PAYPAL PHILIPPINES, INC - February 1, 2020 to January 31, 2021 Period of Coverage - PayPal Benefits
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PAYPAL
PHILIPPINES, INC.
Period of Coverage
February 1, 2020 to January 31, 2021
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
1. Parents
Not over 65 years old
SINGLE PARENTS
PRINCIPALS
1. Children (Eldest to Youngest)
Biological / Legitimate/ Legally Adopted
15 days old – 21 years old
Unmarried & Unemployed
2. Parents
Not over 65 years old
MARRIED
PRINCIPALS
1. Legal Spouse
Not over 65 years old
2. Children (Eldest to Youngest)
Biological / Legitimate/ Legally Adopted
15 days old – 21 years old
Unmarried & Unemployed
EXTENDED DEPENDENT
3. Parents
Not over 65 years old
UNMARRIED
PRINCIPALS
1. Children (Eldest to Youngest)
Biological / Legitimate / Legally Adopted
15 days old – 21 years old
Unmarried & Unemployed
2. Domestic/ Common Law / Same
Gender Partner
Not over 65 years old
UNMARRIED
PRINCIPALS
REQUIREMENTS 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
ENROLLMENT
POINTERS
20- Calendar Day Window Period
Dependents shall be enrolled within 20 days from the
effectivity of coverage.
No additional enrollments except for:
New born baby: 20 days from date of eligibility
Spouse of a newly wed employee: 20 days from date of
marriage
Dependent of a new employee: 20 days from effective date
of Principal memberENROLLMENT
POINTERS
DEPENDENTS REQUIREMENTS
Parents Birth Certificate
Spouse Marriage Contract
Birth Certificate or Certificate of Live Birth
Child
Birth Certificate/ Barangay Certificate of
Domestic /Common Law/
Cohabitation/ CENOMAR (Certificate of No
Same Gender Partner Marriage)
Skipping of Hierarchy:
Dependents with Existing Active HMO membership
Dependents residing/working abroad
Legally Separated
DeathPLAN LIMITS
ROOM AND BOARD MAXIMUM BENEFIT LIMIT
(Regardless of the price) (Per type of Illness)
OPEN PRIVATE 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 CLINICSPLAN LIMITS
PRE-EXISTING CONDITION (PEC)
Existing New
Principals
Dependents Dependents
Up to MBL Up to MBL Up to MBL
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
FOR ALL MEMBERS
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.
Wellness Program shall be covered up to four (4) sessions per member per
year
Routine Immunization (except cost of vaccines)
Note: APE process for employee and dependents to be announcedOUT-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 Maximum Benefit limit/member/year.
NOTE:
With access to Healthway Medical ClinicsOUT-PATIENT
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:
With access to Healthway Medical ClinicsOUT-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: Certain out-patient procedures will require filing of Philhealth.www.aventusmedical.com
NORTH EDSA
2/F Philippine College of Surgeon Bldg., 992 North Edsa,
Quezon City
METRO MANILA ☎: (02) 8352-4676 / (02) 8352-4677
MAKATI – AYALA NORTH EXCHANGE
3/F Retail 61 & 62, Amorsolo St., Ayala Ave., ALABANG
Makati City 2/F Sycamore ARCS 1 Building, Buencamino St. cor.
☎: (02) 8587-8053 Alabang-Zapote Road, Alabang, Muntinlupa City
☎: (02) 8556-3596 / (02) 8556-3592
MAKATI – FILOMENA BLDG.
6/F Filomena Bldg., 104 Amorsolo St., Legaspi Village,
Makati City REGIONAL
☎: (02) 8519-6787 / (02) 8817-1464 / (02)8 869-3289 CALAMBA
Unit 201-203 SQA Corporate Center, Barangay 1, National
BGC Highway Crossing, Calamba City, Laguna
G/F Citibank Plaza, 34th St. Corner Lane D., Bonifacio ☎: (045) 499-8417 / (045) 499-8419
Global City, Taguig City
☎: (02) 8352-8335 / (02) 8362-0042 STA. ROSA
2/F Carvajal Building 2, National Highway, Balibago City,
MANILA Sta. Rosa, Laguna
5/F Times Plaza Bldg., U.N. Ave. corner Taft Ave., Ermita, ☎: (049) 508-1806 / (049) 306-0397
Manila City
☎: (02) 8353-6807 / (02) 8353-6808 CLARK
G/F BPO Building 5, SM City Clark, M.A. Roxas
PASAY Highway,Brgy. Malabanias, Angeles City, Pampanga
Scape Bldg., Macapagal Avenue, cor. Pearl Drive, Central ☎: (045) 499-8417 / (045) 499-8419
Business Park 1, San Rafael, Brgy. 76, Pasay City
☎: (02) 8541-5645 / (02) 8838-0627 CEBU IT PARK
Unit 203 TGU Tower, Asiatown, IT Park Apas, Cebu
ORTIGAS ☎: (032) 479-9261
G/F AIC Grande Tower, Sapphire St. cor. Garnet Road,
Ortigas Center, Pasig City CEBU CYBERGATE
☎: (02) 8584-2430 / (02) 8584-1013 L/3 Robinsons Cybergate, 2029 Don Gil Garcia & J.
