining same as spouse

Cooling period of 12 months in partner enrolment change

Both Partners should be single, not legally married to or the domestic partner of anyone else

PRINCIPALS

ENROLLMENT

20- Calendar Day Window PeriodDependents shall be enrolled within 20 days from theeffectivity of coverage.

No additional enrollments except for:

New born baby: 20 days from date of eligibilitySpouse of a newly wed employee: 20 days from date ofmarriageDependent of a new employee: 20 days from effective dateof Principal member

POINTERS

DEPENDENTS REQUIREMENTS

Parents

Spouse

Child

Domestic /Common Law/

Same Gender Partner

Birth Certificate

Marriage Contract

Birth Certificate or Certificate of Live Birth

Birth Certificate/ Barangay Certificate of

Cohabitation/ CENOMAR (Certificate of No

Marriage)

Skipping of Hierarchy:Dependents with Existing Active HMO membershipDependents residing/working abroadLegally SeparatedDeath

ENROLLMENTPOINTERS

PLAN LIMITS

ROOM AND BOARD(Regardless of the price)

MAXIMUM BENEFIT LIMIT(Per type of Illness)

OPEN PRIVATE (Principals)

OPEN PRIVATE (Dependents)

200,000

200,000*Net of PhilHealth

NOTE:WITH ACCESS TO HEALTHWAY MEDICAL CLINICS, MAKATI MEDICAL CENTER, ST. LUKE'S (QC & GLOBAL CITY), ASIAN

HOSPITAL, CARDINAL SANTOS, THE MEDICAL CITY AND ITS AFFILIATED CLINICS

PLAN LIMITS

ROOM AND BOARD(Regardless of the price)

MAXIMUM BENEFIT LIMIT(Per type of Illness)

OPEN PRIVATE (Dependent

Parents) 500,000

*Net of PhilHealth

NOTE:WITH ACCESS TO HEALTHWAY MEDICAL CLINICS, MAKATI MEDICAL CENTER, ST. LUKE'S (QC & GLOBAL CITY), ASIAN

HOSPITAL, CARDINAL SANTOS, THE MEDICAL CITY AND ITS AFFILIATED CLINICS

(Grandfathered List Only. No enrollment shall be accommodated in the middle of the contract)

HMO PREMIUM CO-SHARE RATE

MBL MemberMarried Single

Single with Domestic Partner

Single ParentSingle Parent with Domestic Partner

(A) (B) (C) (D) (E)

PHP 200,000 per year Employee PayPal - 100% PremiumPayPal - 100%

PremiumPayPal - 100% Premium PayPal - 100% Premium PayPal - 100% Premium

PHP 200,000 per year Spouse PayPal - 100% Premium NA NA NA NA

PHP 200,000 per yearDomestic / CL

PartnerNA NA PayPal - 100% Premium NA PayPal - 100% Premium

PHP 200,000 per year Children (Up to 3) PayPal - 100% Premium NA NA PayPal - 100% Premium PayPal - 100% Premium

PHP 200,000 per yearChildren (More

than 3)

Employee - 100% PremiumNA NA

Employee - 100% PremiumPHP 17,128 p.a. per child

Employee - 100% PremiumPHP 17,128 p.a. per childPHP 17,128 p.a. per child

PHP 200,000 per year Parents (Up to 2)Employee - 50% Premium

PHP 15,817 p.a. per parentPayPal - 100%

PremiumPayPal - 100% Premium PayPal - 100% Premium

Employee - 50% PremiumPHP 15,817 p.a. per parent

PHP 500,000 per year Parents (Up to 2)

Employee - 50% Premium for PHP 200k MBL + Top-

Up PremiumPHP 20,563 p.a. per parent

Employee - Top-Up Premium

PHP 3,362 p.a. per parent





Employee - 50% Premium for PHP 200k MBL + Top-

Up PremiumPHP 20,563 p.a. per parent

Notes:• Deductions will start from March onwards. March deduction will be for 2 months (Feb and March) and April onwards it will be monthly deduction• Please contact PayPal Support (Employee Central) for any inquiries on the salary deduction• All premiums are in PHP & Vat Inclusive

PrincipalsExisting

DependentsNew

Dependents

Up to MBL Up to MBL Up to MBL

PRE-EXISTING CONDITION (PEC)PLAN LIMITS

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.

