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Insular Health Care Inc Makati Office Clinic

Summary of Plan Benefits for Individual and Family

Plan A (“Open Access to Accredited Hospitals” Program)

Under this plan, a member may use any Insular Health Care accredited hospital nationwide including Asian Hospital & Medical Center, Cardinal Santos Medical Center, Makati Medical Center, St. Luke’s Medical Center (Q.C.), The Medical City except St. Luke’s Medical Center (GC).

Plan B (“Preferred Hospital” Program)

Under this plan, a member will have to select and strictly use his preferred  hospital except during genuine emergencies (as defined in the “Agreement”) whereby he may use any hospital nearest him. If a member uses an accredited hospital, we afford him full coverage according to his benefits classification. If a member uses a non-accredited hospital, reimbursement of expenses will be governed by the Emergency Benefits provision of the Agreement.

Except Asian Hospital & Medical Center, Cardinal Santos Medical Center, Makati Medical Center, St. Luke’s Medical Center (Q.C.), St. Luke’s Medical Center (GC).

Plan features applicable to both Plan A & Plan B

  1. For primary care (non-emergency cases), entry point to all accredited hospitals SHOULD BE THE COORDINATOR’S OFFICE. During off-clinic hours, and only for genuine emergency cases (as defined in the Agreement), a member may go to the Emergency Room for treatment.
  2. Makati Medical Center (MMC) users will first have to pass through the Insular Health Care Clinic (at the Insular Health Care Building in Makati City and avail of its services. When the member requires services that are only available in MMC will he be referred to the hospital. During the genuine emergencies (as defined in the Agreement), a member may use any hospital nearest him. If a member uses an accredited hospital, we afford him full coverage according to his benefits classification. If a member uses a non-accredited hospital, reimbursement of expenses will be governed by the Emergency Benefits provision of the Agreement.
  3. Some accredited Metro Manila and provincial hospitals no longer have semi-private rooms or no longer admit HMO patients to semi-private rooms (e.g. Makati Medical Center, The Medical City, UST Hospital, Chong Hua Hospital, Mary Chiles General Hospital, and Dr. Jesus Delgado Memorial Hospital). For members who select the semi-private room accommodation plan and / or use hospitals without semi-private rooms for in-patient benefits, please be advised that these hospitals will automatically admit the member to the next higher room accommodation on a step-ladder basis. For genuine emergency cases (as defined in the Agreement), Insular Health Care takes care of the difference in upgraded costs for the first 24 hours. After the first 24 hours, the member pays for the difference in upgraded costs prior to his discharge from the hospital. For elective cases, the member pays for the difference in upgraded costs from day one of his confinement prior to his discharge from the hospital. Please see provision “b” under Room and Board of In-Patient Benefits.