Coverage is subject to the Maximum Benefit Limit per person per illness or injury per year:
Neurological Disorder

• Blood dyscracia

• Collagen/Immunological disorder

• Liver Cirrhosis

• Chronic Pulmonary/Renal disorder

• Cardiovascular disorder

• Cancer

• Any condition which necessitates the use of Intensive Care Unit subject to other limitations.

• Accidental injuries

• Other conditions causing partial or total organ damage or failure.

An illness or condition shall be considered pre-existing if before the Effective Date of the Agreement:
1. Any professional advice or treatment was given for such illness or condition prior to effective date of coverage.
2. Such illness or condition was in any way evident to the member prior to effective date of coverage.
3. The pathogenesis of such illness or condition has already started prior to effective date of coverage (which the member may not be aware of)

After the member has been continuously covered with I-Care for 12 months and the agreement is renewed, PECs are covered provided that the PEC is not considered part of the "Permanent Exclusions to Health Care Coverage." and that such PEC was declared by the member in the original application. Genuinely unknown (and therefore undeclared) PECs will be covered provided these are not concealment cases. In case an application is disapproved due to an adverse medical condition, an applicant may still avail of the I-Care program by executing a "waiver" relinquishing or limiting coverage for the particular adverse condition.

• Hernias
• All tumors and malignancies involving any body organ or system
• Endometriosis, Dysfunctional Uterine Bleeding
• Hemorrhoids
• Diseased tonsils requiring surgery
• Pathological abnormalities of the nasal septum and turbinates
• Hyperthyroidism / Goiter
• Cataract
• Sinus condition requiring surgery
• Asthma/Chronic Obstructive Pulmonary Disease
• Liver cirrhosis
• Tuberculosis
• Anal fistulae
• Cholelithiasis/Cholecystitis
• Calculi of the urinary system
• Gastric or duodenal ulcer
• Hallux valgus
• Diabetes mellitus
• Hypertension
• Collagen disease/auto immune disease
• Cardio-vascular disease
• Hormonal dysfunction
• Seizure disorder

The following health conditions may be covered (either fully or up to certain amounts) provided pre-existing conditions of an account are likewise covered.

• Organ transplants and/or open heart surgery/ angioplasty and all services (e.g., coronary angiogram) related thereto (except organ and donor services)

• AIDS and AIDS-related diseases except when sexually transmitted

• Congenital abnormalities and conditions are covered up to P10,000.

• Chronic glomerulonephritis, gullain-barre syndrome

• Physical deformities (e.g., scoliosis, spinal stenosis, vitiligo, psoriasis, etc.). Only consultations are covered.

• Care by non-accredited Physician and / or in a non-preferred or non-accredited hospital/clinic except in emergencies wherein the emergency provision of the agreement will apply.

• All pregnancy related conditions requiring medical/surgical care and screen tests related thereto.

• Sterilization of either sex or reversal of such, artificial insemination, sex transformations or diagnosis and treatment of infertility, and circumcision.

• Rest cures, custodial, domiciliary or convalescent care.

• Cosmetic surgery, dental/oral surgery, and dermatological procedures for the purpose of beautification except reconstructive surgery to treat a dysfunctional defect due to disease or accident.

• Psychiatric disorders, psychosomatic illnesses, hyperventilation syndrome, adjustment disorders, anxiety disorders, alcoholism and its complications or conditions related to substance or drug abuse, addiction and intoxication.

• Sexually transmitted diseases.
  Medical and surgical procedures which are not generally accepted as standard treatment by the medical profession.

• Procurement or use of corrective appliances, artificial aids, durable equipment, and orthopedic prosthesis and implants.

• Surcharges resulting from additional personal (luxuries/accommodation) request or service including special nursing services.

• Physical examination required for obtaining employment, medical certification, insurance or a government license, and procedures for   purely diagnostic / screening purposes including among others, procedures conducted prior to hormonal replacement therapy

• Injuries or illnesses due to military, paramilitary, police service, high risk activities, or suffered under conditions of war.

• Reimbursement of procedures obtained through government programs

• Injuries or illnesses, which are self-inflicted, caused by attempt at suicide or incurred as a result of or while participating in a crime or acts involving the violation of laws or ordinances

• Out-patient/take-home medicines

• Valvular Heart Disease or Rheumatic Heart Disease 17 Medico-legal consultations

• Medico-legal consultations

• When a member is discharged against medical advice

• Blood/Organ Donor screening / other screening procedures

• All hospital charges and professional fees after the day and time hospital discharge has been duly authorized and professional fees of Assistant Surgeons

• All conditions and complications requiring dental care

• All confirmatory tests used to document health conditions not covered under the program

• Hypersensitivity tests

• Hospital Admission Kits

1. Membership fees are based on a specific number of, principal enrollees that were culled from the client's employee census.

2. If membership fee is employer-employee shared or employee-paid, we require at least 75% participation of employee-principals.

3. Accommodation/Benefits Plan of Principal Members must follow a uniform category (e.g., officers at Private room, rank-and-file employees at Semi-Private room, etc.) pre-established by the client at the start of the program.

Principal members:

Participation and Enrollment:

• If Dependents' Coverage is Employer-paid, we require 100% participation of employee-principals enrolling at least two (2) immediate dependents each following our hierarchy guidelines.

• If Dependents' Coverage is Employer-Employee-Shared or Employee-paid, we require at least 75% participation of employee-principals enrolling at least two (2) immediate dependents each following our hierarchy guidelines.

• In both instances above, if the minimum participation requirement is not met (because of employees who may have only one or no eligible dependent/s), we may still offer Dependents' Coverage. Applications will be individually underwritten subject to acceptance or denial as the case may be. It is understood that a re-quote of dependents' rates based on the actual number of enrollee-dependents may be done, if necessary.

• Dependents should be enrolled simultaneously with principal members.

• Newly married spouse, newly born child/sibling should be enrolled within 31 days from date of qualification as a dependent.

• Accommodation/Benefits Plan of Dependents must follow a uniform category pre-established by the client at the start of the program; and must be equal to or lower than the Principal's accommodation/benefits plan.

Our program is integrated with benefits under Philhealth and/or Employees Compensation Commission (ECC); therefore such Philhealth and / or ECC benefits to which the member is entitled to shall be deducted from the claim cost in the computation of benefits under our program, unless agreed otherwise through a special endorsement in the contract. All covered members are assumed to be Social Security System (SSS) members. In case a member and/or any dependent is not an SSS member, he shall be charged the amount equivalent to the Philhealth benefit in case he is hospitalized. I-Care shall pay only all hospital bills in excess of the Philhealth benefits. Philhealth benefits may not be used to cover excess charges or services not entitled to coverage.

An applicant applying for coverage is required to accomplish an enrollment form otherwise there will be no coverage despite having paid a deposit for membership fees. Changes in the application may be done prior to the underwriting process or the issuance of the ID card. Exceptions, if any, will be handled on a case-to-case, non-precedent setting basis. It is understood that I-Care reserves the absolute right to approve or disapprove any application for membership. In case an application is disapproved due to an adverse medical condition, an applicant may still avail of the I-Care program by executing a "waiver" relinquishing or limiting coverage for the particular adverse condition. Non-compliance of underwriting requirements within me prescribed period -will mean the exclusion from coverage of the condition for which an underwriting requirement has been prescribed. It will likewise mean the non-issuance of the member's ID card. While the member's health care program is in effect, hospitals will have to call the I-Care Office before providing services for a member without an ID card. In case of pre-termination of coverage or resignation/deletion of members, the client should return the ID card(s) of members. Any misuse of the ID card by a member will be for me account of the client and/or the member.