PREVENTIVEANNUAL PHYSICAL EXAMINATION (APE)

Basic 5

• Physical Examination • CBC

• Chest X-Ray • Urinalysis • Stool Exam

For 35 years old and above: Pap smear and ECG

HIV Testing/STD Testing for Principal members only to be availed by walk in at

Aventus Clinics only.

To be scheduled by your HR in coordination with Intellicare.

Six (6) sessions of wellness program for the Client (counseling on health

habits, diet and family planning).

Routine Immunization (except cost of vaccines)

FOR ALL MEMBERS

Note: APE process for employee and dependents to be announced

OUT-PATIENT

NOTE:With access to Healthway Medical Clinics

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 Maximum Benefit limit/member/year.

OUT-PATIENT

NOTE:With access to Healthway Medical Clinics

Speech (for stroke patients) up to 12 sessions/year.

Physical Therapy/ Occupational therapy excluding subspecialties such

as cardiac rehabilitation, pulmonary rehabilitation and the like shall be

covered as follows:

- For IP: up to PEC limit;- For OP: up to 12 sessions per member per year; subject to PEC limit

Note: Therapy of one (1) body area shall be considered as one (1) session

NOTE: Certain out-patient procedures will require filing of Philhealth.

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

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

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.

AVAILMENT PROCESSOUT-PATIENT

METRO MANILAMAKATI – AYALA NORTH EXCHANGE3/F Retail 61 & 62, Amorsolo St., Ayala Ave., Makati City☎: (02) 8587-8053

MAKATI – FILOMENA BLDG.6/F Filomena Bldg., 104 Amorsolo St., Legaspi Village, Makati City☎: (02) 8519-6787 / (02) 8817-1464 / (02)8 869-3289

BGCG/F Citibank Plaza, 34th St. Corner Lane D., BonifacioGlobal City, Taguig City☎: (02) 8352-8335 / (02) 8362-0042

MANILA5/F Times Plaza Bldg., U.N. Ave. corner Taft Ave., Ermita, Manila City☎: (02) 8353-6807 / (02) 8353-6808

PASAYScape Bldg., Macapagal Avenue, cor. Pearl Drive, Central Business Park 1, San Rafael, Brgy. 76, Pasay City☎: (02) 8541-5645 / (02) 8838-0627

MANDALUYONGLower 2/F St. Francis Square, Doña Julia Vargas Ave. cor. Bank Drive, Ortigas Center, Mandaluyong City☎: (02) 8542-6578 / (02) 7255-8974

ORTIGASG/F AIC Grande Tower, Sapphire St. cor. Garnet Road, Ortigas Center, Pasig City☎: (02) 8584-2430 / (02) 8584-1013

CUBAOG/F Manhattan Parkview Tower One, General Romulo Ave., Araneta City, Cubao, Quezon City☎: (02) 8245-0976

NORTH EDSA2/F Philippine College of Surgeon Bldg., 992 North Edsa, Quezon City☎: (02) 8352-4676 / (02) 8352-4677

ALABANG2/F Sycamore ARCS 1 Building, Buencamino St. cor. Alabang-Zapote Road, Alabang, Muntinlupa City ☎: (02) 8556-3596 / (02) 8556-3592

CALAMBAUnit 201-203 SQA Corporate Center, Barangay 1, National Highway Crossing, Calamba City, Laguna☎: (045) 499-8417 / (045) 499-8419

STA. ROSA2/F Carvajal Building 2, National Highway, Balibago City, Sta. Rosa, Laguna☎: (049) 508-1806 / (049) 306-0397

CLARKG/F BPO Building 5, SM City Clark, M.A. RoxasHighway,Brgy. Malabanias, Angeles City, Pampanga☎: (045) 499-8417 / (045) 499-8419

CEBU IT PARKUnit 203 TGU Tower, Asiatown, IT Park Apas, Cebu☎: (032) 479-9261

CEBU CYBERGATEL/3 Robinsons Cybergate, 2029 Don Gil Garcia & J. Llorente St., Capitol Site, Cebu☎: (032) 236-9028 / (032) 238-3922 / (032) 238-7672

REGIONAL

www.aventusmedical.com

PREFERRED NETWORKS

Daniel Mercado Medical Center – BatangasMercado General Hospital San Jose Del Monte Inc. – San Jose Del MonteQualiMed Clinic - Fairview TerracesQualiMed Clinic - UP Town CenterQualiMed Clinic - Mckinley RoadQualiMed Surgery Center - Manila

