The document summarizes the benefits and services provided by a health maintenance organization established in 1995. It has over 473,000 members with access to over 650 hospitals and 10,000 physicians nationwide. Key benefits include inpatient and outpatient care, emergency care, dental care, and additional benefits like annual physical exams and financial assistance. The summary also outlines procedures for availing different services and benefits.

2. Established in 1995
100% wholly-Filipino owned
50M pesos paid up capitalization
473,000 membership base
Widest accreditation network
Over 650 major hospitals and first-class clinics
Approximately 10,000 reputable physicians and specialists
More than 400 dentists nationwide
Strong manpower complement and infrastructure
24/7 Customer Service assistance
Highly-personalized service of Patient Relations
Officers during in-patient cases
Satellite offices in key cities and provinces
3 mobile clinics and 8 full service clinics
Above 90% client retention rate

6. • ELIGIBLE DEPENDENTS
• Enrollment must follow this order
(Hierarchy Rule)
• For Single Principal Members
1. Mother or father
– not over 65 years old
2. Siblings
– Not over 21 years old
– Unmarried
– Unemployed
*For Single Parents, Biological Children
may be enrolled first before the parents

7. • For Married Principal Members
1. Legal spouse
– not over 65 years old
2. Children
– Biological / Legitimate / Legally adopted
– 30 days – 21 years old
– Unmarried
– Unemployed

8. • Enrollment period – 30 days window
Dependents – 30 days from effectivity date of coverage
No additional dependents except for:
Newly born baby – 30 days from date of birth
Spouse of newly wed employees – 30 days from date of
marriage
Dependent of a new employee – 30 days from effectivity date
of Principal member

9. OP Availment ACCREDITED FACILITIES EXCEPT HEALTHWAY
IP Availment OPEN DOOR POLICY
Room and Board MBL Per illness/ member/ year
REGULAR PRIVATE 120,000
Pre-Existing Condition* Coverage
Existing Principals New Principals Existing Dependents New Dependents
MBL MBL MBL 15,000
Philhealth Required
System Uses Electronic Eligibility Verification System
(through Medilink Network Inc.’s POS Terminals)

10. Features and Benefits
Determines member’s status and extent of
benefit prior to service availment
Generates an electronic approved or declined response upon
swiping magnetized card
Faster transactions in terms of verification of status of
membership
Efficient tracking of fraud
Dynamic data is stored in our database not in the card
(no need to reprint new cards e.g. during renewals, changes in
plan)
POS Terminals are accessible 24/7 (major Intellicare providers
have POS terminals in place and are ideally located in –
Admitting, Billing, Credit and Collection, Industrial
clinics, Information, Emergency Room of the hospitals).
Refer to your directory for locations of POS terminals

11. For Active and Eligible Members –
POS Terminal will instantly generate a 2-page LOE
(Letter of Eligibility) depending on type of claim
e.g. OP-Outpatient, IP-Inpatient,
ER-Emergency
For Inactive and Ineligible Members
– POS Terminal will display “Call IntelliCare”
When POS terminal is down –
(e.g brownouts) Hospital staff will issue a Manual
LOE
*For accredited clinics/hospitals
without POS terminals –
proceed to the IntelliCare Hospital Coordinator or
call IntelliCare Customer Service for assistance

12. Name of Provider Name of Provider
Name of Member Name of Member
Date & Time of Date & Time of
Availment Availment
Line 1 Payor, LOE No. Line 1 Payor, LOE No.
Line 2 Policy Number Line 2 Policy Number
Line 3 Member’s Name Line 3 Member’s Name
Line 4 Age, Plan Effectivity, Coverage Line 4 Age, Plan Effectivity, Coverage
Line 5 Benefits Line 5
Line 6 PHIC Required or Not Line 6 Benefits
Line 7 PEC Coverage or Line 7 Room and Board
Non Coverage Line 8 Philhealth
Line 8 Exclusions, if any Line 9 PEC Coverage or
Line 9 Instructions to Providers Non Coverage
Re: Procedures

13. Preventive Care
Annual Physical exam
Routine Immunization
Outpatient care
Out Patient Care Guidelines
Inpatient care
In Patient Care Guidelines
Emergency care
Emergency Care Guidelines
Reimbursement Guidelines
Additional Benefits
Dental Care
Dental Care Guidelines
Financial assistance

