iCare’s HMO for small businesses in the Philippines is designed specifically for micro and small enterprises with 5 to 99 employees. This comprehensive yet affordable program provides essential healthcare coverage that meets the unique needs of smaller teams, ensuring your employees receive quality care without straining your company’s budget.
With a focus on delivering high-value benefits at a reasonable cost, iCare’s plans empower small businesses to offer competitive health packages that attract and retain top talent.
Huge Health Benefits for Your Small Business
Our HMO for small businesses in the Philippines gives you the option to tailor your plan, from choosing your benefit limit to picking your hospital provider access.
In-Patient Benefits
This includes services of all accredited Physicians including surgical services, room and board, general nursing service, and other services or supplies deemed medically necessary.
Out-Patient Benefits
This includes services of all accredited Physicians including surgical services, room and board, general nursing service, and other services or supplies deemed medically necessary.
Emergency Care Benefits
Such as ambulance services, emergency care-related procedures in accredited and non-accredited hospitals, and room upgrade.
Customizable Options with Competitive Premium Rates
iCare’s plans include access to a vast network of accredited healthcare providers across the country, along with extensive coverage options that range from preventive care to emergency services.
Option 1
Access to all iCare-accredited facilities nationwide, except Healthway and Fortmed.
Option 2
Access to all iCare-accredited facilities, except Asian Hospital and Medical Center, Cardinal Santos Medical Center, Makati Medical Center, St. Luke’s Medical Center (QC and BGC) and The Medical City, Fortmed and Healthway Clinics.
Option 3
Access to all iCare-accredited facilities in the Visayas and Mindanao area, except Healthway Clinics.
Option 4
Access to all iCare-accredited facilities in Luzon outside NCR, except Healthway Clinics.
Flexible options with competitive premium rates
Have the freedom to choose quality health benefits that best fit your business. InHealth Biz gives you the option to tailor your health plan, from choosing your benefit limit, to picking your hospital provider access.
Healthcare Plan for Small Businesses: Summary of Benefits
By choosing iCare, micro entrepreneurs can rest assured that their employees are well-protected, allowing them to focus on growing their business while promoting a healthier, more productive workforce. Here’s an overview of the key advantages of our HMO for small businesses in the Philippines.
Membership Guidelines
Age Eligibility |
18 to 65 years old, as of last birthday |
| for 66 – 70 y.o. principal members, x2.5 the standard rates | |
| for 71 – 75 y.o. principal members, x3.5 the standard rates | |
Philhealth Amount (Non-Philhealth) |
Additional P3,500 per non-Philhealth enrollees, inclusive of VAT |
Effective date proviso |
Not waived. Under the Effective Date Provision, if the enrolled person, on account of injury or illness, is not actively working in full time employment on the date his coverage would otherwise have become effective as provided above, the coverage shall not become effective until the date such person returns to full time active work. If the enrolled dependent, on account of injury or illness, is confined in a hospital on the date his coverage would otherwise have become effective as provided above, the coverage shall not become effective until the date such dependent is discharged from the hospital. |
Timeline for Deliverables (Cards, SOA & Health Care Agreement or HCA) |
iCare to provide the deliverables within 10 to 15 working days from inception date; provided all documents are submitted & complete |
Payment Arrangement |
15 working days from SOA receipt |
Submission of Signed HCA by the client |
Should submitted back to iCare within ten (10) working days from receipt of final version of the HCA. |
Digital-Enabled Customer Experience |
HR Portal for authorized representative. Please provide name and email address of the appointed representative. All enrolled members may download and use iCare Mobile App once activated. |
Utilization Report |
The provided utilization format will be in compliance to data privacy act. |