5 Person Ward Emergency

Intellicare Lane Private Room

PREFERRED NETWORKS

Cebu Doctor's University Hospital

Mactan Doctors Hospital

Cebu North General Hospital

Cebu South General Hospital

San Carlos Doctors Hospital

PREFERRED NETWORKS

CDO Polymedic Medical Plaza CDO Polymedic General Hospital

www.medgatephilippines.com


Call

1

Triage

2

Teleconsultation

3

E-treatment

4

Save on travel cost

Multiple touchpoints No waiting in line

Save on time 24/7 | 365 days a year Save money

Optional medicationdelivery

No disease exposure

3-Day unli consults38 pre-approved labs


(02) 8705 0700(032) 265 5111 (Cebu) 0917 536 2156 (Globe)

(035) 522 5111 (Dumaguete)

(082) 285 5111 (Davao)

0925 714 7794 (Sun)

0998 990 7540 (Smart)

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)


Call Doc. Anywhere.Anytime. No Line.

TM

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 (Accredited OR Non-accredited Hospital/ Clinic to

Accredited Hospital/ Clinic) shall be covered through reimbursement

up to Php2,500.00 per conduction (regardless of the location within the

Philippines)

Secure an admitting order from an Intellicare -affiliated physician.

Sign the Referral Control Sheet (RCS 3) issued by the visiting Intellicare

Patient Relations Officer.

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.

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

benefit.

AVAILMENT PROCESS

NOTE: File for Philhealth upon discharge.

d

IN-PATIENTFORM (RCS 3)

IN-PATIENT

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.

INVOLUNTARYROOM UPGRADING

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.

VOLUNTARYROOM UPGRADING

EMERGENCY

Up to Php30,000thru reimbursement

Up to Php30,000thru reimbursement

Up to MBL

100%80%100%

100% *RVS80% *RVS100% *RVS

*Relative Value Scale (RVS) – HMO Rates

MAXIMUM COVERAGE

HOSPITAL BILLS

PROFESSIONAL BILLS

ACCREDITED HOSPITAL NON-ACCREDITED FOREIGN TERRITORIES(LEADING TO CONFINEMENT)

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)

PROCESSREIMBURSEMENT

Sending of reimbursement documents (soft copy) is through Paypal'sField Customer Service Support (FCSS).

Intellicare Field Customer Service Support schedule is every Monday, Wednesdays and Fridays 12:00 NOON to 9:00 PM.

For initial evaluation of reimbursement, employees must send all (soft copies) of documents and requirements to FCSS at [email protected] (acknowledgment of email is during scheduled work day only.)

EMAIL SUBJECT LINE: CLAIMS REQUISITION_Paypal_LAST NAME_DATE SUBMITTED.

Late Filling is not allowed. Filing period of claims is 30 days from Official receipt date or availment date.


NOTE:Submit to Intellicare not more than 30 days from date of availment.Processing of the request is within 20 working days upon receipt of

complete documents.Hard copies of reimbursement must be sent to 3rd F Axa Life Bldg, Sen

Gil Puyat Ave cor. Tindalo St. San Antonio Makati City.Kindly address the documents to Kenneh Ke or Maques Jules Calleja for

delivery of documents.Please contact our reimbursement hotline (0998-9624175) prior sending

the documents to ensure availability of POC's to receive the documents.Sending of documents is every Monday to Fridays except holidays from

8:30am to 4:30pm (with lunch break 12:00nn-1:00pm.


DENTAL

Dental examination & oral health education

Once a year oral prophylaxis

Unlimited Simple tooth extraction

Unlimited Temporary fillings

Permanent Fillings - up to two (2) teeth per year

Emergency out-patient dental treatment

Restorative and prosthodontic treatment planning

Desensitization of Hypersensitive teeth - up to two (2) teeth per

year

Simple adjustment of dentures

Thru:

☎: 1-800-101DENTAL (PLDT Toll-free) | (02) 8911-7777 (PLDT Trunk Line)

DENTAL

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

Thru:


AVAILMENT PROCESSDENTAL

d

DENTAL FORM

Set an appointment with an affiliated Dental Network Company dentist.

