Frequently Asked Questions
Q: What happens if I fail to make the modal premium payments on time?
A: If you miss paying membership fees with dues that fall on a monthly, quarterly or semi-annual mode, you are given a 31-day extension period to pay in order to keep your health care plan active. You may avail of the benefits under the Health Care Agreement during the extension period only if you pay the membership fees due for the whole period prior to the availment of such benefits. Non-payment of membership fees 31 days from the due date will automatically void your Health Care Agreement.
Q: I am entitled to a private room accommodation. May I be admitted to the most expensive private room in an accredited / preferred hospital offering different private room categories?
A: This is allowed when the most expensive private room is the only available accommodation among the different private room categories offered by the accredited/preferred hospital. The “stepladder” rule serves as our guide. The cheapest available private room as categorized by the hospital must be occupied by a member requiring admission. Any upgrading to a more expensive private room when a cheaper one is available shall entail corresponding charges, which shall be imposed on the member.
Q: Is my Insular Health Care membership activated after paying my membership fee and submitting my application?
A: Insular Health Care reserves the absolute right to approve or disapprove any application for membership or renewal thereof. In effect, your payment is considered a deposit subject to Insular Health Care’s final action on your application or membership renewal. Whichever is applicable, each application or membership renewal is evaluated based on the current health care costs. Your medical compliance with underwriting requirements among others, This is done on a yearly basis considering the 12-month effectively of our health care agreements. In case an application or a membership renewal is disapproved due to adverse medical conditions, an applicant or Member may still avail of the Insular Health Care program by executing a waiver relinquishing or limiting coverage for the identified adverse conditions.
Q: When can I use a non-preferred hospital belonging to the Insular Health Care network of accredited hospitals?
A: You may use an accredited, non-preferred hospital only for genuine emergencies (as defined in the Agreement). For unanticipated life-threatening situations, a member may use any hospital nearest him. If the hospital is accredited, we will afford you full coverage according to your benefits classification. If the hospital is not accredited with Insular Health Care, reimbursement of expenses incurred will be governed by the Emergency Care Provision of the Agreement.
Q: Will Insular Health Care allow me to use my non-accredited personal doctor considering that my physician already knows my medical history?
A: No, care by a non-accredited physician is not entitled to health care benefits as stipulated in the Agreement. Nonetheless, Insular Health Care will facilitate continuity of care through its line-up of qualified specialists.