Details below are as of August 2020. Etiqa confirmed that there are no changes as of March 24, 2021.
The Philippine Health Insurance Corporation (PhilHealth) will shoulder the cost of treatment for patients with COVID-19 based on a case-rate package. The state-run insurance agency has also clarified that patients may use their health insurance coverage and mandatory discounts, such as senior citizen and PWD discounts, to help substantially cover the cost of treatment.
As your partner in healthcare management, ActiveLink reached out to Etiqa on how the HMO policy will apply for the duration of the community quarantine period. For your guidance, please refer to the information below:
1. Will Etiqa cover availments for COVID-19?
Etiqa will continue to provide coverage for COVID-19 provided that the patient availed the services within the Etiqa-accredited network.
However, confinement of patients showing mild COVID-19 symptoms may not be coverable by Etiqa healthcare benefits as confinements that are considered domiciliary in nature are not covered. The patient must first present a compelling reason for admission to be entitled of coverage.
HMO benefits will be deducted first before applying the PhilHealth benefits for medical expenses related to Probable and Confirmed COVID-19 cases inpatient care. This is in compliance with PhilHealth Circulars 2020-009 and 2020-011. Please take note that Etiqa’s coverage will be based on the final diagnosis and the member’s maximum benefit limit.
2. Will Etiqa cover testing costs?
Etiqa will cover testing fees for symptomatic patients provided that it falls under these criteria, and subject to evaluation of submitted supporting documents and limits of your benefits plan:
Further, testing under the following conditions will not be covered:
Aside from the criteria, members will need to provide the following supporting documents for COVID-19 testing to be covered:
3. If the treatment was done in a government hospital, will Etiqa allow reimbursement?
No. Etiqa will not cover treatment availed in government hospitals.
4. How much will PhilHealth cover for COVID-19 treatment?
For patients who were admitted starting April 15, 2020, PhilHealth will cover the admission cost based on a case rate package:
|SEVERITY||PACKAGE AMOUNT (PHP)||HOSPITAL CATEGORY|
|Mild pneumonia in the elderly or with comorbidities||43,997||Levels 1-3 hospital, private room|
|Moderate pneumonia||143,267||Levels 1-3 hospital, private room|
|Severe pneumonia||333,519||Levels 2-3 hospital, private room, ICU|
|Critical pneumonia||786,384||Levels 2-3 hospital, private room, ICU (capable of ECMO, RRT)|
5. How much will PhilHealth cover for COVID-19 testing?
Yes, PhilHealth will cover COVID-19 testing based on the following case rates:
6. I have other questions regarding COVID-19. Whom can I contact?
Should you have further concerns or clarifications; you may get in touch with:
Etiqa's Customer Care Support:
You may also call the following COVID-19 dedicated hotlines:
Should you have other questions, please don’t hesitate to reach us.
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