Proceed to the dental clinic on your scheduled date and present your Intellicare

Membership Card with two (2) valid IDs for membership status validation.

Avail the entitled benefit and sign the Dental Form.


Thru:

MOBILE NUMBERS:(0923) 809-5376 (Sun)

(0916) 761-5277 (Globe)

Eye laser treatment for retinal tear, retinal hole, retinal detachment and glaucoma except for cases

of myopia or correction of error of refraction (such as lasik, PRK and the likes) shall be covered up to

Php10,000.00 per eye per member per year.

Electrocauterization of skin lesions such as plantar warts, flat warts, periungual warts, filiform

warts and molluscum contagiosum, (from face down except genital warts and condyloma acuminata)

shall be covered up to Php2,000.00 per member per year to be done at Aventus Clinics provided that

an accredited physician recommends it and only for cases that affect the physiological functions of

the member (not for cosmetic/aesthetic purposes).

ADDITIONAL BENEFITS

Sclerotherapy for varicose veins (excluding medicines and for cosmetic purposes) shall be covered

up to Php30,000 per member per year provided that it is medically necessary and recommended by

an affiliated vascular surgeon (not for aesthetic purposes).

Allergy Testing/ Allergy screening shall be covered up to Php2,500.00 per member per year per

member per year if prescribed by Accredited Physician.

Tuberculin Test shall be covered up to Php600.00 per member per year if the member shows

symptoms of Tuberculosis and if prescribed by accredited physician.

ADDITIONAL BENEFITS

Treatment for animal bites and tetanus shall be covered as follows:

- Passive and active vaccines for treatment of animal bites and tetanus - up to Php20,000.00 per

member per year.

- Inital treatment for animal bites - up to the maximum benefit limit per member per year for the first

twenty-four (24) hours from the time the member was bitten.

Botox injection shall be covered up to Php5,000.00 per member per year if recommended by an

accredited/ affiliated physician to be medically necessary (NOT for aesthetic/beautification

purposes).

ADDITIONAL BENEFITS

Work-related conditions shall be covered up to the maximum benefit limit per member per year

subject to the exclusions and limitations of the contract.

Motor vehicular accidents shall be covered up to the maximum benefit limit per year subject to the

exclusions and limitations of the contract and a Police report MUST be submitted to Intellicare for

evaluation.

Provoked and unprovoked assault including domestic violence whether initiated by a known or

unknown third party shall be covered up to the maximum benefit limit per member per year subject

to the exclusions and limitations of the contract and a police report must be submitted to Intellicare

for evaluation.

ADDITIONAL BENEFITS

Scoliosis including necessary procedures, except physical therapy sessions, whether congenital, pre-

existing, developmental or acquired shall be covered up to Php40,000.00 per member per year

Note: Physical therapy sessions shall form part of the limit for Physical therapy/ Occupational therapy

limit

Congenital conditions including Congnital Hernia shall be covered up to Php40,000.00 per member

per year subject to pre-existing condition limit (whichever is lesser).

Note: Physical therapy sessions shall form part of the limit for Physical therapy/ Occupational therapy limit.

ADDITIONAL BENEFITS

Coverage for complications of congenital conditions shall form part of the limit for congenital illness

Consultation for chronic dermatoses shall be covered up to the maximum benefit limit per member

per year.

Consultations and treatment for Scabies shall be covered per year.

Hepatitis B (if acquired) shall be covered up to the maximum benefit limit per member per year.

ADDITIONAL BENEFITS

Rapid Antibody Test & RT-PCR Test shall be covered through reimbursement for all members

without symptoms of COVID-19 to be done at any accredited facility as long as prescribed by an

accredited physician/doctor.

Optical benefit which includes optical consultations, examinations, contact lens, spectacle shall be

covered thru reimbursement up to Php3,500.00 for per member per year.

Note: Optical procedures will be based only upon doctor’s request

ADDITIONAL BENEFITS

Gender reassignment surgery benefit shall be covered up to Php200,000 for principal members who

are diagnosed with Gender Dysphoria.

- Consultations through accredited/non-accredited endocrinologist including prescribed hormonal

treatments (through IV or injection only) shall be covered up to Php20,000 per principal per year thru

reimbursement.

- Consultation reimbursement through Psychiatrist shall have a maximum of Php1,500 per

consultation.

