INTELLICARE’S CLINIC-BASED PROGRAM: WHAT YOU NEED TO KNOW
Intellicare’s Clinic-Based Program puts modern, multi-specialty clinics at the forefront of healthcare delivery for you and your dependents.
Under the Clinic-Based Program, your nearest Intellicare-accredited clinics become your first stops for services such as:
You will also retain hospital access for confirmed-emergency cases and hospital confinements, subject to the provisions of your Intellicare plan.
WHAT YOU CAN EXPECT
For outpatient consultations, routine medical procedures, and referrals, please follow Intellicare’s hierarchy of accredited facilities:
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Cases
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Facility
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All referrals, consultations, and procedures
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Intellicare Aventus clinics or any Intellicare-accredited clinics (e.g., Hi-Precision)
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No available specialists or prescribed procedure in any accredited clinic |
Intellicare-accredited hospital |
Note: Outpatient coverage does not include clinics affiliated with major hospitals (except The Medical City clinics).
You also retain hospital access for confirmed-emergency cases and hospital confinements, subject to the provisions of your Intellicare plan.
AVAILMENT IN PROVINCIAL AREAS
In some cases, however, you may require special consultations or medical procedures that are not available at your nearest accredited clinics. When this happens, Intellicare prescribes the following steps:
Get assistance from Intellicare
STEP 1: Call Intellicare’s Hotline at (02) 7902-3400 or (02) 8789-4000. Inform Intellicare of the specialist consultation or medical procedure you need.
STEP 2 : Get a referral to an accredited hospital. During your hotline call, if Intellicare determines that there are no clinics that can serve your needs, you will be referred to an accredited hospital instead.
STEP 3: Proceed to the referred hospital to avail of your intended outpatient service.
Proceed to nearby non-accredited facility
Please take note that availments in non-accredited facilities are via reimbursement.
STEP 1: Proceed to nearby non-accredited clinics for consultations and laboratory procedures, or hospitals for confinement and emergency cases.
STEP 2: Secure required supporting documents for filing reimbursement claims:
- Original official receipt (with TIN)
- Statement of Account from the accredited hospital
- Medical certificate with diagnosis
- Laboratory result (if applicable)
- Operative record with histopath (if with operation)
- Police report and medico-legal report (if required)
STEP 3: File reimbursement claims via Agora App or through ActiveLink’s Helpdesk.
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Availments at non-accredited facilities are reimbursable 1. Members are allowed to avail services from non-accredited doctors and non-accredited hospitals for inpatient and outpatient cases. 2. Reimbursement shall be up to 100% of hospital bills and 100% of professional fees based on Intellicare’s Relative Value Scale (standard fees). 3. This does not apply for the following dental services and accredited hospitals or facilities that are specifically excluded in the agreement. |
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