This is the Health Care Agreement for the following products. The complete terms and conditions of the benefits under these products are contained in this guide.

The products under the Dengue Flex and K12 Health Card Series are generally suitable for those who are relatively healthy and would like to be covered for emergency care medically necessary for dengue, leptospirosis and COVID-19 cases.

The products under the  Dengue Flex and K12 Health Card cover health risks to which most everyone is exposed, only in varying degrees. Insular Health Care wants to offer coverage to those who need it while in the Philippines, so these products are also available to non-Filipinos. Please note that the emergency care will be rendered by medical professionals and facilities within the Philippines.

Persons experiencing chronic conditions, now or in the past, should carefully review the services offered by these products. The  Dengue Flex and K12 Health Card do not cover pre-existing conditions and/or chronic conditions. Many persons with pre-existing and/or chronic conditions control and manage their illnesses while leading active lifestyles. If they want to benefit from coverage that provides emergency medical care arising from the specific conditions mentioned above, they may consider availing of this product for themselves for those contingencies.

Please refer to Section 2 for the details on the coverage and benefits.

How to use this information

There are several benefits under each health care product and the information contained in this booklet includes full details of them all. To understand the coverage, first identify the product under which the Member is or will be registered, and then read this booklet alongside the personalized Voucher and the Frequently Asked Questions (FAQ). If there is any discrepancy between this Health Care Agreement and FAQ, the Health Care Agreement will prevail.

By reading this booklet, one will understand:

• The accidents and illnesses that are covered by the above-mentioned Insular Health Care products
• How to purchase products under the Insular Health Care Dengue Flex and K12 Health Card
• How to register a person under the Insular Health Care Dengue Flex and K12 Health Card
• When is it medically appropriate to seek emergency care
• Where one should go to avail of emergency care
• What to expect at the Emergency Room of a hospital accredited by Insular Health Care
• What to do if the medical diagnosis/diagnoses is/are covered
• What to do if the medical diagnosis/diagnoses is/are not covered
• With which medical professional and where to seek non-emergency medical consultation
• How to self-generate a Letter of Authorization for the consultation
• How to ensure that a person is always covered under the Insular Health Care Dengue Flex and K12 Health Card

By registering or using this product, as the Purchaser and/or Member, you certify that you have read, understood and agree to this Health Care Agreement and the Return, Replacement and Refund Policy which can be viewed at https://www.insularhealthcare.com.ph/returnrefundpolicy/.

If you are not the Purchaser and you did not submit information about yourself, but you subsequently received an email with your Personal Information and Sensitive Personal Information and you confirmed their accuracy and further provided consent to Insular Health Care, consistent with Section 4 – Data Privacy in this guidebook, you certify that you have read, understood and agree to this Health Care Agreement, Insular Health Care’s Privacy Policy and the Return,

Replacement and Refund Policy which can be viewed at https://www.insularhealthcare.com.ph/privacy-policy/ and https://www.insularhealthcare.com.ph/returnrefundpolicy/

Section 1 – Purchasing and Registering

The Insular Health Care  Dengue Flex and K12 Health Card can be purchased online by visiting shop.insularhealthcare.com.ph/.  We offer a range of products and services on the shop. One should read and understand each product before selecting it for purchase. Please be mindful of the following:

• The service/s that it offers
• The places where the service/s can be availed
• The medical diagnosis/diagnoses that is/are covered and not covered
• The age requirement, if any
• The gender requirement, if any
• The information about the person to be covered required for registration
• Other limitations of the product

For the  Dengue Flex and K12 Health Card, the covered ages are as follows:

Purchasers who want to seek advice on the medically appropriate health care product for his/her requirements and those of his/her family, may chat with us online, send a private message on Facebook or request for a return call via a Facebook private message.