ADDITIONAL BENEFITS

NOTE:This GRS provision of Php200,000 would be over and above the MBL. For example, if an employee X avails GRS claim worth Php120,000, his

MBL for HMO would still remain Php200,000 and can be utilized for medical treatments as per HMO policy. Since PayPal is paying the GRS expenses (P120,000) plus 10% admin charge through the special fund of 5M, the MBL of the employee must not be touched.

INTELLICARE shall reimburse out-patient medicines up to Five Thousand Pesos (Php5,000.00) per

family unit per year. Out-patient medicines must be prescribed by an accredited physician/doctor.

The following items shall be reimbursed with prescription:

ADDITIONAL BENEFITS

- Dermatological medicines and products

- Medicines for psychological/psychiatric cases

- Maintenance medicines

- Pre and post-natal medicines

- Injectible medicines (such as but not limited to chemo

therapeutic drugs, vaccines

The following items shall be reimbursed without prescription:

- Vitamins and supplements

- Over-the-counter medicines

ADDITIONAL BENEFITS

Exclusions are: Contraceptive pills and beautification/ cosmetic products, ointments, solutions, lotions for derma cases, soap/ cleanser for skin diseases.

Maternity Assistance: A maternity assistance program shall be made available to all enrolled female

employees and legal spouse of male employees of the company and Domestic partner. The enrolled

member may avail of the maternity assistance only once per contract period:

(1) Caesarean Delivery - PHP40,000.00

(2) Normal Delivery - PHP25,000.00

(3) Home Delivery - PHP10,000.00 (thru reimbursement only)

(4) Miscarriage / Abortion - PHP15,000.00

(5) Threatened Abortion - PHP15,000.00

(6) Any maternity complications - PHP25,000.00

ADDITIONAL BENEFITS

INTELLICARE will only process maternity reimbursement if all originals of the following pertinent

documents are submitted to INTELLICARE:

- Official Receipt

- Certified True Copy of Birth Certificate

- Medical Certificate (stating nature of delivery: i.e. Normal, Caesarian)

- Statement of Account (with itemized hospital bills)

Note: Maternity benefit may be covered outright if availed in an accredited hospital through an accredited physician. However, for hospitals with blanket authority, availment will still be on a reimbursement basis. Excess charges must be settled by the member before discharge.

ADDITIONAL BENEFITS

All procedures that are not covered in the HMO Dental Plan and any prescribed dental procedure or

surgery once every contract year is covered up to MBL as long as prescribed for all

employees/dependents. For reimbursement filing, dental prescription with dental procedure details,

original receipts and all required documents must be submitted to Intellicare for processing.

Intellicare shall cover flu vaccine (Influenza Trivalent) for all employees per year through ASO

program, to be availed at Aventus Clinics only. Administration of flu vaccine to be scheduled by

Intellicare (minimum of 200 vials). (Flu vaccines process will be shared by HR).

ADDITIONAL BENEFITS

FLU VACCINE PROCESS:

1. Employee to select any preferred aventus clinic branch for the flu vaccine.

2. Employee will e-mail below details to order the vaccine in advance at least 2 months prior target

date to Intellicare Representative for consolidation of orders and endorsement to Intellicare/Aventus

(PayPal to provide email address to employees). Template for stock reservation stated below:

Name of Employee:

Clinic/Aventus Branch:

Date Preferred:

Type of Vaccine: Flu vaccine

ADDITIONAL BENEFITS

FLU VACCINE PROCESS:

3. Intellicare representative will send the order request the vaccine to Intellicare/Aventus. Sending of

orders to Intellicare representative can no longer be cancelled as we advance the ordering of vials for

proper coordination of stock availability.

4. Intellicare Representative will advise the employee once vaccine is already available and schedule

must be facilitated before going to the clinic - no appointment no schedule of vaccine (Tentative: April

onwards)

5. Employee must bring their HMO card or valid ID during the availment date.

ADDITIONAL BENEFITS

POS Coverage effective July 1, 2021. Point of Service (POS) for All Members: Members are allowed to

avail of services from non-accredited doctors and non-accredited hospitals for in-patient which shall

be covered through reimbursement provided originals of all pertinent documents are submitted to

INTELLICARE. Reimbursement shall be up to eighty percent (80%) of hospital bills and eighty percent

(80%) of professional fees based on INTELLICARE relative value scale (RVS).

