FREQUENTLY ASKED QUESTIONS

Makati Medical Center, The Medical City, St. Lukes Medical City, QualiMed, Cardinal Santos Medical Center, Asian Hospital and Medical Center.

Please visit https://etiqa.com.ph for the full list.

Principal Plan Member - All regular, full-time employees aged 18 up to 65 years old.

• Coverage automatically ends on the day before the employee celebrates his 66th birthday or retires from employment whichever is earlier.

Start with the legal Spouse aged 18 up to 65 years old.

• Coverage automatically ends on the day before the spouse celebrates his 66th birthday.

Followed by Children who are single, unemployed, and at 30 days up to 22 years old.

• Coverage automatically ends on the Policy year before the child celebrates his 23rd birthday.

Start with Parents who are not more than 65 years old.

• Coverage automatically ends on the day before the spouse celebrates his 66th birthday.

Followed by Siblings who are single, unemployed, and at 30 days up to 22 years old.

• Coverage automatically ends on the day before the sibling celebrates his 23rd birthday.

Start with Parents who are not more than 65 years old.

• Coverage automatically ends on the day before the spouse celebrates his 66th birthday.

Followed by Children who are single, unemployed, and at 15 days up to 22 years old.

• Coverage automatically ends on the Policy year before the child celebrates his 23rd birthday.

• Number of medical consultations & follow-up consultations
• referral consultation with Specialists: Including pre and post-natal consultation
• administration of vaccine (except the cost of vaccine)
• prescribed laboratory /diagnostic examination for covered illness/injuries
• emergency treatment and minor surgeries not requiring hospitalization
• emergency first dose of anti-rabies, anti-venom & anti-tetanus

• Room and Board accommodation up to the limit of your plan
• General Nursing Services
• Services of Physicians, Specialists, Surgeons and Anesthesiologist
• Anesthesia and its administration, dressing, sutures, casts, and other medical supplies
• Use of Operating/DeliveryRoom
• Prescribed laboratory examinations including complex diagnostics procedures such as but not limited to CT Scan and MRI
• Transfusion of blood, blood elements & other intravenous fluids;
• ICU confinements - subject to the Maximum Benefit Limit;
• Chemotherapy, radiotherapy, physical therapy, speech therapy and dialysis, etc - subject to the provisions on 'Maximum Benefit Limit' & 'Pre-existing Conditions';
• All other expenses directly related to the medical management of the
• illness and/or injury that resulted to a plan member's confinement including Admission Kit.

•  oral examination/diagnostic as needed
• oral prophylaxis every six (6) months (twice per year);
• Gum problem consultation and treatment
• Simple tooth extraction when indicated (excluding impaction)
• temporary fillings when indicated
• re-cementation of loose jacket crowns
• Adjustment/repair of dentures
• oral hygiene instruction
• Dental health education and consultation
• orthodontic treatment and consultation
• 2 surface permanent fillings
• discounted rates of up to 20% for other services not covered by the dental plan  (e.g. dentures, crowns, bleaching, orthodontic treatment, x-rays, and dental surgery)

Plan Members may avail of the following dental benefits at Health Partners Dental Access Inc. on a no-cash-out basis (strictly no reimbursement).

 Ambulance Services

• Emergency ambulance service expense, transfer of the Plan Member from where the medical emergency occurred to the nearest medical facility, incurred by the Plan Member shall be reimbursable up to a maximum of Php 5,000.00.Reimbursement of ambulance service expense is limited to one per Plan Member per Policy Year.

In Accredited Hospitals Nationwide

• of All expenses directly related to the direct medical management of the illness and/or injury that resulted to the Plan Member's emergency treatment shall be covered on a no-cash-out basis.
• of Including drugs & medicines administered during emergency treatment except prescribed medicines to be taken outside the hospital (take home medicines).

• Complete Blood Count (CBC) Routine Fecalysis
• Routine Urinalysis
• Chest X-ray
• Complete Physical Exam including:  Oral Exam and Visual Acuity
• Medical History
• ECG for members 35 years old and above
• Pap smear for female members 35 years old and above

 In Non-Accredited Clinics/Hospitals

Submission from the employees' end must be within 30 days from date of consult/discharge

15 working-day TAT from point of receipt of complete document

Disclaimer: Turn-around-time might vary due to lacking requirements

 For cash payment concerns send email to philgasea1990@yahoo.com

Note: Please attach complete documents (HMO application and proof of payment)

Payment thru cash payment

PhilGASEA Land Bank Account (Current): 1692-1008-47

Look for Ms. EMELYN R. BAGULBAGUL - Cashier

Email Address: philgasea1990@yahoo.com

Contact No.: 0995-098-3119/0950-726-2962

1.) PhilGASEA Application HMO 2023

2.) Payment (Official Receipts / Bank Transfer copy / Fund transfer)

"Same as for members and retirees"

 For application thru PhilGASEA Loan, please attach complete documents (Loan Application, COA ID with the latest payslip)

Look for Mr. ROGIE B. BATULAN - Chief of Staff

Email Address: rogiebatulan0027@gmail.com

Contact No.: 0985-820-3403

Note: Subject for evaluation of Account Officer

 Mr. EDGARDO LAMBERTO L. RAMOS-President

Email Address: thephilgaseapresident@gmail.com 

Contact No.: 0925-307-5887