AIA Med-Assist FAQs | HMO Insurance Plan FAQs

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.

MediCard consistently updates its list of affiliated doctors and medical providers. You may search the list from their website https://www.medicardphils.com/accredited-providers/ , or download the MediCard Go app.

MediCard 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 MediCard 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 a MediCard accredited hospital and have your case managed by a MediCard 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, MediCard 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, MediCard 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 MediCard-accredited facility that has no “cash basis only” policy. 

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 MediCard’s Relative Value Scale (RVS). For any recommended procedures, MediCard will cover the member immediately according to the plan benefit.

MediCard will exert all its effort to negotiate for the MediCard 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 MediCard 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. MediCard will not cover injuries resulting from causes under the general exclusions and limitations.

You can present your MediCard membership proof through the MediCard Go app.

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.