AIA Med-Assist FAQs | HMO Insurance Plan FAQs

Don't let your hospital bill add to your worries! AIA Med-Assist will help you focus on your recovery by covering 90% of your in-patient expenses, as well as other medical expenses that can pile up without notice.

It is a co-pay plan that comes in four different packages to match your budget, with a long-term payment plan for more manageable premium payments.

Ages 0 to 55 can avail of this plan, renewable to age 65.

AIA Med-Assist covers your in-patient hospitalization and medical expenses through the Avega health card that comes with the plan. Because of its convenient co-pay arrangement, 90% of the bill will automatically be charged to AIA Philippines so that you will only have to pay the remaining 10%.

AIA Med-Assist can shoulder up to P4,000,000 annually.

It also has life insurance, daily hospitalization income benefit, medical savings fund, waiver of premium, and AIA Vitality benefits!

Co-pay, also known as co-insurance, means AIA Philippines covers most of your in-patient needs, but you will also cover the little that’s left of the expenses. These expenses are specifically for treatment, hospital charges, and nurses’ fees during your confinement.

For example, if your total hospital bill is P15,000, AIA Philippines will shoulder 90% of it, which means all you have to pay is P1,500 or the remaining 10%

In the event of loss of life, AIA Med-Assist will pay out a lumpsum cash benefit to your beneficiaries, which can go as high as 90 times your basic annual premium. This will help ease the financial burden that your loved ones may experience.

Get up to P3,000 worth of Daily Hospitalization Income for every day that you're confined, over the course of a year, to offset any income loss you may experience from being hospitalized. Avoid the stress of medical expenses and focus on recovery instead of having to worry about your daily income!

On top of providing financial solutions to health-related concerns, AIA Med-Assist also has an investment fund that can help you build your own medical fund in the future. So not only will you be covered for medical emergencies in the future, but you can also grow a considerable sum of medical savings after a designated duration.

In the event of total and permanent disability, you won't have to pay your basic annual premiums and special top-up payments anymore. This waiver frees you from financial worries so you can focus on more important things.

The best response to hospitalization is avoiding it altogether. By living better, you avoid sickness and other medical conditions that require confinement. AIA Med-Assist comes with AIA Vitality —a science-backed platform that encourages a healthier lifestyle by rewarding you for every step through your fitness journey. It empowers you to know your health, improve your health, and enjoy the rewards, keeping you strong and helping you live a healthier, longer, and better life.

Get in touch with me to avail of your AIA Med-Assist plan:

You can start to use your health card after 30 days from the effective date of your Life Insurance Policy.

Your health card is valid or useful as long as:

  1. the Policy is not terminated;
  2. the Policy is not lapsed due to non-payment of premiums;
  3. the Policy anniversary at which you have not attained the age of 65 years old;
  4. your health card is not suspended due to payment of premium;
  5. you have not reached the lifetime maximum limit of the Policy.

AVEGA consistently updates its list of affiliated doctors and medical providers. You may download the list from their website (www.AVEGA.com.ph), our Facebook Page (www.facebook.com/avegamanagedcareinc).

AVEGA may have an assigned coordinator(s) per hospital who will accommodate members for outpatient and non-emergency consultations during their specified clinic hours. For hospitals that have no coordinators but have an HMO or Industrial office, you may secure AVEGA Referral Forms from either office.

For medical emergencies, you may proceed directly to the emergency room of the hospital for immediate treatment. However, assessment of whether the case is emergency or not will depend on the Emergency Room physician.

Consultation, treatment and referral for diagnostic procedures and/or confinement coming from a non-accredited doctor is non-reimbursable. For you to enjoy the benefits of your health plan, you must avail of your benefits in an AVEGA accredited hospital and have your case managed by an AVEGA affiliated doctor, except during emergency cases.

Yes, you may occupy a room category higher than what is entitled to you. However, during voluntary upgrading (when you choose to occupy a higher room category even if you’re allowed room is available), you will pay all incremental charges. Due to socialized pricing in hospitals, the higher the room occupied - the higher the cost of services. This includes room rate, professional fees, medicines, medical supplies, hospital procedures and the like.

The same charges may also apply if you are admitted in a hospital that does not provide or does not allow confinement of nonprivate patients in the room category corresponding to your plan. The AVEGA Patient Relations Officer shall explain and remind you to pay these charges prior to hospital discharge.

Any and all illnesses proven to be related or is a complication of a certain illness shall share the same Benefit Limit.

It is the member’s responsibility to file the PhilHealth forms. If you fail to file upon hospital discharge, you will pay the amount corresponding to your PhilHealth benefit and apply for reimbursement directly from the PhilHealth Office afterwards.