14. For Principals & Dependents
• ANNUAL PHYSICAL
Complete Blood Count
EXAMINATION (APE)
Urinalysis
-To be scheduled by your HR /
Fecalysis
Benefits Administrator in
coordination with IntelliCare Chest x-ray
Physical Examination
Pap smear (for women 35 years old and above of
if prescribed by attending physician)
Electrocardiogram (for 35 years old and above or
if indicated by attending physician)

15. • Routine Immunization (except cost of vaccines)
• Counseling on health habits and quarterly Wellness Programs
(upon request)

16. • Medical Consultations with IntelliCare affiliated doctors
• Referral to IntelliCare accredited specialists
• Treatment of minor injuries such as lacerations, mild
burns, sprains and the like
• Laboratory, x-ray, and other diagnostic procedures
prescribed by an IntelliCare accredited physician
• Minor surgery not requiring confinement
• Pre- and post-natal consultations with any IntelliCare
affiliated OB-GYN up to 14 sessions/year.
• Speech / Physical Therapy up to 12 sessions per year.

17. OUT-PATIENT
1. GO TO OP POS terminal in an accredited
clinic or hospital.
Present your card
(Hospital staff will swipe your card to validate
membership status)
2. Coordinator of accredited hospitals. Present Intellicare
card and LOE
3. Secure Intellicare referral slip* (RCS 1 OR RCS 2) prior
to any consultations / treatment diagnostic tests/lab
procedures
4. Present Intellicare card and RCS to accredited doctor
or area where the procedure will be done.
5. Avail consultation / treatment or procedure (sign RCS after)
6. File Philhealth for Philhealth required procedures

18. • Room & Board Accommodation within the limits of the PLAN
• Professional fees of attending IntelliCare affiliated physicians
• Diagnostic procedures referred by the attending IntelliCare affiliated
physicians / specialists.
• Administered Medicines
either orally or intravenously

19. • Transfusion of blood and intravenous fluids
• Anesthesia and its administration
• Standard nursing care services, standard
admission kit, sutures, dressings, plaster
casts, and other items directly related to
the medical management of the patient
• Use of Intensive Care Unit
• Use of Operating Room & Recovery Room facilities
• Assistance in administrative requirements through the IntelliCare Patient Relation
Officers
• Ambulance Service (hospital to hospital) to be covered thru reimbursement up to
Php 3,000/member/year.

20. IN-PATIENT
1. GO TO (In-patient) IP POS terminal in an accredited clinic or hospital.
Present your card.
(Hospital staff will swipe your card to validate membership status)
2. Proceed to admitting section and present your LOE
and admitting order
OCCUPY ALLOWED ROOM
INVOLUNTARY UPGRADING
- Member are allowed to occupy a room one level higher than what
he is entitled to due to non availability for up to 24 hours (1 day) w/o
incremental charges (except suite room). After 24 hours (2nd day) whether
Room becomes available or not, incremental charges will be billed to
the account of the member.
*You must transfer once your room becomes available, otherwise,
pay all incremental charges *starting from the first day of confinement.
VOLUNTARY UPGRADING
*Pay ALL Incremental charges from first day of confinement
-30% increment in hospital services.
-Room and board difference.
-Professional fee difference.
3. File your Philhealth before hospital discharge
*Non-filing or late filing of Philhealth AND
*Non-Philhealth members
must pay the Philhealth portion upon discharge
4. Sign RCS and hospital bill and settle miscellaneous
charges upon discharge

21. • life-threatening situations
ACCREDITED NON- FOREIGN
requiring urgent medical HOSPITALS ACCREDITED TERRITORIES
or surgical care e.g. heart HOSPITALS
attack, stroke, poisoning,
Covered up Covered thru Covered thru
loss of consciousness or to MBL reimbursement reimbursement
respiration and up to 30,000 up to 30,000
convulsion
Hospital bills – Hospital bills – Hospital bills –
100% 80% of IntelliCare 80% of IntelliCare
Intellicare RVS RVS
RVS
Professional Professional fees Professional fees
fees – 100% – 80% of – 80% of
IntelliCare IntelliCare RVS IntelliCare RVS
RVS
*RVS (Relative Value Scale)

22. EMERGENCY CARE PROCEDURES
1. GO TO the Emergency Room of an accredited
clinic or hospital
Hospital staff will swipe your card to validate
membership status
2. Undergo medical treatment
3. If declared as an outpatient case only, do not forget
to sign RCS and hospital bill upon discharge and settle
non-covered charges
4. If for admission, notify Intellicare Customer Service
within 24 hours. Occupy allowed room. ( incremental
charges will apply during room upgrading
5. If treated in a non-accredited hospital, you may file
reimbursement of your medical bills
upon discharge