Online Purchase: Purchaser, Buyer’s Web-Based Account

When the Purchase has made a selection and is ready to check-out, he/she will be asked to open a free Insular Health Care Buyer’s web-based account to proceed. Insular Health Care will use the information that the Purchaser has submitted to us through this account to fulfill the purchase; e.g. send an email to confirm the purchase. The Purchaser may also use this account when he/she wants to purchase from the Insular Health Care store again. As the Purchaser, he/she will be able to see all of the products he/she has purchased and the status of each. The Purchaser will be able to view the following information:

• If a person has been registered under a specific product
• If the product is expired
• If a person has been registered, the Purchaser will know whether the coverage is inactive or active
• If a product is used.

In the process of check-out, the Purchaser has to select the payment method and make the payment. After receipt of payment is confirmed, Insular Health Care will send the Purchaser an email to confirm the purchase. The email will contain the product serial code that one needs to be able to register the person to be covered by the product.

The Purchaser can be registered under a product by registering himself/herself under a specific product. The Purchase is not covered under any product unless he/she has registered under it.

Online Registration of the Person to be Covered: Becoming a Member, Activation Period, Start Date of Coverage, Coverage Period, and Free-look Period

Registering is the process by which one identifies and submits the details of the person to be covered by the Insular Health Care product. This person who will be covered shall be called the Insular Health Care ‘Member’. Without a successful registration, no coverage can be provided by the Insular Health Care product to a Member. The Purchaser or the prospective Member must register the prospective Member under the purchased product as soon as possible so that the registration process can begin. Insular Health Care will send confirmation of the successful registration and details thereof to the Member. There is a maximum of 90 calendar days from purchase date to register the person; after which, a person can no longer be registered under the product. The product will be forfeited, and the payment will not be refunded.

If the Purchaser registers himself/herself or his/her child below 18 years old, he/she will receive the Product Voucher through the email address provided. If the Purchaser submits data of another adult, an email will be sent to that person through which he/she will confirm and provide his/her consent to submit the data to Insular Health Care. After he/she has given his/her consent, the Product Voucher will be sent to his/her provided email address.

Please see below for the activation period applicable to each product. Activation period refers to the number of calendar days from the date of successful registration to the start date of coverage. Activation period applies to everyone and cannot be waived for anyone. Activation period starts from the day after successful registration; after it ends, coverage begins.

Please see below the coverage period applicable to each product. The coverage period is defined by a start date and an end date and within this period, as long as the product has been successfully registered and is not terminated prematurely (see below Section 3 on ‘Availment’), the product is available for use by the registered Member, subject to the terms of coverage. The start date or effectivity date signifies the beginning of the coverage period.

Please see below a sample illustration of registration, activation period and coverage period. Once we have confirmed that a person has been successfully registered, coverage will automatically begin according to the activation period applicable to the product registered. Insular Health Care may send further notice that the coverage has begun.

Insular Health Care shall provide a “free-look” period during which the person who has successfully registered under any product may return or cancel the contract, if he/she disagrees with the contract conditions after receiving it, such as the presence of pre-existing conditions and exclusions after reading and evaluating the contract, or if he/she changes his/her mind in buying the product. The amount paid shall be returned in full to the Purchaser.  For all  Dengue Flex and K12 Health Card variants, the free-look period shall be fifteen (15) days from the start of coverage date.

The product’s free-look feature is no longer applicable at the end of the indicated period or if the Member already availed of any of the product’s benefits, even if the request for return or cancellation falls under the free-look period.

Product Voucher 

Once successfully registered under a product, the Member will receive a confirmation via email. The declared legal guardian of the registered children (anyone below 18 years old) will also receive the confirmation email. This email contains the important details concerning the coverage. It also includes the Product Voucher needed to be presented at the clinics of our accredited doctors and dentists for consultations, or to accredited hospitals to be able to seek emergency medical care. The Product Voucher also contains the Member ID which has to be given to the telemedicine provider to allow them to validate the telemedicine privilege, if applicable.

The email confirmation summarizes the benefits under the specific product registered. The Product Voucher contains the product name, the Member’s complete name, the Insular Health Care Member ID and the start and end dates of coverage. It is recommended that the Product Voucher be printed and a copy be kept in an accessible place, like one’s wallet. The Product Voucher, personalized with the Member’s details, together with a valid government-issued ID will have to be presented. If the covered person is a child without a school ID, the responsible adult accompanying him/her should present their government-issued ID.

