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Etiqa and PhilHealth Coverage for COVID-19

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:

  1. Tested positive via rapid test or RT-PCR (via reimbursement basis)
  2. Tested positive in a rapid test and requiring a confirmatory RT-PCR test
  3. Tested positive via RT-PCR in a non-accredited facility (via reimbursement basis)
  4. Showing COVID-19 symptoms consulted via Etiqa’s telemedicine service.

Further, testing under the following conditions will not be covered:

  1. Showing no symptoms but exposed to a confirmed COVID-19 case
  2. Asymptomatic but requiring RT-PCR test for elective medical surgery

Aside from the criteria, members will need to provide the following supporting documents for COVID-19 testing to be covered:

  • Written doctor's referral or prescription
  • COVID-19 diagnoses, validated with chief complaint and symptoms
  • Physician's Clinical Statement
  • PhilHealth filing, if applicable
  • Other documents, not limited to medical, that may be deemed needed for evaluation

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:

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:

  • All services for testing are procured and provided by the testing laboratory - Php3,409
  • Test kits are donated to the testing laboratory - Php 2,077
  • Test kits are donated to the testing laboratory; cost of running the laboratory and RT-PCR machine for testing is included in the facility budget - Php 901

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:
(02) 8895-3308

  • 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

Should you have other questions, please don’t hesitate to reach us.

Thank you.

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