23. 1. Secure IntelliCare Reimbursement Form and fill up completely.
2. Complete the following documents and attach to the
Reimbursement Form:
a. OUTPATIENT
Original Official Receipt (with TIN)
Statement of Account from the hospital
Medical Certificate*
Laboratory result (if with diagnostic procedure)

24. REIMBURSEMENTS – cont….
b. IN-PATIENT
Original Official Receipt (with TIN)
Medical Certificate*
Statement of Account (Itemized Hospital Bill)
Operative Record with Histopath Result (if with operation)
Police Report & Medico-Legal Report (if required)
NOTES:
• Submit to IntelliCare not more than 30 days from expiration of
treatment
• IntelliCare will process the request within 20 working days upon
receipt of complete documents

25. *MEDICAL CERTIFICATE

26. • First dose of anti-rabies, anti-venom and
anti-tetanus are covered up to PHP
15,000.00.
• Congenital illnesses shall be covered for
Principal members shall be covered up to
PHP 20,000.00 per illness / member /
year.
• Cautery of warts up to PHP 1,000.00 /
member / year.

27. Lithotripsy = PEC limit
Laparoscopic Procedures = PEC limit
Arthroscopic / Hysteroscopic Procedures = PEC limit
Transurethral Microwave Therapy of Prostate = maximum of 50,000
Percutaneous Ultrasonic Nephrolithotomy = PERC limit
Heart Surgery / Angiogram = up to 50,000
Neuroscan = PEC limit

28. Perfusion Scan = PEC limit
Magnetic Resonance Imaging (MRI) = PEC limit
Nuclear Radioactive Isotope Scan (NRIS) = PEC limit
Chemotherapy / Radiotherapy = PEC limit
Ultrasound (except maternity cases) = PEC limit
Dialysis = PEC limit
CT Scan = PEC limit

29. Notes on Availment of Latest Modalities of
Treatment & Special Procedures
Procedures mentioned are covered up to the limits indicated or
PEC limit (whichever is lesser)
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 / counterparts
will have a maximum limit of Php5,000 subject to the exclusions
and limitations of the contract

30. Dental Examination
Bi-Annual Oral Prophylaxis
Simple tooth extraction
Temporary fillings
Two (2) teeth permanent lightcure fillings
Recementation of jackets, crown, inlays and onlays
Treatment of minor gum problems, mouth lesions, wounds and burns
Orthodontic consultations (braces and malposition of teeth)
Temporo mandibular joint consultation (clicking of jaws)
Pre-natal check of teeth and gums
Emergency dental treatment for the relief of pain
Dental health education

31. DENTAL
Check out list of IntelliCare Accredited Dentists
Call dentist to find out if they implement
FIRST-COME , FIRST-SERVED or BY
APPOINTMENT policy
Go to the ACCREDITED DENTAL CLINIC
Present IntelliCare Card
Avail of Dental treatment/ consultation
Sign-off dental referral control sheet after
consultation / treatment

32. Natural Death - Php 10,000.00
Death due to Accident - Php 20,000.00
Loss of both hands - Php 10,000.00
Loss of both feet - Php 10,000.00
Loss of sight (both eyes) - Php 10,000.00
Loss of one hand and one foot - Php 10,000.00
Loss of one hand and sight on one eye - Php 10,000.00
Loss of one foot and sight on one eye - Php 10,000.00
Loss of one hand or one foot or sight on one eye - Php 5,000.00
NOTE: Provided, that the death or injury results from causes that
are covered and not under the exclusions provision.

33. PROCEDURES FOR AVAILMENT
(Financial Assistance)
1. Secure IntelliCare Reimbursement Form and fill up completely.
2. Complete the ff: documents and attach to Reimbursement Form:
a. Filled up Internment Assistance Form
b. Attending Physician’s Certification
c. Certified original copy of Death Certificate
d. Certified original copy of the deceased and the beneficiary’s Birth
Certificates
e. Certified original copy of Marriage Contract
f. Latest DTR (Daily Time Record)
g. Police Report and Autopsy (if accidental death)
NOTE:
IntelliCare will process the request within 30 days upon receipt of
complete documents

