Out-Patient Care Benefits: (Without Access to Healthway Clinics)

• • Referral to Specialists covered up to PEC Limit

  • Regular consultations & Treatment (Except Medicines) up to PEC Limit

  • EENT Treatment covered up to PEC Limit

  • X-ray and Laboratory Procedures covered up to PEC Limit     

  • Cataract extraction (excluding cost lens) up to MBL

  • Speech and physical therapy Covered up to 16 sessions to PEC Limit

  • Laser treatment for glaucoma and retinal detachment except for cases of myopia or correction of an error of refraction covered up to PEC Limit

  • Pre & Post-natal consultations except Laboratories covered up to MBL

  • Cauterization of warts (from neck down except genital warts) covered up to MBL at Aventus Clinics

  • 1st dose of anti-rabies, anti-venom, and anti-tetanus is covered up to Php10,000

  • A free consultation fee of the following doctors (Gen Surgeon, OB, Pedia, Family Med, Gen Internist, Gen Practitioner) at Aventus Clinics.

In-Patient Care Benefits: 

• • No deposit upon admission

  • Regular Private Room and Board

  • Use of Operating Room and Recovery room     Services of Specialists

  • Services and medical for general/spinal anesthesia and other anesthesia deemed necessary for surgical operation

  • Fresh whole blood product transfusions and intravenous fluids     X-ray and Laboratory examinations

  • Administered medicines

  • Dressing, sutures and plaster casts and other items related to management of the patient     ICU Confinement

  • Radioactive Iodine Therapy

  • Hepatitis B (except if sexually transmitted)

  • Modern  therapeutic  and  interventional  surgical  procedure  such  as  but  not  limited  to laparoscopic

  • Cholecystectomy/ adrenalectomy and lithotripsy/ESWL

  • CT Scan/ MRI and ultrasound/Chemotherapy/ Radiotherapy/ Dialysis

  • Human blood products and its screening /processing except gamma globulin for Kawasaki disease up to MBL per year

  • Work-related illness/accidents except those in the exclusions

  • Congenital illnesses (e.g. AV Malformation, Mitral Valve Prolapse, Indirect Inguinal Hernia)     Open heart surgery (except cost of pacemaker) including angioplasty and the like

  • Sleep disorder covered up to Php20,000.00 per member per year     Slipped disc, scoliosis, spondylosis and spinal stenosis

  • Admission kit including wee bag during confinement     Stereotactic Brain Biopsy

  • Gamma Knife Surgery (based on cobalt/ radiotherapy)     Transurethral Microwave Therapy of Prostate

  • Cryosurgery covered up to Php 1,000 per area subject to PEC Limit

  • Hyperventilation syndrome covered up to Php 10,000 per year for Principals only

  • New modalities, diagnostics & treatment procedures for conditions with established etiologies and its use is only alternative to the conventional methods

  • Laboratory/ancillary services for conditions whose pathogenesis is not yet fully established in Medical Science Professional fee for assisting physician in surgical procedures

  • Assistance of Patient Relation Officers

  • All other items related to the management of the case

  • Angiography (e.g. coronary, cerebral, retinal, pulmonary, GI, etc.) Serum Chemistry panels (e.g. Chem 23, Spec M, etc.)

  • Pulmonary Perfusion Scan

  • Tests involving use of Nuclear Technologies (e.g. Radionuclide Ventriculography/ Thallium Stress Testing/ Radionuclide/ Thyroid Scan, etc.) Nuclear Technologies such as Pyrophosphate Scintigraphy, Positron Emission Tomography, Radio Isotope Scanning, etc.

  • Electromyography, Nerve Conduction Velocity Studies     24-Hour Holter Monitoring, 2-D Echo and Doppler

  • Treadmill Stress Test, Myelogram, Mammography, and Sonogram, Bone Densitometry Scan

  • Diagnostic Endoscopy (including 1 video), Diagnostic Arthroscopy, Diagnostic Hysteroscopy, Adrenocortical Function, Plasma/urinary cortisol, Plasma Aldosterone, Adrenocortical Function, etc.

  • Immunologic studies, anti-nuclear antibody ana, c-reactive protein, lupus cell exam     Genetic studies.

Dental Care Services

• • Dental examination

  • Twice a year prophylaxis (scaling/polishing); Deep scaling once a year 

  • Simple tooth extractions

  • Temporary fillings

  • Permanent amalgam filling (2 teeth per member/year) Light cure Fillings (3 teeth per member/year)

  • Re-cementation of jackets, crowns, inlays, inlays

  • Treatment of minor gum problems, mouth lesions, wounds, and burns  Orthodontic consultations (for braces and malposition of teeth)

  • Temporary mandibular joint consultation (for the clicking of jaws) Pre-natal check of teeth and gums

  • Emergency dental treatment for the relief of pain

Availment procedure: Dental Care

• • 1. 1. Set an appointment with an Intellicare -affiliated dentist.

       2. Proceed to the dental clinic on your scheduled date and present your INTELLICARE MEMBERSHIP ID CARD with two (2) valid IDs.

       3. Avail the entitled benefit and Sign the Referral Control Sheet (RCS) 5 made available at the dental clinic.

Additional Benefits

• • Anti-rabies vaccines shall be covered up to Twenty Thousand Pesos (Php20,000.00) per member per year

  • Allergy Testing/allergy screening will be covered up Php2,500.00 per member per year if prescribed by an Accredited Physician

  • Chronic dermatoses shall be covered for consultations only

  • Congenital  conditions  shall  be  covered  up  to  Php10,000.00  per  member  per  year;  subject  to  PEC  limit (whichever is lesser)

  • Electrocauterization  of  skin  lesions  such  as  plantar  warts,  flat  warts,  periungual  warts,  filiform  warts, and molluscum contagiosum, in any part of the body, except genital warts and condyloma acuminata, prescribed by an Accredited Physician/Specialist shall be covered up to Php1,000.00 per member per year

  • Eye laser treatment for retinal tear, retinal hole, retinal detachment and glaucoma (excluding eye correction such as lasik, PRK and the like) shall be covered up to Php10,000.00 per member per year

  • Organ transplant excluding the cost of organ and any expenses associated with the donor shall be covered up to PEC limit per year

  • Poliomyelitis shall be covered for consultations only

  • Blood chemistries shall be covered up to PEC limit per year

  • Sclerotherapy shall be covered up to Php5,000.00 per leg per year provided that it is medically necessary and recommended by an affiliated vascular surgeon.

  • Scoliosis shall be covered up to Php10,000.00 per member per year.

  • Slipped disc and spondylosis shall be covered up to PEC limit per year

  • Tuberculin Test will be covered up to Php 600.00 per member per year if the member shows symptoms of Tuberculosis and if prescribed by an accredited physician.

  • Work-related cases shall be covered up to the maximum benefit limit per principal per year subject to the exclusions and limitations of the contract

  • Unprovoked murder & assault 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

  • Sleep Study (must be directly related to an organic illness) shall be covered up to Twenty thousand pesos (Php 20,000.00) per member per year.

DEATH AND DISMEMBERMENT: Thru FWD Insurance

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