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ALLCARE for Individuals Terms & Conditions

Benefits Details

Health Benefit Limit (HMO)

  • PHP 150,000.00, PHP 100,000.00 or PHP 50,000.00 Maximum Benefit Limit via Etiqa (formerly Asian Life)
  • Access to over 1,500 hospitals and clinics nationwide
  • Access to Top 9 hospitals in the country - including but not limited to Cebu Doctors, Chong Hua and Davao DoctorsHospital and the Big 6 Hospitals in Metro Manila
  • Can be used for emergency care, outpatient consultations, non-confinement; medical procedures; Inpatient (confinement in a small private room or equivalent)
  • All pre-existing conditions are covered up to PHP 30,000.00 for the 1st year and covered up to MBL for the 2nd year
  • Congenital disease/deformities are covered up to PHP 30,000.00
  • Special Modalities covered up to MBL
  • No pre-availment medical exam
  • HIV-related cases coverage up to 30% of MBL as long as medically necessary

Life Insurance

The plan member is provided with a life insurance coverage to serve as financial assistance for his designated beneficiaries as a result of his death:

Death due to natural causes :PHP 50,000.00
Death due to accident :PHP 100,000.00

Annual Physical Exam (Basic 7)

Free one (1) Annual Physical Exam voucher consists of:

  • Complete Blood Count
  • Urinalysis
  • Fecalysis
  • Xray
  • Physical Examination
  • Papsmear (for female enrollees 35 years old and above); and
  • ECG (for enrollees 35 years old and above) to be conducted at/provided by a specific Etiqa-accredited APE provider.

The Annual Physical Exam benefit of each member shall be available for claim after the membership fee of said member has been fully paid:

  • Annual: APE can be availed any time after full premium remittance;
  • Semi-annual: APE can be availed after full premium remittance due for the 2nd semester;
  • Quarterly: APE can be availed after full premium remittance due for the last quarter.
  • Monthly: APE can be availed after full premium remittance due for the last month.

Teleconsultation

12 months access to doctors and nurses via video consultation from the comfort of your home via Etiqa.

Dental Care

  • Two (2) Oral cleaning service
  • Two (2) Pc of Permanent Filling or Light Filling
  • Unlimited consultations
  • Simple Tooth Extractions (does not include molars, wisdom tooth)
  • Adjustment of Dentures
  • Treatment for pains, lesions and burns
  • Up to 20% discount on dental services on HPDAI-accredited dental clinics

Emergency Ambulance Service

One-time reimbursable up to a maximum of PHP 5,000.00 per year.

Eye Care Benefits

Sarabia Optical

  • Two (2) Oral cleaning service
  • Two (2) Pc of Permanent Filling or Light Filling
  • Unlimited consultations
  • Simple Tooth Extractions (does not include molars, wisdom tooth)
  • Adjustment of Dentures
  • Treatment for pains, lesions and burns
  • Up to 20% discount on dental services on HPDAI-accredited dental clinics

Vision Express

  • 7-Step Comprehensive Eye Exam
  • Buy 1, Get 1 Promo
  • 15% discount on all regular items
  • 15% discount on pre-packed Tony Morgan London computer glasses
  • 15% discount on Shamir and Tokai Lenses
  • 10% discount on all Bausch and Lomb Contact Lenses
  • Unlimited free custom fitting and frame adjustments
  • Unlimited free ultrasonic eyewear cleaning
  • Replacement of screws and nose pads for frames
  • Eyecare health talk/webinar

Shinagawa

  • Up to 65% off on select Lasik services
  • Up to 60% on select implantable contact lenses
  • Free comprehensive eye screening (worth PHP 3,500)
  • Up to 70% off on select Aesthetics/Derma services

Mental Health Benefits

Mental Health Survey

A free comprehensive survey to better understand your mental health status.

Mental Wellness Consultation

Two free Empath sessions with a consultant via Empath.

Limitations

The benefits package excludes coverage of the following:

  • Expenses that should be taken cared by any government programs such as PhilHealth and the likes;
  • Services rendered or supplies provided free of charge;
  • Additional hospital charges and/or professional fee charges resulting from the Plan holder’s taking a room accommodation more than his Room & Board limit (excesses and/or incremental costs);
  • Maternity and maternity-related conditions and/or complications except those benefits that may be provided by the (optional) Maternity Benefit;
  • Sterilization of either sex or reversal of such, artificial insemination, sex change, consultation/confinement regarding infertility;
  • Non-recommended confinement, convalescent/domiciliary/custodial care; rest cures,
  • Dental-related cases except those that may be provided by the (optional) Dental Benefits and to the extent that are necessary for the repair or alleviation of damage caused solely by accidental injury sustained (and not caused) by the Plan Member;
  • Circumcision, cosmetic/aesthetic procedures except re-constructive surgery to treat functional defect(s) due to a covered disease and/or accidental injury;c
  • Psychiatric disorders, psychosomatic conditions, treatment for any mental or nervous disorders, illness/injury/condition/complication arising from the Plan Member’s too much alcohol intake and/or use of regulated/prohibited drugs;
  • Illnesses and/or injuries arising from the Plan Member’s participation in brawl, riots, commission of a crime, violation of ordinances and the likes;
  • Illnesses/injuries resulting under conditions of war or sustained from combat-related activities;
  • Illnesses/injuries resulting from the Plan Member’s active participation in hazardous activities such as, but not limited to, bungee jumping, hang-gliding, scuba diving, mountain/wall climbing including professional sports;
  • Illnesses/injuries attributable to the Plan Member’s own misconduct/ gross negligence/immoral habits, willful and unnecessary exposure to danger or hazard to health;
  • Self-inflicted injuries including and, not limited to, any form of suicide attempt;
  • Rehabilitative treatment on alcoholism and drug abuse;
  • Acquisition of prosthetic appliances, artificial aids, durable equipment, surgically implanted devices and external prosthetic devises except those that are explicitly covered and enumerated in the “Special Procedures or New Modalities of Treatment” provision of this Agreement;
  • Organ transplant-expense relating to organ donation of the donating party/parties;
  • Executive check-ups and/or confinement purely for diagnostic purposes and non-recommended confinements;
  • Medico-Legal Fees including costs of Medical Certificates that a Plan Member may require for any purpose it may serve him;
  • Medical and/or surgical procedures/diagnostic tests that are experimental in nature and/or not generally accepted by the medical profession such as, but not limited to, iridology, chiropractic services, acupuncture.

