HMO Healthcare Benefits for Family & Individual InLife Health Care
1. Outpatient Benefits
Annual Physical Examination
- Taking of Medical History
- Physical Examination
- Chest X- RayLaboratory Examination
- CBC, Urinalysis, Fecalysis
- ECG (for members 35 years old and up)
- Pap Smear (for female members, 35 years old and up)
Preventive Care
- Immunization (excluding cost of Vaccine) Consultation and advise on diet
- Periodic Health Monitoring
- Family Planning/ Counselling (except for Infertility)
- Health Education and Wellness Program Medical Information
Outpatient Services
- Consultation, including specialists’ evaluation
- First aid treatment of injury and illness Laboratory examinations and all diagnostic procedures as prescribed by an accredited doctor
- Minor surgery not requiring confinement
- ENT care
- Tuberculin Test up to P600/member/year Allergy Test up to P2,500/member/year
2. Inpatient Benefits
Room and Board
Services of all accredited specialist General nursing services
Use of operating room
Use of recovery room
Anesthesia and its administration
Drugs and medication for use in the hospital Oxygen and its administration
Dressing, plaster cast
Transfusion of blood (except donor screening)
Chemotherapy/radiotherapy
ICU confinement (max of 14 days but subject to MBL)
Dialysis (max of 10 treatments but subject to MBL)
Physical Therapy (max of 10 sessions but subject to MBL)
Speech Therapy (max of 7 sessions but subject to MBL)
Medical services and supplies
Ambulance services (hospital to hospital; limited to P2,500.00/conduction) Admission Kit
3. Emergency Services
Doctor’s services Administered medicines Intravenous fluids
Oxygen and its administration
Diagnostic & laboratory procedures necessary for patient’s emergency management
Other services related to the management of the case Emergency availment within IHC’s provider network will be covered up to 100% of the covered benefits of the member’s plan.
Emergency availment outside IHC’s provider network will be covered on REIMBURSEMENT basis:
- Within 30 km. radius & Foreign Territory – up to 80% of the IHC standard rates not to exceed P 30,000
- Outside the 30 km. radius – up to 100% of the IHC standard rates
4. Additional Benefits
Prescription Medicine
The Member is entitled to prescription medicine up to the amount of Php 1,000 during the contract period of one (1) year relative to treatment of a health condition that is covered under the Agreement. The medicine must be prescribed by an InLife Health Care Physician. The Member must present original receipts for reimbursement and other supporting documents within sixty (60) days from date of purchase.
Term Life Insurance Coverage
Coverage for death benefit in the event of death due to natural cause or accident provided that the case is covered under the agreement.
| ROOM ACCOMMODATION | STANDARD RISK | SUBSTANDARD RISK |
| Suite | Php 50,000 | Php 25,000 |
| Private | Php 25,000 | Php 12,500 |
| Semi Private | Php 15,000 | Php 7,500 |
| Ward | Php 10,000 | Php 5,000 |
5. Optional Benefits
Dental Benefits
Any number of consultations on dental problems including but not limited to lesions, wounds, burns, and gum problems
Annual Oral Prophylaxis (mild to moderate cases)
Unlimited simple tooth extractions, except surgery for impaction or extraction of impacted tooth or complicated extractions involving the use of other dental instruments aside from pliers and/or the re-administration of anesthesia
Unlimited temporary fillings
Re-cementation of jacket crowns, inlays and on lays (limited to 4 abutments)
Dental education and counseling during consultations Simple adjustment ofdenture clasps
Any number of consultations/dental examinations including treatment of lesions, wounds, burns, gum and other dental problems except diagnostics, prescribed medicines, surgeries and “root-canal” procedures
No limit as to the number of abutments covered (on item 5 above) Orthodontic consultations.
Aesthetic dental consultations.
Emergency desensitization of hypersensitive teeth.
Member has the option to choose between three (3) surfaces of amalgam fillings or two (2) surfaces of “light cure” filling.