IndieGo 60k

IndieGo 60k

PHP2,050.00

(In Stock)

IndieGo 60k

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A one-time health plan with coverage up to Php 60,000 outpatient emergency care, hospitalization coverage for viral and bacterial illnesses, and treatment of most accidents in 500+ PhilCare-accredited hospitals nationwide. This also includes a one-time (1) teleconsultation with a doctor and a one-time (1) mental health counseling session.


Age Eligibility and Validity

IndieGO 60 is for age 18 year old and above. This certificate of coverage is non-transferable.

Benefit Coverage

IndieGO 60 provides coverage for up to Php 60,000 outpatient emergency care and hospitalization coverage for viral and bacterial illnesses, and treatment of injuries resulting from accidents (except for stroke) in 500+ PhilCare accredited hospitals nationwide excluding nine (9) premium hospitals (Makati Medical Center, St. Luke’s Medical Center in QC and Global, Asian Hospital, The Medical City, Cardinal Santos Medical Center, Manila Adventist Medical Center, Notre Dame de Charles Hospital and Philippine Orthopedic Institute). This also includes a one-time (1) teleconsultation with a doctor and a one-time (1) mental health counseling session thru the HeyPhil app.

OUTPATIENT EMERGENCY CARE AND HOSPITALIZATION:

  • One-time emergency coverage up to Php 60,000 for viral, bacterial illnesses, and most accidents.
  • Room and board (Semi-private)
  • Doctor’s fees
  • Laboratory and diagnostics procedures
  • Special modalities of treatment as medically necessary during ER and subject to Php 5,000 inner limit
  • Medicines (except vaccines) as medically necessary during ER and confinement, subject to standard inner limits
  • Diagnostics and therapeutic procedures as medically necessary during ER and confinement

COVERABLE CASES

The voucher covers acute cases of bacterial and viral infections such as:

  • Appendicitis
  • Bronchitis
  • Gastritis
  • Gastroenteritis
  • Pharyngitis
  • Urinary tract infections
  • Sinusitis
  • Tonsillitis
  • Upper respiratory tract infection
  • Cellulitis
  • Dengue fever
  • Pneumonia
  • Typhoid fever

This also covers accidents except for cerebrovascular accidents (stroke) and injuries suffered because of member’s misconduct, voluntary participation in hazardous sport or activity, and military service or under conditions of war. Emergency cases are the sudden, unexpected onset of illness or injury, which at the time of contract reasonably appeared as having the potential of causing immediate disability or death or requiring the immediate alleviation of severe pain and discomfort. Emergency cases include but are not limited to the following: (a) Massive Bleeding; (b) Acute Appendicitis; (c) Fractures/multiple injuries secondary to accidents; (d) Convulsions; (f) Illnesses or conditions resulting in moderate or severe dehydration such as diarrhea or fever; and (e) Syncope. Pre-existing conditions and those conditions under the general exclusions of PhilCare are not covered.

GENERAL EXCLUSIONS

No Healthcare Benefits shall be paid for the following services, procedures or conditions unless otherwise specified in the Agreement.