AVEGA Patient Relation Officers (PROs) will provide assistance in reminding you to submit the said forms.

They, however, will not be directly responsible for the actual filing.

Note: In the case of a non-PhilHealth member, member must pay the PhilHealth portion of the hospital bill prior to hospital discharge.

If you were treated in a non-accredited hospital for a medical emergency, AVEGA will reimburse your medical expenses based on the Relative Value Scale (RVS), subject to your co-pay of 10%.

If you were treated in a non-accredited hospital for a medical emergency, AVEGA will reimburse your medical expenses based on the Relative Value Scale (RVS).

Submission of the duly accomplished AVEGA Reimbursement form and required attachments is within 30 days from the date of hospital discharge or treatment.
AVEGA will process the request within 20 days upon receipt of the complete documents.

You should call AVEGA’s Trunk line through telephone numbers (02)7902-3430 or (02)8789-4030 for assistance and verification of the service being charged.

You may pay for the cost of the procedure first then file for reimbursement later on. Reimbursement shall be based on the Relative Value Scale (RVS) or pre-agreed rates for laboratory and diagnostic examinations (i.e. CT scan, MRI, etc.). If you do not want to shell out the amount being asked for, you may transfer to another AVEGA-accredited facility that has no “cash basis only” policy. You may call AVEGA’s Trunk line for assistance.

 

The professional fees of Neurologists at the moment are on a “cash basis” policy for all HMO members. This policy is in accordance with the guidelines set by the Society of Neurologist of the Philippines. You may pay for the cost of professional fees first then file for reimbursement based on AVEGA’s Relative Value Scale (RVS). For any recommended procedures, AVEGA will cover the member immediately according to the plan benefit.

AVEGA will exert all its effort to negotiate for the AVEGA rate to be charged once the member is referred to a non-affiliated specialist. If the physician does not agree to the rate, you will be asked to pay the cost of their professional fee first then file for reimbursement based on the AVEGA Relative Value Scale (RVS)

In this case, you need to submit a police report and other pertinent documents for any injuries sustained in vehicular accidents and other medico-legal cases (i.e. shooting, stabbing, mauling, etc.) subject for evaluation. AVEGA will not cover injuries resulting from causes under the general exclusions and limitations.

You should notify AVEGA’s Trunk line within 24 hours upon discovery of the loss. You need to submit an Affidavit of Loss and will be charged Php 100.00 for the replacement of the card. If you need medical care while your new card is still being processed, you may contact AVEGA’s Trunk line for endorsement to the medical facility where the procedure or consultation/treatment will be conducted.

 

You may create an incident report and e-mail to AVEGA at info@ AVEGA.com.ph. For urgent matters, you may call AVEGA’s Trunk line for immediate assistance. Please give all pertinent information for AVEGA to be able to address the concern/s as quickly as possible

While your premium increase every year because of medical inflation we will not deny your coverage due to your being diagnosed with a chronic or critical medical condition. In other words, all our Policyholders' premiums increase at the same rate depending on their age group. Your coverage will continue until you reach the maximum age limit or the lifetime benefit limit whichever comes first.

 

No. You are not allowed to upgrade or downgrade your medical coverage at any point in time.

Aggregate limit means the maximum liability that Philam Life shall assume for all covered benefits rendered to you within one year term of the Policy. The aggregate limit is replenished upon renewal of the Policy.

This is the maximum amount of the medical benefit available to you during your lifetime. Once you reached this amount you can no longer avail of the benefits or get any reimbursement.

Get in touch with me to avail of your AIA Med-Assist plan:

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The Fine Print

  • The contents of this page are for illustration purposes only. Actual terms and conditions are found in the Policy Contract. In case of conflict, the terms of the policy shall prevail.
  • Reminder on Pre-existing Conditions and Free-Look: Upon receiving the Policy Contract, you may refer to it for the full details on critical illness definitions, exclusions including the pre-existing conditions, and other limitations. If after reading the Policy Contract you decide that this plan is not suitable for your needs, simply return it to AIA Philippines within 15 days from the date you or your authorized representative received it and we will refund the total premiums you have paid.
  • For insured age 0-17, the benefit of the plan would include the Life Insurance Coverage and the Medical Benefit only.
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When he is not busy watching "The Office", lounging at the beach, or playing 1st person shooting games, Argel consistently invests in the stock market, both local and global. He loves learning through books, training, seminars, and workshops. He also helps Pinoys create, manage, grow, and protect their wealth as a globally-certified Professional Financial Advisor. Get in touch with him by sending an email to contact[at]argeltiburcio.com

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