HMO Benefits 2023 - Intellicare

Welcome to the IO HMO Program! Our Current HMO Provider is Intellicare.

Availment Type

1. We are on a Hospital Based type of availment with the provider, Intellicare: all consultation/check up/outpatient (including laboratory exams) transactions can be accommodated by accredited medical facilities by Intellicare, whether clinics or hospitals. All in-patient, admission and emergency cases are also covered in accredited major hospitals.
   
2. The coverage of our maximum benefit limit is per sickness, per year
3. Certificate of Coverage for 2023 - see file attached to this page

HMO Account and Card Number Checker

Digital Registration to Agora Website and/or Mobile Application

1. For the ease of access to your HMO benefits, provider services, accredited medical facilities, digital HMO ID and more! Register through the AGORA website or mobile application! 
   
2. Check the link for the registration guidelines: Intellicare Website Access and Mobile Application

Dependent Enrollment Request

A. A team member may enroll their dependent/s during the following occasions:

• For new hires - within 30 days from hire date 
• Employee Anniversary Hire Date - within 30 days from anniversary hire date
• Change of civil status - from single to married (will enroll spouse or child), within 30 days from date of marriage (based on marriage certificate)

• Enrollment of newborn - within 30 days from birth date (based on birth certificate of newborn)

• Due to Promotion - within 30 days from effective date of promotion

• HMO renewal period - base on released communication/announcement from HR

Reminders: (Please read)

1. Dependent endorsement should be sent to HR within 30 days of the applicable enrollment period



2. Late endorsement of dependent/s may result to disapproval by the provider



3. Endorsed dependent can only be enrolled for the same plan type of principal member, upgrade/downgrade of plan type is not accommodated



4. Employee may only endorse a maximum of 2 dependents on their first applicable enrollment period, enrollment of 3rd and 4th dependents may be accommodated once a member reach their 3rd year anniversary



5. Only a maximum of 4 dependents (2 free and 2 employee paid) can be enrolled per employee

For cases where the a member wish to skip the eligibility of hierarchy, please provide as well any of the applicable supporting documents:
-if first eligibile dependent have HMO already: a copy of the HMO card or certificate of coverage

-if first eligible dependent is not in PH: a copy of their valid ID abroad or active VISA

-if separated from spouse/husband: a copy of the annulment/legal documents

-if deceased: a copy of the death certificate

• For us to request your dependent enrollment, the following details are required by the HMO provider:

• Send the complete details and attach soft copies of supporting requirements/documents in a ticket here.
• Update/s will be sent to the employee within 2-3 weeks from date of endorsement if provider requested for additional requirements/clarifications, enrollment is approved or disapproved.
  

• Below is the current premium rate guide for the 2023 coverage year
  

  

  
  

E. How would I know my Maximum Benefit Limit?

• This is indicated in your signed job offer and employment contract as your “Healthcare Benefit”




• If not available, please submit a ticket request for us to provide you with the information.

Cancellation Request

A. When to send a dependent cancellation request:

• Every renewal period – will be subject for review and approval of provider



• Employee’s Anniversary hire date –  within 30 days from anniversary hire date



• Dependent has been deceased – employee to provide a copy of the dependent’s death certificate



• Dependent went abroad – employee to provide a copy of the dependent’s valid ID abroad or copy of visa with latest stamp

B. Reasons that the provider may consider for approval of dependent  cancellation/replacement request:

• If  employee had a change of civil status (from single to married and will enroll spouse or child in replacement of their enrolled initially enrolled dependent/s, if any) – provide the marriage and birth certificate for reference



• If dependent recently acquired their own HMO coverage/card – provide a oft copy of the new HMO card



• If dependent went abroad – provide a copy of the dependent’s updated visa/valid ID abroad

• Please send the request via a ticket and include the following details:
  1. Name of Dependent
  
  
  
  2. Reason for cancellation request
• Attach any of the required supporting documents as reference for the request
• Update/s will be sent to the employee within 2-3 weeks from date of endorsement if provider requested for additional requirements/clarifications, cancellation request is approved or disapproved.

HMO Details Correction/Update Request

• Please send the request via a ticket and include the following details:
  

1. Name of Employee/Dependent
2. Detail for correction

• Include supporting documents for the request as an attachment:
  
  • Birth certificate
  • Marriage certificate
  • Valid Government ID

FAQs

• Only immediate and legal family members of the employees are eligible to be enrolled as their dependents.



• Married members can only enroll their spouse and child/children as per the provider's hierarchy of eligible dependent