  1. All forms of behavioral disorders whether congenital or acquired; developmental or psychiatric disorder; psychosomatic illness.
  2. All Sexually Transmitted Diseases such as but not limited to herpes, gonorrhea, syphilis and conditions such as vulvar warts
  3. Injuries resulting from direct participation in riots, strikes, and other civil disturbances.
  4. All diseases declared as epidemic or pandemic by the Department of Health or any recognized health agencies.
  5. Cosmetic procedure and surgery and oral surgery solely for purpose of beautification, including but not limited to wart removal through excision or electrodessication/ cauterization, mesotherapy, liposuction, except reconstructive surgery to treat functional defects due to disease or accidental injury.
  6. Weight reducing programs, surgical operation or procedure for treatment of obesity, including but not limited to gastric stapling.
  7. Dental examination, extraction, fillings and general dental attention and conditions and all complications arising there from, including oral surgery and prosthodontics procedures following accidental injury to teeth for purposes of beautification. Exceptions are treatment to the extent necessary for repair and or restoration of function of the Member caused solely by accidental injuries.
  8. All pregnancy-related conditions and their complications, requiring medical and surgical care, regardless of time/date of occurrence (during the actual time of pregnancy or thereafter). MATERNITY-RELATED or PREGNANCY-RELATED. Any cause or condition arising out of or during any one pregnancy, childbirth, miscarriage or abortion or any complications arising from the same.
  9. Circumcision, sterilization of either sex or reversal of such, artificial insemination, sex transformation or diagnosis and treatment of infertility.
  10. Medical or surgical procedures that are experimental in nature and those that are not generally accepted as standard medical treatment by the medical profession that may include but is not limited to Chiropractic Services, Acupuncture and Reflexology.
  11. Routine physical examinations required for obtaining or continuing employment, requirement in school, insurance, government licensing, health permit and other similar purposes.
  12. Procedure and/or services considered screening.
  13. Treatment for injury and its complications resulting from self-inflicted injuries including infections as a result of tattoos, piercing of the ear or in any body part, whether self-inflicted or done by a third party or attempted suicide or self-destruction, whether sane or insane.
  14. Treatment of any injury received wherein there is negligence, unauthorized use of prohibited or regulated drugs, alcoholic liquor intake, direct or indirect participation in the commission of a crime whether consummated or not, violation of a law or ordinance or unnecessary exposure to imminent danger, knowingly or unknowingly, or hazard to health, by the Member.
  15. Any injury, illness or condition which the Member may suffer after he/she has taken intoxicating drugs or alcoholic beverage as evidenced by clinical history or alcoholic breath as duly determined by the examining physician/medical personnel and/or as indicated in the police report and other official medical documents conditions or illnesses resulting from alcoholism and drug addiction.
  16. Treatment of injuries or illnesses caused directly or indirectly by engaging in any professional sport or hazardous activity such as but not limited to scuba diving, surfing, water skiing, mountain climbing, rock climbing, mountaineering, parachuting, airsoft, drag racing, paintballing, wakeboarding and bungee jumping.
  17. Treatment of injuries or illnesses due to military service or suffered under conditions of War.
  18. Treatment for Chronic Dermatoses
  19. Services obtained for non-emergency conditions from physicians and hospitals in any of the following circumstances:
    • non-affiliated physicians in non-affiliated hospitals or non- affiliated clinics
    • non-affiliated physicians in affiliated hospitals or affiliated clinics
    • affiliated physicians in non-affiliated hospitals or non-affiliated clinics or other healthcare facility.
  20. Additional hospital charges and physician’s professional fees resulting from:
    • room-upgrading beyond twenty-four (24) hours during Emergency Conditions;
    • extension of hospital stay despite release of discharge order from Member’s Attending Physician;
    • fees of the assistant surgeons for surgeries with less than 250 RUV units/resident doctors who assisted the Attending Physician in the process of rendering the medical services shall not be chargeable to PhilCare except for hospitals that do not have resident physicians to assist during surgeries subject to the prior approval of PhilCare;
    • use of extra bed, TV, electric fan, DVD/VCD and other similar items unless such appliances and items are necessarily and ordinarily included in the Member’s Room and Board Accommodation;
    • extra food, toilet articles like face towel, soap, toothbrush and the like;
    • difference in Room and Board Accommodation, the incremental rate differences for professional fees, diagnostic and laboratory examination, and other ancillary medical services brought about by obtaining a room and board accommodation higher than the Member’s Room and Board Accommodation limit;
    • services of a private or special nurse;
    • all other items not medically necessary in the medical management of the Member.
  21. Custodial, Domiciliary, Convalescent and Intermediate care. These pertain to care in a skilled affiliated facility or an institution that meets certain standards for medical car and includes nursing care and therapeutic services following hospital confinement.
  22. Medical Certificates.
  23. Professional fees of medico-legal officer/s.
  24. All expenses incurred in the process of organ donation and transplantation if the Member is the donor and its complications.
  25. Benefits covered by PhilHealth and all other government funded healthcare entitlements as provided for by law.
  26. Cost of the medical services and professional fees in excess of the MBL and applicable inner limits of the Plan.
  27. Purchase of lease of any Durable Medical Equipment, oxygen dispensing equipment, and oxygen except during covered in-patient care.
  28. Procurement or use of corrective appliances, prosthesis, artificial aids and durable equipment such as but not limited to the following: (a) stents; (b) prolene mesh; (c) pins, screws, plates, wires; (d) VP shunt, clips; (e) hearing aids; (f) intraocular lens, eyeglasses, contact lenses; (g) balloons, valves; (h) braces, crutches; (i) pace maker.
  29. Hepatitis B, C and D.
  30. Allergens used for hypersensitivity testing regardless if administered as an out-patient or in-patient procedures.
  31. Blood screening, blood typing, cross-matching for potential donors.
  32. Executive check-ups and confinement which are for purely diagnostic purposes except as specified in the Agreement.
  33. All cases of assault perpetrated by the Member including domestic violence which result in harm or injury to the Member perpetrator.
  34. Charges by Physicians and health professionals, whether or not affiliated by PhilCare, on the difference between their charged rate and PhilCare standard professional fees for specific medical services.
  35. Take-home medicines, preventive and/or non-therapeutic drugs, such as but not limited to vitamins, supplements, hormonal preparations, medicines or drugs during confinement which are not available in the Philippines, immunizing agents and all other medicines/drugs not approved by the Bureau of Food and Drugs (BFAD).
  36. Out-patient medicines, with the exception of intravenous chemotherapy medicine and those administered during an emergency treatment.
  37. Vaccines, whether elective or administered during an emergency treatment.
  38. Diagnosis and treatment of Error of Refraction conditions such as myopia, astigmatism, and the like, including laser treatment for the purpose of corrective eye refraction.
  39. Out-Patient Pain Management is not covered except in cases of emergency. In-patient Pain management necessitating specialized pain management team and/or the use of specialized equipment.
  40. Complications arising from non-covered procedures and surgery.
  41. Treatment of injuries or illnesses wherein the care or reimbursement of services is provided by law or a government program, up to the stipulated limits.