34. 1. Services rendered by non-accredited doctors, except
with the prior written authorization of an IntelliCare
Coordinator, or in Emergency cases
2. Hospital charges for special or private nursing services,
supplemental foods and medicines like vitamins and
minerals (unless prescribed), extra accommodation
and non-medical personal appliances such as radio,
television, telephone, computer and refrigerator
3. Health / Annual / Pre-employment check-ups for other
companies, government requirements, insurance
purposes or travel abroad
4. Recuperation such as confinement in a sanitarium or
convalescent home, rehabilitation medicines,
custodial, domiciliary care, government imposed
quarantines

35. GENERAL EXCLUSIONS / LIMITATIONS – cont…
5. Medical Certificates
6. Professional fees in medico-legal cases
7. Refusal to undergo recommended treatment or demanding
treatment for which IntelliCare doctors believe a
professionally acceptable alternative exists
8. Vaccines for immunization, anti-rabies, anti-venom, steroid
injection
9. Out patient medicines and medical supplies except in
emergency cases
10. Procurement or use of eye glasses, special braces, steel
implants, wheelchairs or prosthetic appliances including but
not limited to items such as artificial limbs, hearing aids,
crutches, intra-ocular lens, contact lenses, artificial hips or
joints, pacemakers, mesh (for hernia), stents and ventilating
tubes

36. GENERAL EXCLUSIONS / LIMITATIONS – cont…
TREATMENT AND PROCEDURES
1. Determining / Ruling out PEC during the first 12 months of
membership if result is positive
2. Determining / ruling out of hepatitis or tuberculosis if result
is negative
3. Circumcision, infertility or fertility and virility/potency
(erectile dysfunctions), artificial insemination, sex change
4. Laser eye surgery for myopia or error of refraction
5. Acupuncture, chiropractic treatment, iridology, chelation,
cell implant theraphy
6. Speech or Physical therapy in excess of 12 sessions

37. GENERAL EXCLUSIONS / LIMITATIONS – cont…
7. Reconstructive surgery (except to treat a functional
defect directly caused by accident or illness covered
herein), cautery of warts, milia, xyringoma, facial
moles, aesthetic, cosmetic or beautification alterations
8. Hypersensitivity tests to check for allergies and
desensitization
9. Sleep study (unless directly related to an organic illness
covered up to 5,000)
10. Blood screening
11. Organ transplants or acquisition of an organ

38. GENERAL EXCLUSIONS / LIMITATIONS – cont…
EXTERNAL FORCES / ACTIVITIES
1. War-like or combat operations, government declared
acts of rebellion, active participation in riots or
demonstrations, strikes or labor disputes, terrorism,
provoked criminal acts, violation of a law or ordinance,
commission of a crime whether consummated of not,
serving in the military, naval or air forces of any country
or international authority, unnecessary exposure to
imminent danger of hazard, active participation in
setting of and/or handling pyrotechnic materials,
attempted suicide, self-inflicted injuries
2. Participation in hazardous activities such as skydiving,
motor sports, judo, karate, taekwondo, boxing, wrestling,
bungee jumping, scuba diving, snorkeling, horseback
riding, polo, hunting, mountain climbing, rock climbing,
hang gliding, spelunking, ballooning, gymnastics or
partaking as a paid professional or semi-professional in
any sport

39. GENERAL EXCLUSIONS / LIMITATIONS – cont…
3. Government declared epidemics, complete or partial
destruction of hospital by fire, flood, or other perils,
earthquake, tsunami, volcanic eruption, acts or order of
Government, brownouts
4. Aviation or aeronautics use or sea travel other than as a fare-
paying passenger on a licensed aircraft/vessel operated by
a recognized airline/operator
ILLNESSES / CONDITIONS
1. Congenital abnormalities such as neonatal hernia, indirect
hernia, hemangioma, phimosis, harelip, clubfoot, cerebral
palsy, renal diseases such as medullary sponge kidney,
pediatric cardiovascular work-up and the like
2. Neuro-developmental disorders such as ADHD (attention
Deficit Hyperactivity Disorder) Autism, Genetic disorder,
which may result to mental retardation (e.g. Down
Syndrome) and other conditions which may require
speech/physical and other related therapies

40. GENERAL EXCLUSIONS / LIMITATIONS – cont…
3. Sexually-transmitted diseases, AIDS and AIDS-related
complex or condition
4. Substance addiction or reaction to use of prohibited
drugs, alcoholism, alcohol intake, anxiety reaction,
psychiatric and psychological illnesses,neurotic and
psychiatric behavior disorders, or accidents arising from
these conditions
5. Guillain-Barre syndrome
6. Developmental delay
7. Any illness or disability which may have affected a
dependent prior to the 30th day after birth
8. Pregnancy, childbirth, miscarriage, pregnancy-related
illnesses, abortion, post-natal care