Llorente St., Capitol Site, Cebu
☎: (032) 236-9028 / (032) 238-3922 / (032) 238-7672PREFERRED NETWORKS
5 Person Ward Emergency
Daniel Mercado Medical Center – Batangas
QualiMed Hospital – IloIlo
QualiMed Hospital – Nuvali, Laguna
QualiMed Hospital – San Jose Del Monte
QualiMed Clinic - Fairview Terraces
QualiMed Clinic - UP Town Center
QualiMed Clinic - Mckinley Road
QualiMed Surgery Center - Manila
Intellicare Lane Private RoomPREFERRED 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 Hospitalwww.medgatephilippines.com
www.medgatephilippines.com
1 2 3 4
Call Triage Teleconsultation E-treatmentwww.medgatephilippines.com
Save on travel cost Save on time 24/7 | 365 days a year Save money
Multiple touchpoints No waiting in line Optional medication No disease exposure
delivery
38 pre-approved labs 3-Day unli consultswww.medgatephilippines.com
Call Doc. Anywhere.
TM
Anytime. No Line.
(02) 8705 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)
; ; ;
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 (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)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)
d
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: 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 Php30,000 Up to Php30,000
COVERAGE thru reimbursement thru reimbursement
HOSPITAL
BILLS 100% 80% 100%
PROFESSIONAL
BILLS 100% *RVS 80% *RVS 100% *RVS
*Relative Value Scale (RVS) – HMO RatesREIMBURSEMENT
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 30 days from expiration of treatment.
Processing of the request is within 20 working days upon receipt of complete documents.☎: 1-800-101DENTAL (PLDT Toll-free) | (02) 8911-7777 (PLDT Trunk Line)
DENTAL
Thru:
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☎: 1-800-101DENTAL (PLDT Toll-free) | (02) 8911-7777 (PLDT Trunk Line)
DENTAL
Thru:
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☎: 1-800-101DENTAL (PLDT Toll-free) | (02) 8911-7777 (PLDT Trunk Line)
DENTAL
Thru:
AVAILMENT PROCESS
MOBILE NUMBERS:
(0923) 809-5376 (Sun)
(0916) 761-5277 (Globe)
Set an appointment with an affiliated Dental Network Company dentist.
Proceed to the dental clinic on your scheduled date and present your Intellicare DENTAL FORM
Membership Card with two (2) valid IDs for membership status validation.
d
Avail the entitled benefit and sign the Dental Form.ADDITIONAL BENEFITS 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. HIV/ AIDS treatment is covered up to the maximum benefit limit per member per year. Note that out-patient medicines are not covered. HIV/STD test is covered ONLY for employees (principal members) once a year and can be availed by walk-in at Aventus Clinics only.
ADDITIONAL BENEFITS Hepatitis B (if acquired) shall be covered up to the maximum benefit limit per member per year. 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. HIV/STD TEST is covered ONLY for employees (principal members) once a year and can be availed by walk-in at Aventus Clinics only. 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. 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.
ADDITIONAL BENEFITS
Maternity Assistance: A maternity assistance program shall be made available to all enrolled female
employees and legal spouse of male employees of the company. 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
Note: Maternity benefit may be covered outright if availed in an accredited hospital through an
accredited physician. Otherwise, coverage shall be on a reimbursement basis.ADDITIONAL BENEFITS
Please note that 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. Otherwise, coverage shall be on a reimbursement basis.www.fwd.com.ph ✉: corporateclaims.ph@fwd.com
LIFE INSURANCE
FOR PRINCIPAL MEMBERS ONLY
Thru:
Group Life Insurance - Php 10,000.00
Family Assistance Benefit - Php 1,000.00
Terminal Illness Benefit - Php 10,000.00
Accidental Death - Php 10,000.00www.fwd.com.ph ✉: corporateclaims.ph@fwd.com
LIFE INSURANCE
FOR PRINCIPAL MEMBERS ONLY
Thru:
SCHEDULE OF INJURIES PERCENTAGE SCHEDULE OF INJURIES PERCENTAGE
Both hands or feet 100% One ear 50%
One hand or foot 100% Thumb (both phalanges) 25%
Either one hand or one foot or one foot 100% Thumb (one phalanx) 10%
& sight of one eye Finger(s) (per phalanx) 3.5%
Loss of speech 50% Great toe 5%
Loss of hearing 50% Toe, other than great toe (one phalanx) 1%
Either one hand or one foot or one eye 50% Fractured leg or patella with 10%
Arm at above elbow 70% established non-union
Arm between elbow & wrist 60% Shortening of leg by at least 5cm 7.5%
Leg at or above knee 70% First or second metacarpals 3%
Leg between knee & foot 60% Third, fourth, or fifth metacarpals 1%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)
GENERAL EXCLUSIONS AND LIMITATIONS 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 Dental surgery, dental X-ray, impacted tooth / wisdom tooth 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
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 Congenital abnormalities Neuro-developmental & genetic disorders (which may result to mental retardation) Developmental delay Sexually transmitted diseases Psychiatric and psychological illnesses
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: Php100.00CERTIFICATE OF COVER
NOTE:
In the absence of the membership
card, member may present the
Certificate of Cover (COC) signed by
an HR representative.WEBSITE
www.intellicare.com.phCONNECT WITH US
Trunk Lines: (02) 7902-3400 / 8789-4000
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 /Intellicare-PHThank You
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