GENERAL LIMITATIONS

The rights of a Member and obligations of PhilCare are subject to the following limitations unless specified in an endorsement which is made part of the Agreement:

  1. If a major disaster or epidemic causes unavailability of facilities or personnel, or if circumstances not within the control of PhilCare such as temporary lack of hospital facilities, complete or partial destruction of facilities, war, riot, civil insurrection, labor disputes, or similar causes occur, then PhilCare shall not be liable for any delay or failure to provide services to the Member. PhilCare shall, however, exert its best effort to provide services to the Member, as the circumstances permit.
  2. In the event that a member requires the services of a sub-specialist not available in the PhilCare Network for a covered condition, PhilCare shall reimburse the professional fees of the said sub-specialist based on PhilCare standard rates, provided the member has been treated in an affiliated hospital/facility.
  3. In case there is no affiliated doctor in the area to perform a covered medical procedure, the member may get the services of a non-Affiliated doctor, and then file for reimbursement, but the computation of the Professional Fee will be based on standard PhilCare rates. Provided that the Member has been treated in an Affiliated hospital/facility.
  4. In cases where the working diagnosis is a non-covered condition and the final diagnosis still has to be established, the Member shall shoulder the cost of services related to the condition. PhilCare shall reimburse according to its standard rates all expenses related to the condition if the final diagnosis turns out to be a covered condition.
  5. Hospital Service is subject to all rules and regulations of the hospital selected, including the rules and regulations governing admission. PhilCare shall not be held liable in case there is no room available in accordance with the Member’s Room and Board benefit provision. In cases where services are denied by the hospital/clinic health facility, PhilCare shall not be held liable for any claims, charges, or damages caused to the member.
  6. In no event shall the cost of covered conditions and their complications during the one-year term of the Agreement exceed the benefit limit.