Product Coverage Period and Termination Schedule

Once successfully registered, and after the activation period, the product coverage period begins.

For the  Dengue Flex and K12 Health Card series, the product coverage period is 12 months or until availed, whichever comes first.

Please see below the termination schedule of the Insular Health Care products:

Insular Health Care may send further notice to the Member that the coverage has been terminated. In any case, Members are urged to record and monitor the end date of their coverage so that they can purchase and register it again, on time and their coverage will be without interruption.

Repeat Purchase of Dengue Flex and K12 Health Card

Members can always stay covered with these Insular Health Care products. Simply visit shop.insularhealthcare.com.ph/ and log in to the account previously created to avoid having to input the buyer details again. Select and purchase the products and make the payment. As soon as the Purchaser has received the email from us confirming the purchase, register the person to be covered according to the Schedule below.

If the  Dengue Flex and K12 Health Card has not been availed, the Member can register as early as 10 calendar days prior to the end date of coverage for uninterrupted coverage. By uninterrupted coverage, it means that the activation period will coincide with the last 10 days of coverage period which avoids the activation period occurring after the coverage period. If the Dengue Flex and K12 Health Card product has been availed, the Member can register for another product as soon as the day following the availment of emergency care under the  Dengue Flex and K12 Health Cardproduct. If the Member has been confined, he/she can still register the day following the date of admission.

Remember that after successful registration, there is an activation period before coverage begins anew.

For concerns or queries relating to registration, please feel free to chat with us or send us an email or private message.

Invalidation of Agreement

Failure to disclose or misrepresent any material information by the Purchaser in the registration or medical examination, whether intentional or unintentional, shall automatically invalidate this Agreement from the very beginning, and liability of Insular Health Care shall be limited to the return of all payments less cost of previous services rendered or amount already refunded plus administration fee.

Section 2 – Benefits, Inclusions and Exclusions

One benefit of a Filipino citizen is universal PhilHealth coverage under Republic Act No. 7875, as amended. Its Implementing Rules and Regulations are available at

https://www.philhealth.gov.ph/about_us/IRR_NHIAct_2013.pdf.  It cannot be emphasized enough that it is to one’s greatest benefit to ensure that he/she is covered by PhilHealth and that he/she makes regular contributions, as necessary, to be able to complement one’s HMO coverage.

These are the services and benefits that one can avail under the  Dengue Flex and K12 Health Card.

Please read carefully how one’s PhilHealth coverage may help in covering the Member’s medical expenses.

Section 3 – Important Information on How to Avail of the Benefits

Availment of Medical Services: Online Letter of Authorization, Diagnostic Procedure Benefits

The Member will need to self-generate a Letter of Authorization to seek face-to-face medical consultation. Please prepare the Product Voucher which contains the Insular Health Care Member ID. The Member ID will be needed to generate the Letter of Authorization.

Availment of Emergency Medical Services: ER at Accredited Hospitals and Letter of Authorization

A medical professional will be able to determine if the Member needs emergency medical care.  Please visit www.insularhealthcare.com.ph/need-medical-attention-where-to-go to know when it is medically necessary to seek emergency care and why the Member should avoid the emergency room for nonemergency situations.

At the emergency room, if the doctor determines that the Member’s case is non-emergency in nature and/or the diagnosis is not coverable under the  Dengue Flex or  K12 Health Card product, the Member will shoulder all the hospital charges.

Also, it is the medical professionals who will attend to the Member who will provide the medical diagnosis of his/her case. They may be able to diagnose the Member within a short period of time or it may take longer, depending on the factors affecting the case. It is not common but it can also happen that they may provide a diagnosis in the beginning and eventually change it as the Member’s condition develops. In the end, it is the final medical diagnosis that will be used to determine if it is covered by the  Dengue Flex or K12 Health Card product under which the Member is registered.

