February 2, 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 Intellicare 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 Intellicare cover availments for COVID-19?
Intellicare will continue to provide coverage for COVID-19 provided that the patient availed the services within the Intellicare-accredited network. Medical 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. However, most facilities apply the HMO coverage net of PhilHealth. Intellicare will follow the hospital's protocol given this case. Please take note that Intellicare’s coverage will be based on the final diagnosis and the member’s maximum benefit limit.
2. Will Intellicare cover testing costs?
Meanwhile, RT-PCR test to be conducted for patients who are not manifesting signs and symptoms of COVID-19 as a screening test will not be covered. The following are also not covered:
3. If the treatment was done in a government hospital, will Intellicare allow reimbursement?
No. Intellicare will not cover treatment availed in government hospitals. Intellicare will only cover reimbursements for emergency availments in non-affiliated private hospitals, subject to:
4. How much will PhilHealth cover for COVID-19 treatment? And how does this apply with Intellicare’s coverage?
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. Will there be additional fees charged to HMO patients?
Effective June 1 to September 1, 2020, Intellicare agreed to increase the professional fees of major medical societies such as Philippine College of Physicians (PCP). Philippine College of Surgeons (PCS), Philippine Obstetrical and Gynecological Society (POGS), and Philippine Pediatric Society (PPS).
Intellicare will also cover charges for the use of Personal Protective Equipment (PPE) for inpatient and emergency room availments (except for outpatient availments), subjects to the limits established by the AHMOPI.
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:
You may also call the following COVID-19 dedicated hotlines:
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