She’s Well Series Health Care Agreement

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 She’s Well Series provide diagnostic packages depending on the current life stage of the member.

Persons experiencing chronic conditions, now or in the past, should carefully review the services offered by these products. The She’s Well Series do not cover pre-existing conditions and/or chronic conditions. Many persons with pre-existing and/or chronic conditions controland manage their illnesses while leading active lifestyles. If they want to benefit from coverage that provides emergency medical care arising from accidents, viral and bacterial illnesses and 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 She’sWell Series
• How to register a person under the Insular Health Care She’sW
• 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 She’s Well Series

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 She’s Well Series 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 She’s Well Series, 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

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. ForShe’s Well, 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 She’s Well 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 She’s Well Coverage

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.

 For the She’s Well Series, the member can register again at any time, after repeat purchase of the product.

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 She’s Well Series. 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 have generated a Letter of Authorization to seek face-to-face medical consultation. This is also the process if the Member seeks to avail the diagnostic examination package of She’s Well. 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.

Telemedicine consultation is as easy as sending an SMS and waiting for the call of the doctor. Please visit

https://mypocketdoctor.com for more information.

Availment of Emergency Medical Care for Accidents: Police Report, Notarized Affidavit

Accidents at home are most unfortunate. For those accidents that result in injuries that require emergency attention at the hospital, the Member can avail of the medical care through the She’s Well Series. Insular Health Care will require a notarized affidavit from the Member for home accidents and accidents involving the Member. Insular Health Care will need this document at the point that the hospital bill is being settled, regardless if the Member was treated at the emergency room only or admitted.

People are also exposed to the risk of motor vehicle accidents, as a bystander, pedestrian, passenger or driver. In unfortunate situations where the Member is involved in a motor vehicle accident in any capacity, due to acts or omissions of another person, Insular Health Care will require a police report. Insular Health care will need this document at the point that the hospital bill is being settled, regardless if the Member was treated at the emergency room only or admitted.

The purpose of the affidavit and police report is to determine if the Member acted in his/her own best interest in protecting himself/herself from harm. For example, the Member needs to have been wearing a helmet or seatbelt if he/she were riding a motorcycle or vehicle, respectively, at the time of the accident. The Member also should not have been intoxicated or under the influence of illegal drugs while involved in an accident. Or the Member should not have been driving against traffic in a one-way street when the Member collided with another vehicle. In these situations, when it has been found out that the Member did not act in accordance with the law and other prescribed rules and regulations, the She’ product cannot respond to the Member’s need for emergency medical care.

Availment of Emergency Medical Services: Telemedicine, ER at Accredited Hospitals, 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 non- emergency situations.

All She’s Well Series variants have a 24/7 telemedicine consultation.

Emergency or not, the Member can avail of a telemedicine consult about any health concern within the coverage period. And when the Member thinks that she needs emergency care, it becomes even more important that the Member seeks telemedicine consultation before going to the emergency room. It is to the Member’s best advantage to do a telemedicine consult before going to the emergency room because the Member will receive a lot of useful and practical information from the doctor that will help the Member make a better-informed decision whether or not to proceed to the emergency room.

• Be properly advised if it is medically necessary to seek emergency care
• Assistance in calling for an ambulance
• Receive first aid instructions on the Member’s way to the hospital
• Be advised on the nearest accredited hospital
• The doctor can brief the destination hospital on the Member’s pending arrival with the details of the medical case
• If the case does not require emergency care, the Member can proceed to a telemedicine consultation, receive a prescription for medicines or diagnostic procedures and even a treatment plan – there is no additional cost to the Member for these services
• For post-diagnostic test, the Member can share her results with the doctor and proceed with a

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 She’s Well 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 She’s Well 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 She’s Well product benefit under which the Member is registered. In case the initial medical diagnosis changes to one that is not covered under the She’s Well 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. She’s Well product will also be reinstated as if it was not used so that it will still be available for future medical availment.

The She’s Well 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 She’s Well 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 non-coverable 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 documentsdetailed 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.