HEYPHIL MIND CARE COUNSELING:

  • One (1) Mind Care counseling session with MyGolana coachers and counselors
  • Fifty (50) minutes of counseling time
  • Mental health screening survey and viewing of results
  • Counseling activities as deemed appropriate by our Counselors

COVERABLE CASES

It can be used for mental and emotional wellness check for persons with any of the following experiences/conditions/feelings/circumstances not needing urgent care:

  • General anxiety
  • General depression
  • Stress management
  • Loneliness
  • Unmotivated
  • Frustration
  • Anger management issues
  • Fear
  • Family conflict/-conflict management (marital/relationship fatigue)
  • Gender issues
  • Domestic violence
  • Self-esteem
  • Blended families
  • Bullying
  • Dealing with HIV
  • Insomnia
  • Phobias
  • Grief
  • Relational Problems

Educational/occupational problems:

  • Housing/landlord issues
  • Finance
  • Neighbor discord
  • Lack of food/adequate drinking
  • Low income/poverty issues

Social environment related problems:

  • Phase of life
  • Living alone
  • Acculturation adjustment
  • Social exclusion/rejection

LIMITATIONS

  • This voucher provides access to HeyPhil Mind Care Coaches and Counselors only.
  • The 50-minute counseling session is done purely online.
  • Any cases needing psychiatric consultations requiring in-person check-up for proper assessment of more appropriate treatment will be advised to visit a clinic. These pertain to severe cases of mental disorders including (but not limited to):
    1. Severe anxiety
    2. Severe depression
    3. Suicidal cases
  • Online diagnosing of disorders and prescribing of medicines are not covered
  • The product benefit is not applicable to any of the following cases:
    1. A person who is advised or is currently under psychiatric care
    2. A person who is mandated by relevant authorities to undergo psychotherapy
    3. Emergency/crisis situations such as:
      • Indication of repeated suicidal ideation
      • Indication of harm to self or others
      • Previously diagnosed psychopathology with violent tendencies
      • Actual emergency event (in the imminent act of committing suicide/harm)

HEYPHIL DIGIMED ONLINE CONSULTATION:

  1. One (1) medical tele-consultation through HeyPhil DigiMed with any of the following physicians:
    • Family Medicine Specialists
    • Internal Medicine
    • General Practioner
  2. Issuance of medical assessment and prescription
  3. Endorsement for lab tests/procedures to clinics if necessary
  4. Referrals for specialty consult if necessary
  5. Interpretation of laboratory test results
  6. Consultations for pre-existing conditions not requiring emergency attention

COVERABLE CASES

This can be used for several outpatient (OP) conditions requiring primary care consultation not needing visualization and physical assessment of the doctor. Primary care is provided by physicians specially trained for and skilled in comprehensive first contact, and continuing care for persons with any undiagnosed signs, symptoms or health concert not limited by problem, origin and organ system. This includes several conditions such as (but not limited to):

  • Respiratory conditions: allergies, asthma, bronchitis, cold or cough, sinusitis or rhinitis, pharyngitis, laryngitis, tonsillitis
  • Cardiovascular conditions for follow up check-up: hypertension, medicine refills
  • Gastrointestinal Issues: diarrhea and vomiting, GERD, dyspepsia
  • Skin Conditions: allergies, rashes, insect bites, skin swelling/inflammations, cellulitis
  • Other conditions/infections: acne breakouts, arthritis, boils (pigsa), conjunctivitis, ear infections, fever, mild injuries, sprains and strains, UTI and bladder infections, general pediatric conditions requiring initial consultation

LIMITATIONS

The exceptions of this health plan are medical conditions which require in-person medical check-up for proper visualization of the case and physical exam for assessment of more appropriate treatment. These medical cases include but not limited to:

  • Emergency related cases
  • Maternity-related cases
  • Dental consultations
  • Mental health related conditions
  • Medical conditions related to all forms of behavioral disorders
  • Developmental or psychiatric disorder and psychosomatic illness whether acquired or congenital
  • Dermatology-related cases
  • Illnesses needing treatments from a medical specialist (e.g. severe cases of chronic illnesses)
  • "Fit to work" assessments requiring medical certification

Other Benefit Coverage

Php 50,000 accidental death and dismemberment coverage

Availment Procedure

EMERGENCY AND HOSPITALIZATION AVAILMENT

  1. Present this voucher together with valid identification to the emergency room personnel at the identified PhilCare-accredited hospital.
  2. ER personnel will facilitate the approval of your availment thru reaching our contact center to verify your membership eligibility and health coverage. The final medical diagnosis is the basis for PhilCare’s approval of coverage.
  3. Once approval has been provided, a request for cancellation of approval to reactivate membership is not allowed.

