Acceptance Age
Ineligible Businesses and Industries
Conditional Businesses and Industries
Grace Period
Lapsation
Reinstatement
Re-application
Renewals
Acceptance Age
Principal
member: 59 years old and below
Dependent
Spouse and Children: at least 6 months old up to 20 years old for
dependent children, and 59 years old and below for dependent
spouse. 
Ineligible Businesses and Industries
-
drug
rehabilitation centers
-
oil
and gas drilling
-
logging
-
cottage
industry type of explosives/fireworks
-
beer
gardens, non-corporate night clubs/spots
-
barber/beauty
shop
-
massage/sauna
parlors
-
embassies
and consulates (expatriates)
Conditional Businesses and Industries
Group
applicants with inherent occupational and/or hobby risks shall be
accepted for evaluation. Conditions shall apply to the following:
-
metal
mining
-
quarries
-
explosive
(industrialized manufacturers)
-
metal
drum manufacturer
-
taxi
and limousine services
-
protective/security
agencies
-
professional
athletic teams
-
applicants
are certified member of ECC
-
may
be approved by Top management on a case-to-case basis but
exclusions shall be issued for job/hobby related conditions and/or
membership fees shall be rated by Philamcare Actuarial Department.
Conditions
(a) and (b) shall apply to the following occupations:
-
security
guard
-
driver
-
carpenter
-
plumber
-
electrician
-
domestic
pilot
-
domestic
seaman
-
house
help/maid
-
athlete
-
waiter
Grace Period
A
member has a 31-day grace period to pay the membership fee from due
date.
Should
there be confinement within the grace period, the member must pay
first the membership fee before Philamcare will issue the Referral
Letter. Philamcare will only cover hospital expenses incurred by the
member on the day Philamcare received the membership fee.
Lapsation
An
Agreement is considered lapsed if membership fee is not received by
Philamcare within the 31-day grace period from due date.
Reinstatement
Payment
received after the 31-day grace period but within the next 30 days is
subject to reinstatement.
The
member is required to submit a Health Statement and Waiver of claims
forms. Approval for reinstatement is subject to Underwriting
guidelines.
The
member is not entitled to any medical benefits until the request for
reinstatement has been approved by Philamcare.
Re-application
After
the 31-day grace period and the member decided to continue his
coverage, he should re-apply by submitting a new application form and
pay the membership fees and processing fees. (no more enrolment fee to
be charged)
Re-application
is considered a new business. The 12-month contestability period shall
be applied.
Renewals
Renewal
payment should be received on or before the termination date of the
agreement.
Payments
received within 31 days after termination date can still be considered
a renewal but no medical benefits can be availed before payment date.
Payment
made after the 31-day grace period would be subject to re-application.
All first year renewals are required to submit a Health Statement and
will undergo re-underwriting.
