Detailed Benefits

IMS Wellth Care (IWC) offers the first Daily Hospitalization Benefit Program in the healthcare industry. The program includes customized, comprehensive and affordable healthcare benefits supported by the IWC Medisystem, an internet and/or dial-up-based network which connects IWC to its accredited Providers (hospitals/clinics) nationwide on real-time basis and by its 24/7 Customer Service.

Through the Medisystem, IWC members who need to be hospitalized will enjoy the benefits of online verification of their plan status as well as generation of payment guarantees prior to consultation, admission or discharge in IWC-Accredited Hospitals. Hospital/clinic staff simply input IWC member’s data into their online computer terminal.

The IWC Gold card opens the gateway to quality health care services from 7,000 highly trained specialist doctors and from over 300 IWC accredited hospitals and clinics nationwide.


HEALTHCARE BENEFITS

1. Hospitalization/ In patient Services
2. Emergency Room Care Services
3. Preventive Health Care
4. Out Patient Services


1. HOSPITALIZATION/ IN PATIENT SERVICES

It is extended for the treatment of illness/ injury requiring confinement in IWC-accredited hospitals:
  • Room & board chosen/ opted by the member according to plan benefits;
  • Professional services of doctors including their fees;
  • Drugs & Medications while confined;
  • Routine laboratory examinations & commonly available diagnostic procedures
  • All other items/ services available & necessary related to the management of the case not exceeding the Daily Hospitalization Benefit as provided for in the plan.

2. EMERGENCY ROOM CARE BENEFITS

It is extended to members due to an accidental injury, the sudden & unexpected onset of a serious illness of such nature that failure to obtain immediate care would place the life in jeopardy or cause serious impairment.

3. PREVENTIVE HEALTH CARE SERVICES

Annual Physical Examination (APE) – includes CBC, urinalysis, fecalysis, chest X-ray in any IWC owned clinics nationwide, after eight (8) months of continuous active membership, or immediately after annual payment.

4. OUTPATIENT BENEFITS COVERAGE

that can be availed in any IWC Accredited Providers nationwide up to the maximum coverage per year.

5. OUT PATIENT:

Can be availed of in any IWC-owned clinics & laboratories* as follows:

  • 1. UNLIMITED Consultation for members and eligible dependents.
  • 2. Laboratory Procedures for Members (upon order of the In-House Physician):

    2.1. Complete Blood Count
    2.2. Urinalysis
    2.3. Fecalysis

  • 3. Diagnostic Procedures for Members (upon order of the In-House Physician):

    3.1. X-Ray
    3.2. Electrocardiogram (ECG)

INSURANCE BENEFITS

1. Life Insurance
2. Accidental Death and Dismemberment


1. LIFE INSURANCE

Planholder’s beneficiary/ies shall receive the amount of coverage once the member dies due to natural cause of death.
Life Insurance is subject to a one (1) year contestability period.

2. ACCIDENTAL DEATH AND DISMEMBERMENT

Accidental Death and Dismemberment Insurance provides indemnity for loss of life, limb, speech, hearing or sight, total and permanent disability, resulting from accidental bodily injury within the 180 days from the date of the accident shall result directly and independently of all other causes in any of the losses enumerated herein, the insurance company will pay the benefit corresponding to such loss. However, only one (1) of the amount specified in items 1 to 14 inclusive, the larger will be paid for injuries resulting from one (1) accident.


THE BENEFIT IN THE EVENT OF ACCIDENTAL LOSS SUSTAINED BY A MEMBER SHALL BE AS FOLLOWS:

LOSS INDEMNITY (Benefits below refers to basic amount of natural death benefit except for the loss of life.)
01. Life The sum insured (refers to
amount under AD&D as indicated in the certificate of cover attached.)
02. Loss of Both Hands or Both Feet or Sight of Both Eyes The sum insured
03. Loss of Hearing of Both Ears
3,000.00
04. Loss of One Hand and One Foot 4,000.00
05.Loss of Speech 6,000.00
06. Loss of Either Hand or Foot and Sight of One Eye 60,000.00
07. Permanent Total Disability
100,000.00
08. Loss of Either Hand or Foot One-half of the sum insured OR Sight of one eye
One-half of the sum insured
09. Loss of Four (4) Fingers of

One Hand One- half of the sum insured

10. Loss of One Foot Above the Ankle One-half of the sum insured
11. Loss of Thumb and Index Finger of Either Hand One-fourth of the sum insured
12. Loss of any two (2) Fingers One-fourth of the sum of either insured
13. Loss of all Toes of One Foot One-fourth of the sum insured
14. Loss of Big Toe 5% of the sum insured

Loss of hand means severance at or above the wrist. Loss of foot means severance at or above the ankle joint. Loss of sight means total and irrecoverable loss of sight.

Total and permanent disability is disability resulting from accidental bodily injury which disability wholly prevents the Employee/Member from engaging in any business and/ or occupation and from performing any work for compensation or profit and which disability has continued uninterruptedly for a period of at least six (6) months.

Upon the occurrence of any of the losses in items 1 to 10, all accident insurance herein shall immediately cease as to injury from any subsequent accident.

The coverage shall include while traveling as a passenger in an aircraft operated by a commercial passenger airline on a scheduled air service over an established route.






Owned and operated by IMS Wellthcare, Inc.

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