Terms of Engagement

Eligibility

  • Enrollees must be enlisted in the Membership Enrollment Form (MEF) and the client must complete the necessary requirements and appropriate membership fees.
  • Eligible members shall be between 30 days to 64 years of age upon enrollment.

Requirements for Enrollment

  • Accomplished Member Enrollment Form (MEF provided by ALLCARE)
  • Valid Government IDs
  • Birth Certificate (for minor plan members)

Membership

  • Membership activation will commence 7-10 working days after date of confirmation of complete requirements and verification of payment.
  • All members must claim their benefits through the ALLCARE MyBenefits Dashboard or ALLCARE MyBenefits app.
  • Unclaimed benefits and perks are not refundable or transferable.
  • In case of membership forfeiture, NO REFUND or TRANSFER shall be made to the customer.
  • The client must provide basic information for members’ registration to be done by ALLCARE.
  • The client and all members accept the standard terms and conditions of each membership found on the ALLCARE website.
  • For married principal members, eligible dependents are the spouse, followed by children. For single principal members, eligible dependents are the parents followed by siblings.
  • All members get access to the ALLCARE MyBenefits Dashboard where disbursement of benefits is automated like Requesting for LOA/LOG, requesting for a dental check-up, annual physical, etc. or in the absence of the member’s card, he/she can use the portal to get their membership number for emergencies.

Dependents Membership

  • Adult Dependents (18-64 years old):Benefits include HMO (MBL), Basic 7 Annual Physical Exam, Life Insurance, Emergency Ambulance Service, Teleconsultation, and Dental Benefits
  • Minor Dependents (1-17 years old):Benefits include HMO (MBL), Basic 7 Annual Physical Exam, Life Insurance, Emergency Ambulance Service, Teleconsultation, and Dental Benefits
  • Dependents Membership fee:The same rate applies as agreed with the principal members

General Utilization Procedure

Every member shall follow each benefits’ utilization procedure as described in their MyBenefits Dashboard

MyBenefits Dashboard

All members of ALLCARE may view and avail all of their benefits through the MyBenefits Dashboard. The MyBenefits Dashboard is accessible on web and on mobile.

Other Online Channels

All members can reach the ALLCARE Benefits team via email at support@allcare.io or via ALLCARE official Facebook and Messenger account.

Emergency Cases

For emergency needs, the member is advised to directly go to the nearest accredited medical facility for immediate medical attention.

Account Suspension and Deletion due to Non-Payment

If the member under Semi-AnnualQuarterly, or Monthly  modes of payment fails to pay the membership within the prescribed period prior to respective service cycles, ALLCARE reserves the right to suspend and delete your account until payment has been made and confirmed.

Service Cycle

The service cycle for the provided services shall commence on the date of activation and recur depending on the member's chosen mode of payment thereafter.

Notification Email

An email notification will be sent to the provided email address:30 days prior to the commencement of the next billing cycle. This email will serve as a reminder to settle outstanding payments.

Payment Due Date

Clients are required to make payment within 15 days of receiving the notification email to avoid any service disruptions.

Suspension Warning

In the event of non-payment 7 days before the service cycle, a suspension warning will be issued via email, notifying the client that their account is at risk of suspension.

Account Suspension

Failure to make payment within the specified 15-day period may result in the temporary suspension of services. The client will be notified of the suspension and given a grace period of 7 days to settle outstanding dues.

Account Deletion Endorsement

If payment is not received within the 7-day grace period after suspension, the account will be endorsed for deletion. The client will receive a final notification stating that their account is slated for deletion unless payment is made within the specified timeframe.

Reactivation of Services

Once payment is received and processed, suspended services will be promptly reactivated. However, if an account has been endorsed for deletion, reactivation may be subject to additional terms and fees.

Payment Methods

Payments shall be made through the designated payment methods as specified in the initial agreement.

Contact Information

It is the responsibility of the Member to ensure that their contact information, including email address, is accurate and up-to-date. Failure to receive notifications due to outdated contact information does not exempt the client from adhering to the specified payment terms.

By utilizing the services provided by ALLCARE, the client agrees to abide by these payment terms and conditions. ALLCARE reserves the right to amend these terms with prior notice. Members will be informed of any changes to the terms and conditions through the email address associated with their account.