| Option for expanded utilization information may only be provided, once client company signs the contract or signs the waiver to |
Outpatient Benefits
ANNUAL PHYSICAL EXAMINATION |
BASIC 5 ONLY |
| Taking of Medical History/ Physical Examination | Covered |
| Chest X-ray | Covered |
| Routine Urinalysis | Covered |
| Routine Fecalysis | Covered |
| Complete Blood Count (CBC) | Covered |
PREVENTIVE HEALTH CARE |
|
| Health Education Counselling on Diet or exercise | Covered |
| Periodic Monitoring of Health Problems | Covered |
| Family Planning Counselling | Covered |
| Passive and active vaccines for treatment of tetanus and animal bites-except human immunoglobulin (ER and Non-ER provided 1st treatment/dose is availed in iCare network) | Covered for the 1st dose up to P20,000 |
| Initial treatment of Animal bites | Covered up to P5,000 per year, except cost of vaccines |
| Covid-19 Vaccines | Not Covered |
OUT-PATIENT CARE |
|
| Consultations during regular clinic hours, except prescribed medicines | Covered |
| Eye, ear, nose and throat (EENT) treatment prescribed by an affiliated physician/specialist | Covered |
| Treatment for minor injuries such as lacerations, mild burns, sprains and the like |
Covered |
| Dressings, conventional casts (plaster of Paris) and Sutures. |
Covered |
| X-Ray, laboratory examinations, routine, and diagnostic procedures prescribed by an affiliated physician/specialist, provided however that the cost of diagnostic procedures covered shall be limited to a specific amount. |
Covered |
| Eye laser therapy for retinal tear, retinal hole, retinal detachment and glaucoma prescribed by an affiliated physician/specialist, excluding eye correction such as Lasik, PRK and the like |
Subject to PEC limit |
| Blood products transfusions and intravenous fluids, including blood screening and cross matching. | Covered (blood screening of donor’s blood is excluded) |
TELEMEDICINE CONSULTATIONS |
Covered |
Laboratory, X-ray and other diagnostic examinations prescribed by physician on duty are covered up to applicable MBL
ROUTINE PROCEDURES |
|
| Blood Chemistries | Covered |
| Chest X-ray | Covered |
| Complete Blood Count | Covered |
| Fecalysis | Covered |
| Urinalysis | Covered |
DIAGNOSTIC PROCEDURES |
|
| 24 Hour EEG Monitoring | Covered, if medically necessary |
| Esophageal Manometry | Covered, if medically necessary |
| Positron Emission Tomography (PET scan) | Covered, if medically necessary |
| Throat Swab | Covered, if medically necessary |
| 24-hour Holter Monitoring/ Ambulatory Cardiac Monitoring | Covered, if medically necessary |
| Adrenocortical Function | Covered, if medically necessary |
| Anti-Nuclear Antibody, C-Reactive Protein, Lupus Cell Exam | Covered, if medically necessary |
| Arterial Blood Gas | Covered, if medically necessary |
| Audiograms and Tympanograms | Covered, if medically necessary |
| Bone Density Test (Dex Scan / Bone Mineral Density Studies) without nuclear or radio isotope | Covered, if medically necessary |
| Computed Tomography Scans (CT Scan) | Covered, if medically necessary |
Diagnostic Radiographs: |
|
| a. Biliary tract: Cholecystogram and Cholangiogram | Covered, if medically necessary |
| b. Chest, ribs, sternum and clavicle | Covered, if medically necessary |
| c. Digestive: Plain film of the abdomen, Barium Enema, Upper GI Series, Lower GI Series, Small Bowel series |
Covered, if medically necessary |
| d. Face (including sinuses), Head and Neck | Covered, if medically necessary |
| e. Urinary: KUB, Pyelograms and Cystograms | Covered, if medically necessary |
| f. X-ray of the extremities and pelvis | Covered, if medically necessary |
| g. X-ray of the spine (cervial, thoracic, lumbo-scaral) | Covered, if medically necessary |
Diagnostic Ultrasounds: |
|
| a. 2D-Echo with Doppler | Covered, if medically necessary |
| b. Abdomen | Covered, if medically necessary |
| c. Duplex Scan | Covered, if medically necessary |
| d. Digestive and Urinary Systems | Covered, if medically necessary |
| e. Ultrasoundof the Lungs and Chest inclduing the Thryroid | Covered, if medically necessary |
| f. 4D Ultrasound except for maternity-related cases | Covered, if medically necessary |
| Electroencephalogram | Covered, if medically necessary |
| Electromyelography and Nerve Conduction Studies | Covered, if medically necessary |
| Endoscopic Procedures (including video gastroscopy & colonoscopy) | Covered, if medically necessary |