To facilitate the Member’s medical care and based on an initial diagnosis, Insular Health Care may already issue a Letter of Authorization (LoA) to the hospital on the Member’s behalf, corresponding to the  Dengue Flex or K12 Health Card product benefit under which the Member is registered. In case the initial medical diagnosis changes to one that is not covered under the  Dengue Flex or K12 Health Card product under which the Member is registered, the Member will be advised at the soonest possible time that the LoA will be withdrawn from the hospital and that the Member will have to make his/her own arrangements with the hospital. The  Dengue Flex or K12 Health Cardproduct will also be reinstated as if it was not used so that it will still be available for future medical availment.

The  Dengue Flex or K12 Health Card product is considered availed when Insular Health Care issues a LoA to the hospital. The LoA may be in an amount less than or equal to the maximum amount of benefits of the  Dengue Flex or K12 Health Card product under which the Member is registered.  Please refer to the table below on how the LoA works to address the coverable charges in the hospital bill. Note that noncoverable charges in the hospital bill are for the Member’s account.

Availment of Emergency Medical Services: ER at Non-Accredited Hospitals

Insular Health Care cannot issue a LOA as a guarantee to the hospital for Emergency Medical Services provided outside its network of accredited hospitals, which means the Member must directly settle all charges corresponding to the medical care provided to him/her by the Non-Accredited Hospital.

A claim for reimbursement must be filed and received by Insular Health Care within sixty (60) days from the date of availment. The request must be submitted using the prescribed Claims Reimbursement Form, which can be accessed via www.insularhealthcare.com.ph/onlineservices/, and the required documents detailed on the said form. No reimbursement shall be made to the Member unless the original documents are submitted by the Member or a representative or if the Member has already been fully indemnified or reimbursed of medical bills or costs incurred under any other health care coverage or insurance policy or any other similar contracts or agreements. Failure to present the required documents within the filing period shall not invalidate nor reduce any claims if it was not reasonably possible to give proof within such time.

The processing period shall be thirty (30) days upon receipt of all necessary documents required by Insular Health Care. In case an additional requirement is needed, the thirty-day (30) period shall be reckoned against the date when the additional requirement is submitted.

All benefits that pertain to the Member will be paid by check to the Member. For dependents, payment in another manner may be done if Insular Health Care considers it more practicable. In case of death, benefits due but remaining unpaid shall be given to the first surviving class of the following classes of successive preference of beneficiaries: (a) widow or widower; (b) surviving children; (c) surviving parents; (d) surviving brothers and sisters; and (e) executors or administrators.

Request for reconsideration for reimbursement claims

lf a claim for reimbursement is denied, or the Member is not satisfied/agreeable to the reimbursement paid by Insular Health Care, a written request for reconsideration must be filed with the Insular Health Care Head Office not later than ten (10) days from receipt of such denial or questioned reimbursement. Otherwise, the claim shall be deemed satisfied or terminated. The request for reconsideration shall contain all the reasons upon which reconsideration is sought and shall be decided upon by the authorized personnel of Insular Health Care, whose decision shall be final. Insular Health Care reserves the right to deny Claims for Reimbursement if the procedures and requirements have not been strictly complied with.

Section 4 – Data Privacy

For purposes of properly administering its services, Insular Health Care shall collect, record, organize, store, update or modify, retrieve, consult, use, and in some restricted instances, consolidate, block, erase, disclose  (collectively, “process”) personal information (name, address, sex and contact information) and sensitive personal information (age, bank information, medical history, results of medical examinations, diagnosis, abstracts, treatments, utilization, records and information, medication, and other information relevant or connected with one’s HMO coverage from, or of one’s diagnosis, treatment or availment of health care services through Insular Health Care).

