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Insular Health Care Inc Makati Office Clinic

Pre-Existing Conditions (PECs) for Individual and Family

A. An illness or condition shall be considered pre- existing if before the Effective Date of the Agreement:

  1. Any professional advice or treatment was given for such illness or condition
  2. Such illness or condition was in any way evident to the member
  3. The pathogenesis of such illness or condition has already started (which the member may not be aware of)

B. PECs are not covered in the first year of coverage.

C. After the member has been continuously covered with Insular Health Care for 12 months and the agreement is renewed, the following provisions on PECs shall apply:

  1. PECs are covered provided that the PECs are not considered part of the “Permanent Exclusions to Health Care Coverage”, and that
    1. such PECs were declared by the member in the original / renewal application;
    2. such PECs are unknown to the member (without established medical history);
  2. Undeclared PECs with established medical history are excluded from coverage. However, said PECs may be evaluated for possible future consideration.
  3. In case an application is disapproved due to an adverse medical condition, an applicant may still avail of the Insular Health Care program by executing a “waiver” relinquishing or limiting coverage for the particular adverse condition/s (as stated in the provision on Enrollment / Approval of Application).

D. Examples of PECs: (inclusive of complications)

  1. Hernias
  2. All tumors and malignancies involving any body organ or system
  3. Endometriosis, Dysfunctional Uterine Bleeding
  4. Hemorrhoids
  5. Diseased tonsils requiring surgery
  6. Pathological abnormalities of the nasal septum and turbinates
  7. Thyroid Dysfunction/Goiter
  8. Cataract
  9. Sinus condition requiring surgery
  10. Asthma / Chronic Obstructive Pulmonary Disease
  11. Cirrhosis of the liver
  12. Tuberculosis
  13. Anal Fistula
  14. Cholelithiasis / Cholecystitis
  15. Calculi of the urinary system
  16. Gastric or Duodenal Ulcer
  17. Hallux Valgus
  18. Diabetes Mellitus
  19. Hypertension
  20. Collagen Disease / Auto Immune Disease
  21. Cardiovascular Disease
  22. Seizure Disorder / Cerebral Insufficiency / Stroke

E. The following health conditions may be covered (either fully or up to certain amounts) provided pre-existing conditions of an account are likewise covered:

  1. Organ transplants and/or open-heart surgery / angioplasty and all services (e.g., coronary angiogram) related thereto (except organ donor services)
  2. AIDS and AIDS-related diseases except when sexually transmitted
  3. Congenital abnormalities and conditions are covered up to Php 10,000.
  4. Chronic glomerulonephritis, gullain-barre syndrome
  5. Physical deformities (e.g. Scoliosis, Spinal Stenosis, etc.); vitiligo & psoriasis (only consultations are covered)