| Impedance Plethysmography | Covered, if medically necessary |
| Lead Electrocardiogram | Covered, if medically necessary |
| Mammography and Sonomammogram | Covered, if medically necessary |
| Myelogram | Covered, if medically necessary |
| Pap`s Smear | Covered, if medically necessary |
| Perfusion Scan | Covered, if medically necessary |
| Plasma/Urinary Cortisol, Plasma Aldosterone | Covered, if medically necessary |
| Pulmonary Function Tests / Lung Function Studies | Covered, if medically necessary |
| Radionuclide Ventriculography | Covered, if medically necessary |
| Surface Electromyography (SEMG) | Covered, if medically necessary |
| TMST-Treadmill Stress Test (except Nuclear TMST) | Covered, if medically necessary |
| Genetic/Immunologic Studies | Covered, if medically necessary |
| Stress Testing (all types except Cardiac and Treadmill Stress Tests) | Covered, if medically necessary |
| Electrophoresis | Covered, if medically necessary |
| Inhalation therapy | Covered, if medically necessary |
| Laryngeal Stroboscopy | Covered, if medically necessary |
| Arthroscopic diagnostic procedures | Covered, if medically necessary |
| M-Mode Echocardiography | Covered, if medically necessary |
| Brain Stem Auditory Evoked Response | Covered, if medically necessary |
| HEPATITIS PROFILE – e.g. HBeAg, HBS Ag, Anti HBc (lgM), Anti-HAV (lgM) |
Covered, if medically necessary |
| ANA Profile e.g. Anti-Nuclear-Antibody, Anti Native- DNA, Anti-SM, Anti-SSA, Beta HCG, ANA |
Covered, if medically necessary |
| Thyroid Profile e.g. T3, T4, TSH, FTA-ABS | Covered, if medically necessary |
| TORCH Profile e.g. Anti-Toxoplasma Gondii (lgM), Anti-Rubella, Anti-Cytomegalo – Virus (Total lg) | Covered, if medically necessary |
| SLE test, FAT Widal Test, ASO Titer, Serum lg-Ci, Alpha-Feto Protein, ESR |
Covered, if medically necessary |
| Urine/Blood culture and sensitivity test | Covered, if medically necessary |
| 24-hour protein determination | Covered, if medically necessary |
| Troponin | Covered, if medically necessary |
| Glycosylated Hemoglobin | Covered, if medically necessary |
| Prostate Specific Antigen (PSA) | Covered, if medically necessary |
| APAS Testing (AntiPhospholipid Antibody Syndrome) | Covered, if medically necessary |
| Microscopic Examination | Covered, if medically necessary |
| Allergy Testing / Desentization (cost of allergens NOT covered) | Covered, except cost of allergens |
Inpatient Benefits
IN-PATIENT SERVICES |
|
| Room and Board according to the Member’s Room & Board Accommodation under which the Member is enrolled | Covered |
| Use of operating room, Intensive Care Unit (ICU), isolation room (if prescribed by attending Physician) and recovery room | Covered |
| Professional fees in accordance with iCare Schedule of Rates | Covered |
| a. Attending Physicians | |
| b. Surgeons | |
| c. Anesthesiologists | |
| d. Cardio-pulmonary clearance before surgery and cardiac monitoring during surgery. |
|
| Standard Nursing Services | Covered |
| Medicines for in-patient use | Covered |
| Blood products transfusions and intravenous fluids, including blood screening and cross matching. |
Covered |
| Laboratory examinations, disgnostic tests and therapeutic procedures incidental to confinement | Covered |
| Dressings, conventional casts and sutures | Covered |
| Anesthesia and its administration | Covered |
| Oxygen and its administration | Covered |
| Standard Admission kit | Covered |
| All other items directly related in the medical managemnet of the patient, as deemed medically necessary by the attending affiliated physician | Covered |
| Assistance in administrative requirements through a Medical Liaison Officer | Covered |
Emergency Care Benefits
EMERGENCY CARE |
|
| In Affiliated Hospitals | |
| a. Doctor’s services | Covered up to MBL |
| b. Emergency Room Fees | |
| c. Medicines used for immediate relief during treatment | |
| d. Oxygen, Intravenous fluids and blood products. | |
| e. Dressings, conventional casts (plaster of Paris) and sutures. | |
| f. Laboratory and diagnostic examinations and other medical services related to the emergency treatment of the patient | |
| g. Room Upgrade (Emergency Case) – Except Suite Room Accommodation | Member shall shoulder excess charges and incremental cost |