41. Always present your IntelliCare Membership Card
and another valid ID during availment.
Lost card – report to IntelliCare immediately
PHP 100.00 – replacement fee for lost card

42. MANILA
(0920) 951-8452 – Smart
(0917) 805-2502 - Globe
BRANCH OFFICES
CEBU (032) 255-1282 (0920)-9073708
BACOLOD (034) 433-1984 (0920) 926-8649
CDO (08822) 726327 (0920) 951-9526
DAVAO (082) 227-4697 (082) 227-4621
(0920) 951-9523
E-MAIL ADDRESS:
intelli_act@intellicare.com.ph

43. Intellicare Makati Clinic
Clinic Hours: Monday-Saturday / 8am to 5pm
2nd floor PNB Beneficial Bldg.,
166 Salcedo St., Legaspi Village, Makati City
Tel. 888-5556 / 830-2320 / 818-8671 local 200
Intellicare Alabang Clinic
Clinic Hours: Monday-Saturday / 8am to 5pm
Unit 53-10 to 20 Green Bldg. – South Station
Alabang-Zapote Road, Alabang, Muntinlupa City
Tel 386-6435
Intellicare Ortigas Clinic
Clinic Hours: Monday-Saturday / 8am to 5pm
Ground Floor, AIC Grande Tower,
Sapphire St., Ortigas Center
Tel. 706-3844
Intellicare Cebu Clinic
Clinic Hours: Monday-Saturday / 8am to 5pm
Unit 203 2/F TGU Tower I.T. Park
Asiatolon, Apas, Cebu City
Tel. 231-0660/61/62/63

44. Intellicare Calamba Clinic
Clinic Hours: Monday-Saturday / 8am to 5pm
Unit S-5, S– 9 to 10 Daniel Commercial Complex, Old
National Hi-Way, Brgy. Parian, Calamba, Laguna
Tel (049) 545-4446/(049) 545-5183
Intellicare Sta. Rosa Clinic
Clinic Hours: Monday-Saturday / 8am to 5m
Unit 26 & 27 Sta. Rosa Commercial Complex,
Balibago, Sta Rosa City Laguna
Intellicare U.N. Avenue Clinic
801 United Nations Ave., Ermita, Manila
Tel 521-8108 / 536-3906
Intellicare PCS Clinic
2nd Floor Philippine College of Surgeon Bldg.,
992 North Edsa, Quezon City
Clinic Hours: M-Sat 8:00am-5:00pm
Tel. # (02) 929-5127 / 929-5412

45. Illnesses diagnosed or pathogenesis has started before
enrollment or during the first year of membership with IntelliCare,
with or without the member’s knowledge.
Includes Dreaded Diseases, which are chronic or irreversible
illnesses present prior to enrolment.

46. The following are considered as PECs:
Hypertension Hemorrhoids and anal fistulae
Thyroid disease, Goiter Tumors
(hypo / hyperthyroidism)
Uterine myoma, ovarian cyst,
Cataracts / Glaucoma / Pterygium endometriosis
ENT conditions requiring surgery Buerger’s disease
Bronchial asthma Varicose veins
Tuberculosis Scoliosis
Chronic cholecystitis, cholelithiasis Arthritis
(gallbladder stones) and other forms of
calcification Chronic allergies
Hernia Gastric and Duodenal ulcers
Prostate disorders

47. The following are classified as dreaded diseases:
Stroke, Paralysis, Epilepsy Rheumatoid arthritis, systemic lupus
erythematosus
Poliomyelitis, Meningitis, Encephalitis
and other neurosurgical conditions Injuries from previous accidents
Coronary, Valvular and Hypertensive Single or multiple organ failure requiring
Heart Diseases dialysis
Asthma, Chronic Bronchitis, Emphysema Burns (if occuring prior to enrollment)
Cirrhosis, Hepatitis, Newgrowth Cancers, Leukemia, Idiopathic
Thrombocytopenic Purpura
Urolithiasis, Obstructive Uropathies
Diabetes mellitus, diabetes insipidus
Chronic gastrointestinal tract diseases
requiring bowel resection and/or ICU confinement and other illnesses
anastomosis requiring an extended stay in the
hospital for an uninterrupted period of
15 days

48. For any concerns or questions regarding Philhealth:
Benefits & Coverage
Eligibility
Membership/Payments/Requirements
Please consult your Human Resource Department or visit their
website at www.philhealth.gov.ph