By buying our product and/or availing our services and providing one’s personal and sensitive personal information, the Purchaser and/or Member, as the case may be, is specifically:

1. Consenting to making one’s personal and sensitive personal information available to Insular Health Care, its affiliates, related entities and partner/ accredited hospitals, clinics, and wellness centers (including their officers, employees, service providers, subcontractors as well as members of their medical staff, house staff, doctors, nurses, allied health care personnel and other clinical staff – “Insular Health Care Related Entities”), and permitting Insular Health Care and Insular Health Care Related Entities to make one’s personal and sensitive personal information available to (i) third parties who provide products and services to Insular Health Care for the purposes described above; and (ii) regulatory authorities and government agencies. Provided, that the sharing of personal and sensitive personal information to Insular Health Care Related Entities shall be subject to (i) the principles of transparency, legitimate purpose, proportionality and data quality and to (ii) appropriate data privacy agreements and the implementation of organizational, physical, technical, administrative, procedural and security measures that are similar or greater than that being observed by Insular Health Care.
2. Authorizing their doctor and/or the hospital, clinic or wellness center that have provided the Member treatment to release any information and related documents (including a summary thereof derived from laboratory services and medical consultations) to Insular Health Care or its authorized representatives for the evaluation of the Member’s claims.
3. Consenting to the processing of the Purchaser and/or the Member’s, as the case may be, personal and sensitive personal information as provided under applicable laws, regulations, and Insular Health Care’s Privacy Policy, as stated in its website (insularhealthcare.com.ph/privacypolicy/).
4. Acknowledging that the personal and sensitive personal information that the Purchase and/or Member, as the case may be, has provided will be retained by Insular Health Care and Insular Health Care Related Entities as prescribed by law, or as long as necessary for the purpose of maintaining one’s medical records and to comply with applicable laws, rules and regulations. The Purchaser and/or Member, as the case may be, has been made aware that he/she and his/her next of kin, dependent or legal representative are entitled to certain rights in relation to the personal and sensitive personal information that may be collected from them, including the right to access, correction, and to object to the processing of the same. They have been made aware that a more detailed description of their rights under Republic Act No. 10173 or the Data Privacy Act of 2012 and its Implementing Rules and Regulations may be accessed and downloaded at privacy.gov.ph. They have likewise been made aware that should they have any privacy concern regarding their personal data, they may consult Insular Health Care’s Data Protection Officer at dataprivacy@insularheathcare.com.ph or Tel: 8813-0131 loc 8505, or the National Privacy Commission at www.privacy.gov.ph
5. They understand that the consent they are giving is in addition to any other consent that they may have already given Insular Health Care and Insular Health Care Related Entities regarding the processing of their personal and sensitive personal information (e.g. in relation to their HMO coverage/ availment, examination, diagnosis, treatment or procedure). They also understand that the consent they have given shall remain in full force for a period of one (1) year unless revoked in writing except to the extent that action has already been taken based therein.
6. Confirming that they understand the foregoing and that they are voluntarily giving their consent to the processing of their personal and sensitive personal information under the terms and conditions provided above.
7. If they registered another person, like a child or an adult under their authority like a specially-abled sibling, they certify that the data are accurate and that they have the legal authority to submit personal information and sensitive personal information about them to Insular Health Care. On their behalf, they authorize Insular Health Care to process their personal information and sensitive personal information for the same above purposes.

Section 5 – Resolution of Issues

Insular Health Care is committed to work with our Members to stay healthy and recover from any illness. Insular Health Care will handle the availment of the Member’s benefits in accordance with accepted Philippine medical standards and in cooperation with the Member and its medical partners. If the Member believes that Insular Health Care was not able to correctly and accurately handle the request for availment of benefits, please let us know so that we can review our procedures and correct them accordingly. Please feel free to communicate with us through phone, email or a private message on Facebook. We urge our members to use any of these methods of communication to preserve your privacy. In case the issue shall remain unacted or unresolved, you may request for settlement of dispute under Section 7 hereof.

Section 6 – Keeping in Touch

We want to stay in touch with members. Please do add our email address to your directory to avoid our emails from being classified as spam. Through email, through notices posted repeatedly on our website and social media accounts, we will communicate any information pertinent to the Insular Health Care products you have purchased. Please do update us of any change in your email address and other contact information so that you do not miss out on any important notices. Please find below a list of the notices we may send through email and possibly through SMS.

• Confirmation of your purchase
• Confirmation of your successful registration
• Confirmation of your availment
• Confirmation of your product’s termination
• Notification of your product’s upcoming expiry
• Changes in the Health Care Agreement

In any case, you may opt-out from receiving notices from us by unsubscribing from our mailing list.