| In Non-affiliated Hospitals | REIMBURSEABLE up to 100% of hospital & professional fees based on iCare rates up to P30,000 per case per member |
| Outside the Philippines | REIMBURSEABLE up to 100% of hospital & professional fees based on iCare rates up to P30,000 per case per member |
| Areas w/o affiliated Hospital | REIMBURSEABLE up to 100% of hospital & professional fees based on iCare rates up to 50% of the MBL |
| Ambulance Service (affiliated to affiliated) | Covered subject to 50% of MBL |
| Ambulance Service (Affiliated/Non-Affiliated to Affiliated); if in Provincial areas – Hospital to Hospital |
Reimburseable up to P2,500 per conduction |
Provider Access
Option 1 |
Access to all iCare-accredited facilities nationwide, except Healthway and Fortmed and American Eye, |
Option 2 |
Access to all iCare-accredited facilities, except Asian Hospital and Medical Center, Cardinal Santos Medical Center, Makati Medical Center, St. Luke’s Medical Center (QC and BGC) and The Medical City, Fortmed, Healthway Clinics and American Eye. |
Option 3 |
All iCare-accredited facilities in the Visayas and Mindanao area, except Healthway Clinics and American Eye |
Option 4 |
All iCare-accredited facilities in Luzon outside NCR, except Healthway Clinics and American Eye |
Other Benefits and Special Services
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Other Benefits & Special Services
Covid-19 Cases are covered up to applicable limits per year Ward Plan – Up to P50,000 per year Semi-private Plan – Up to P75,000 per year or MBL,
which ever is lessPrivate Plans – Up to P100,000 per year or MBL,
whichever is lessCovid-19 Testing Covered up to P2,500 if SYMPTOMATIC;
otherwise not coveredMotor Vehicular Accidents If in an iCare accredited provider: up to P10,000 per incident but not to exceed 50% of MBL. If in non-iCare accredited provider, 100% of hospital bills and professional fees up to P10,000 per case on reimbursement basis Unprovoked Assault, including domestic violence, whether initiated by the Member or by a known or unknown third party DENTAL CARE (Optional)
Reliant Health Med Alliance Corp (PACKAGE 2) PREVENTIVE SERVICES Unlimited Consultations Covered Oral Hygiene Instruction Covered Oral Prophylaxis (mild to moderate) Covered (Once per year) Annual Dental Examination Covered RESTORATIONS Unlimited Temporary fillings Covered Permanent Fillings Three (3) surfaces Amalgam OR Two (2) surfaces Light cure Unlimited recementation of jacket crown inlays and onlays Covered Unlimited Simple Tooth extraction except surgery for impaction Covered DENTURES & ORTHODONTICS
Adjustment of Dentures – limited to adjustment of clasp Covered Orthodontic Consultation Covered Aesthetic Dental Consultation Covered Dental education and counselling Covered TREATMENTS Treatment for lesions, wounds and burns Treatment of Dental related pain excluding cost of prescribed medicines Covered Relief and/or prescription for acute dental pain Covered Emergency desensitization of hypersensitive teeth Covered Gum Treatment(except gum surgery)excluding cost of prescribed medicines. This shall include the management of other dental problems excluding surgeries. Covered GROUP LIFE WITH ACCIDENTAL DEATH & DISABLEMENT (AD&D) BENEFITS (Optional)
Life 10,000 AD&D Coverage a. life 100% of amount of insurance b. entire sight of both eyes 100% of amount of insurance c. both hands or both feet 100% of amount of insurance d. one hand and one foot 100% of amount of insurance e. either hand or foot and sight of one eye 100% of amount of insurance f. Arm at or above elbow 70% of amount of insurance g. Leg at or above knee 60% of amount of insurance h. One hand at or above wrist 50% of amount of insurance i. One foot at or above the ankle 50% of amount of insurance j. Hearing of both ears 50% of amount of insurance k. Sight of one eye 50% of amount of insurance l. Four fingers and thumb of one hand 50% of amount of insurance Eligible Members 18 to 65 years old, as of last birthday Overage principal members may be accepted subject to substandard rating of x2.5 (for ages 66 – 70)
and x3.5 (for ages 71 – 75).
Preexisting Conditions
FOR PRINCIPAL MEMBERS: Pre-existing conditions are covered up to MBL
FOR DEPENDENTS: Pre-existing conditions are covered once 75% minimum participation is met; otherwise subject to the following:
If 50% <= P < 75%; subject to 1 year contestability
If 25% <= P < 50%; subject to 1 year contestability (with adjusted rate)