COVID-19: Intellicare and PhilHealth Coverage
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
- Any rapid antibody tests
- Patient is asymptomatic
- Even if recommended by a doctor to undergo swab test after testing positive in a rapid antibody test conducted in the company
- Even if exposed to a COVID-19 positive patient
- Initial test is negative, unless symptomatic
- Test is for pre-surgery, maternity delivery and other gynecological procedures
- Prescribed by doctor to undergo swab test after testing positive in a company-conducted antibody test.
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:
- Intellicare’s Relative Value Scale;
- Member’s maximum benefit limit; and
- Evaluation and approval of Intellicare.
- Outright coverage applies if member availed in an Intellicare-accredited facility.
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:
5. Will there be additional fees charged to HMO patients?
PACKAGE AMOUNT (PHP)
|Mild pneumonia in the elderly or with comorbidities
||Levels 1-3 hospital, private room
||Levels 1-3 hospital, private room
||Levels 2-3 hospital, private room, ICU
||Levels 2-3 hospital, private room, ICU (capable of ECMO, RRT)
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:
- Intellicare's 24/7 Call Center Hotline: (02) 7902-3400 or (02) 8789-4000
- Dedicated Helpdesk
- ActiveLink Mobile Application's Admin Connect
You may also call the following COVID-19 dedicated hotlines:
- Department of Health: (02) 894-26843 or dial 1555
- Philippine National Police:
- Globe: 0917 312 5626
- Smart: 0998 894 0013
- Philippine General Hospital (Telemedicine Hotline): Dial 155200
- Philippine Red Cross: Dial 1158