Learn more about Medicare Plus
Who is Medicare Plus?
Medicare Plus Inc. is a Health Maintenance Organization which is regulated by the Insurance Commission. A health maintenance organization (HMO) is a network or organization that provides health insurance coverage for a monthly or annual fee. Medicare Plus Inc. is not an Insurance Company.
Am I eligible for a healtcare plan?
Any Filipino citizen is eligible to apply for a health plan with Medicare Plus Inc.
Do you have an age limit on healthcare plans?
Ages 15 days old to 65 years old can enroll for a health plan with Medicare Plus Inc. In case,
You are not in the age bracket, you can contact our health plan agents at firstname.lastname@example.org to discuss possible health plans that may be available to you.
How do I find out if my hospital / clinic / doctor is accredited?
Do you offer installment payment?
Yes, members can pay with annual or semi-annual payment options.
Your membership entitles you to Out-Patient consultations including laboratory and diagnostic procedures deemed medically necessary by our affiliated Physicians and Specialists. Hospital confinements that may require medical management or surgical procedures covered by your Maximum Benefit Limit (MBL). Among others are Emergency Treatment and Annual Physical Exam (APE).
You may include Standard Dental Care as an added benefit with additional fee per member.
Pre-existing conditions are not covered during the first year of membership under the contestability period. A known pre-existing illness/condition and its complication prior to application and when occurred during the first year of coverage after the effective/reinstatement date shall be considered Pre-existing and subject to EXCLUSION of coverage.
Treatment of pre-existing conditions and its complications under the care of our affiliated hospital/clinic and Physician is covered within MAXIMUM BENEFIT LIMIT on your second year of membership except those that come out during contestability period.
Examples for Pre-existing conditions:
Hypertension and other cardiovascular diseases
Diabetes Mellitus, Goiter and other endocrine diseases
Asthma, Pulmonary Tuberculosis and other chronic pulmonary diseases
Gastric ulcer and other gastrointestinal disorders
Endometriosis, Myoma and other gynecologic diseases.
Cataracts, other chronic eye conditions and ENT conditions that may require surgery
Cirrhosis of the liver, calculi of the urinary and biliary systems
Osteoarthritis, Rheumatoid Arthritis and other musculoskeletal diseases
Hemorrhoids and fistulae
All tumors and cancer (malignancies)
Pregnancy, and pregnancy related cases, congenital & physical deformities, behavioral disorders, development or psychiatric disorders, psychosomatic illnesses, pre-existing Hepatitis B and sexually transmitted diseases are not covered.
One MBL (Maximum Benefit Limit) shall be given per sickness including treatment of related illnesses and its complications
Yes, it is the member’s responsibility to file it prior to discharge. Failure to file PHILHEALTH means you will pay PHILHEALTH portion of your hospital bill. Coordinate with your company HR representative to secure the forms required for filing.
You will be reimbursed up to 100% of the medical expenses incurred during the first 24 hours of treatment up to P15,000 per illness per member per year based on Medicare Plus standard rates.
You will need to submit the following documents within thirty (30) days from the date of consultation/treatment/discharge:
1.Duly accomplished Medicare Plus Claim Form
2.Medical / Doctor’s Certificate
3.Official Receipts -provisional receipt is not acceptable
Reimbursment is processed and released within thirty (30) working days upon receipt of complete requirements at Medicare Plus office.
The professional fee of Neurologists is currently on “cash basis” policy in accordance with the guidelines set by Philippine Neurological Association to all HMO members. This is reimbursable based on Medicare Plus standard rates. However, the requested diagnostic procedures may be covered based on your plan benefits.
Yes, provided that you will shoulder the incremental costs, excess in room & board and professional fee difference incurred during confinement as a result of voluntary upgrading.
If your room category is not available at the time of admission, you may downgrade or occupy a lower room category, or upgrade to the next higher room level (except for Suite) and transfer to your room entitlement when it becomes available. Involuntary room upgrading is allowed within the first 24 hours only.
Incremental and excess charges shall be billed to the member after 24 hours up to the time of discharge during involuntary room upgrading. Incremental costs apply to laboratory, diagnostic procedures, use of operating/delivery and recovery rooms, medicines and medical supplies charged at a higher cost due to socialized pricing being practiced hospitals.
LOA means Letter of Authorization which serves as an official document of approval from Medicare Plus thus, authorizing your consultation, laboratory/diagnostic procedures during out-patient treatment or confinement. You may secure the LOA from our designated hospital coordinators or HMO/OPD section during regular clinic hours.
Hepatitis screening and other tests considered screening including vaccines are not covered.
You should report lost/stolen ID to Medicare Plus Medical Services/Underwriting Department immediately. To request a new ID, a request letter for ID replacement must be submitted and addressed to Underwriting Department. ID replacement costs P500.00 only. While the new card is being processed or you fail to bring it during availment, call our Medical Services Department for endorsement and present any valid ID for identification.
Call our Medical Service Department first to verify if you are already eligible to undergo Annual Physical Exam(APE). Medical Services Team shall arrange the APE schedule and provide endorsement at designated Medicare Plus Clinic.
You may cancel your membership within fifteen (15) days from effective date of your Health Assure Plus contract in case you disagree with the contract conditions after receiving it and no medical availment has been made prior to termination of membership.
Membership ID and Health Assure Plus contract must be surrendered to Medicare Plus otherwise, no premium refund shall be allowed.
The P300.00 enrollment processing fee is not included in the premium refund.
Is a person with pre-existing conditions still eligible for a plan?
Yes, individuals with pre-existing conditions are also eligible for a Medicare Plus plan.
Who is eligible for a Medicare Plus plan?
All individuals aged 2 months old and above are eligible for a plan.
What are the requirements?
For Individual Plans, you need to provide 2 valid IDs and an accomplished Signed Application Form (SAF).
For Corporate Plans, your company needs to provide us with a DTI or business permit and a master list.
What are the terms of payment?
As of the moment, we only accept cash and payment through credit cards.
What is the difference between individual and family plans when it comes to benefits?
Same benefits and coverage, the only difference is the rate.
Do you have a plan for 6 years and above?
Yes, we cover 2 months old and above for Individual Plans.
Are senior citizens allowed to get a Medicare plan?
Yes, senior citizens are also eligible for a Medicare Plus plan.
Is Medicare Plus a scam? Medicare Plus is a Health Maintenance Organization duly registered with the Securities and Exchange Commission and duly licensed to offer health insurance by the Insurance Commission (IC) with license number/registration number HMO-2020-23-R.
We are a member of the Association of Health Maintenance Organization of the Philippines (AHMOPI) and accredited by Procurement Service - PhilGEPS.
We are aware that finding the best healthcare plan might be confusing, so we have Medicare Plan Advisors to assist you.Please let us know if you would like one of our Medicare Plan Advisors to call you to address any concerns you may have.