The Point of Service (POS) shall not apply to the following services/facilities:

- Dental services;

- Accredited hospitals or facilities that are specifically excluded in the group corporate agreement.

ADDITIONAL BENEFITS

FOR PRINCIPAL MEMBERS ONLYLIFE INSURANCE Thru:

Sum Assured: Php 10,000.00

Group Life Insurance (GLI) - Php 10,000.00

Family Assistance Benefit (advanced from GLI) - Php 1,000.00

Terminal Illness Benefit (advanced from GLI) - Php 10,000.00

Accidental Death, Dismemberment - Php 10,000.00

and Disability Benefit (ADDD)*Double Indemnity shall apply if the cause of death is due to accident

www.fwd.com.ph ✉: [email protected]

NOTE:Group Life Insurance shall be provided for members up to sixty-five (65) years old

Thru:

FOR PRINCIPAL MEMBERS ONLYLIFE INSURANCE

SCHEDULE OF INJURIES PERCENTAGE

Both hands or feet

One hand and one foot

Either one hand or one foot and

sight of one eye

Arm at above elbow

Leg at or above knee

Arm between elbow & wrist

Leg between knee & foot

Loss of Speech

Loss of Hearing

Either one hand or one foot or one eye

100%

100%

100%

70%

70%

60%

60%

50%

50%

50%

SCHEDULE OF INJURIES PERCENTAGE

One ear

Thumb (both phalanges)

Thumb (one phalanx)

Fractured leg or patella with

established non-union

Shortening of leg by at least 5cm

Great toe

Finger(s) (per phalanx)

First or second Metacarpals

Toe, other than Great toe (one phalanx)

Third, fourth, or fifth Metacarpals

50%

25%

10%

10%

7.5%

5%

3.5%

3%

1%

1%

www.fwd.com.ph ✉: [email protected]

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, anti-rabies, anti-venom, steroid injections

Organ transplants or acquisition of an organ

Procurement of orthotics, prosthetics, take-home medical appliances and other

durable medical equipment (DME)


Determining / ruling out PEC during the first 12 months of membership

if result is positive

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

Hypersensitivity tests to check for allergies and desensitization

Any disability which may have affected a dependent prior to the 30th day after birth

Pregnancy and pregnancy-related conditions


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

Congenital abnormalities

Neuro-developmental & genetic disorders (which may result to mental retardation)

Developmental delay

Sexually transmitted diseases

Psychiatric and psychological illnesses

MEMBERSHIP CARD

NOTE:LOST / DAMAGED CARDS: must be reported to Intellicare immediately.REPLACEMENT FEE: Php100.00

Always present your IntellicareMembership Card and another

valid ID during availment.

CERTIFICATE OF COVER

NOTE:In the absence of the membershipcard, member may present theCertificate of Cover (COC) signed byan HR representative.

WEBSITEwww.intellicare.com.ph

Trunk Lines: (02) 7902-3400 / 8789-4000TOLL – FREE NUMBER OUTSIDE METRO MANILA:

24/7 CALL SUPPORT MOBILE HOTLINE NUMBERS

(0920) 970 – 4724 Smart

(0917) 840 – 4894 Globe

(0922) 891 – 3957 SUN

24/7 TEXT SUPPORT MOBILE HOTLINE NUMBERS

(0920) 951 – 8452 Smart

(0917) 805 – 2502 Globe

(0922) 891 – 3925 SUN

1-800-10-789-4000

CONNECT WITH US

/Intellicare @Intellicare @Intellicare @Intellicare Intellicare-PH

Trunk Lines: (02) 7902-3400 / 8789-4000TOLL – FREE NUMBER OUTSIDE METRO MANILA:

24/7 CALL SUPPORT MOBILE HOTLINE NUMBERS

(0920) 970 – 4724 Smart

(0917) 840 – 4894 Globe

(0922) 891 – 3957 SUN

24/7 TEXT SUPPORT MOBILE HOTLINE NUMBERS

(0920) 951 – 8452 Smart

(0917) 805 – 2502 Globe

(0922) 891 – 3925 SUN

1-800-10-789-4000

CONNECT WITH US

/Intellicare @Intellicare @IntellicarePH /IntellicarePH /Intellicare-PH

Thank You

PAYPAL PHILIPPINES, INC.

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