*PhilHealth coverage is required during admission. However, for those who do not have PhilHealth coverage, member may just pay the PhilHealth portion of the hospital bill before discharge.

HEYPHIL MIND CARE ONLINE COUNSELING PROCEDURE

  1. Download the HeyPhil DigiMed application through Play Store (for android phones) or App Store (for IPhones)
  2. Click Need Online Mental Counseling or Medical Consultation? Click Here found at the bottom part of the app screen.
  3. Go to With Reference No? Click Here found at the upper part of the app screen.
  4. Fill out the Patient Profile then click submit.
  5. Select Mind Care tab.
  6. Member will be redirected to the Mind Care platform. Agree to the Terms and Conditions by ticking the checkbox.
  7. Answer the short survey and see the results.
  8. Member can then proceed to set an appointment by clicking on the Make Appointment button.
  9. Select your preferred date, time and counselor.
  10. Log-in on your scheduled appointment and proceed with your mental health counseling.

HEYPHIL DIGIMED CONSULTATION PROCEDURE:

  1. Download the HeyPhil DigiMed application through Play Store (for android phones) or App Store (for IPhones)
  2. Click Need Online Mental Counseling or Medical Consultation? Click Here found at the bottom part of the app screen.
  3. Go to With Reference No? Click Here found at the upper part of the app screen.
  4. Fill out the Patient Profile then click submit.
  5. Enter your Chief Complaint or the reason why would you like to seek for medical consultation.
  6. Attach a photo of your most recent doctor’s prescription or laboratory test results if available, otherwise, proceed to read and agree with the terms and conditions in availing a digital consultation.
  7. Click the Request Consultation to queue your digiconsult request with one of our DigiMed doctors.
  8. Stand by for your DigiMed Doctor’s call until the submitted chief complaint and copies of prescription and laboratory test results have been assessed. Please be reminded that your DigiMed Doctor calls from an unregistered number in your contact list.
  9. Engage with a medical tele-conferencing with your DigiMed Doctor.
  10. Check on the medical assessment and prescription sent to your registered email.
  11. Rate and send your feedback about your HeyPhil DigiMed consultation experience.

Terms and Conditions


By buying, registering or availing coverage of any of the above products, I certify that I have read, understand and agree to these Terms and Conditions. If I disagree with these Terms and Conditions and I have not registered the product, I can request for a refund, subject to the PhilCare Returns & Refund or Replacement, or Cancellation Procedures (http://shop.philcare.com.ph/return-refund-terms).


I certify that the information given and to be given by me or on my behalf is true and correct and that any material misrepresentation or falsity therein shall be construed as an act to defraud PhilHealthCare Inc. (PhilCare), and serves as sufficient ground for any and all of the following actions: the rejection or cancellation of my application or membership, non-coverage of medical expenses at accredited providers, collection of receipt from me in case of payment of medical expense advanced by PhilCare. I hereby authorize PhilCare to inquire about and investigate all declared information from whatever sources PhilCare may consider appropriate.


I agree that receipt of the corresponding membership fees by PhilCare does not constitute acceptance of my application until the corresponding application has been approved. For HeyPhil Mind Care, coverage starts after successful payment of the health plan and is terminated once the benefit is used, or after one (1) year from the date of purchase if the benefit is not used. Coverage shall automatically begin,regardless of the status of receipt of notice advising the member of successful registration and coverage period.


I agree to the procedure for availment of HeyPhil Mind Care services stipulated above.


I agree to the limitations and other exclusions applicable to the HeyPhil Mind Care mental health counseling and medical teleconsultation coverage found at http://shop.philcare.com.ph/non-covered-illnesses-and-diseases. PhilCare shall have the final decision to determine if the online counseling or teleconsultation service requested is caused by coverable or non-coverable condition.


I hereby agree to PhilCare in retrieving and processing any and all medical information drawn or obtained pursuant to its services based on my coverage, provided, that (a) such information shall only be utilized in accordance with lawful and official business purposes of PhilCare; (b) such information shall not be disclosed to non-essential personnel or entities; and (c) all reasonable efforts shall be taken to maintain the confidentiality of said information.

IMPORTANT NOTES:

*See FAQs for more details.

**Check the list of Non-Covered Illnesses and Diseases .

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