DigiMed – What’s Included

• ✅ One (1) medical tele-consultation through HeyPhil DigiMed with any of the following physicians:
  • 🩺 Family Medicine Specialists
  • 🩺 Internal Medicine
  • 🩺 General Practitioner
• ✅ Issuance of medical assessment and prescription
• ✅ Endorsement for lab tests/procedures to clinics if necessary
• ✅ Referrals for specialty consult if necessary
• ✅ Interpretation of laboratory test results
• ✅ Consultations for pre-existing conditions not requiring emergency attention

Coverable Cases

This plan covers outpatient conditions that require primary care consultation but do not need physical examination or visualization by the doctor.

• ✔️ Respiratory: allergies, asthma, bronchitis, colds/cough, sinusitis/rhinitis, pharyngitis, laryngitis, tonsillitis
• ✔️ Cardiovascular follow-up: hypertension, medicine refills
• ✔️ Gastrointestinal: diarrhea and vomiting, GERD, dyspepsia
• ✔️ Skin conditions: allergies, rashes, insect bites, swelling/inflammation, cellulitis
• ✔️ Other conditions: acne breakouts, arthritis, boils (pigsa), conjunctivitis, ear infections, fever, mild injuries, sprains and strains, UTI and bladder infections, general pediatric conditions for initial consult

Limitations

Not intended for cases requiring in-person examination or visualization.

• Emergency-related cases
• Maternity-related cases
• Dental consultations
• Mental health related conditions
• Behavioral or developmental/psychiatric disorders and psychosomatic illness
• Dermatology-related cases needing specialist care
• Illnesses requiring treatment from a medical specialist (severe chronic conditions)
• "Fit to work" assessments requiring medical certification

MindCare Counseling – What’s Included

• ✔ One (1) Mind Care Counseling Session with MyGolana coaches and counselors
• ✔ Fifty (50) minutes of personalized counseling time
• ✔ Mental health screening and review of results
• ✔ Counseling activities based on your needs, as advised by counselors

Coverable Cases

• ✔️ Mental & Emotional Health: anxiety, depression, stress, loneliness, lack of motivation, frustration, fear, phobias, grief, low self-esteem, insomnia, anger management issues.
• ✔️ Relationship & Family Issues: family and marital conflict, relationship fatigue, blended family challenges, bullying, domestic violence, gender issues, relational problems.
• ✔️ Social & Environmental: living alone, social rejection, acculturation difficulties, phase-of-life transitions, neighbor conflict, housing/landlord issues.
• ✔️ Educational & Work: academic or occupational problems.
• ✔️ Economic & Basic Needs: financial struggles, poverty, lack of food or clean water.
• ✔️ Health-Related: dealing with HIV.

Limitations of MindCare Counseling

• Only covers access to HeyPhil Mind Care Coaches and Counselors.
• Each session is 50 minutes and conducted entirely online.
• Psychiatric consultations requiring in-person check-ups are not included.
• No online diagnosis and prescription of psychiatric medication.
• Not applicable to individuals:
  • Currently under psychiatric care or previously advised to seek psychiatric treatment
  • Mandated by authorities to undergo psychotherapy
  • In emergency or crisis (repeated suicidal ideation, risk of harm to self/others, known violent psychopathology, active or imminent suicide or harm attempt)

DigiMed teleconsult benefits and limitations are the same as in IndieGO 40.

MindCare counseling session coverage and limitations follow the same structure as IndieGO 40.

DigiMed teleconsult benefits and limitations are the same as in IndieGO 40.

MindCare counseling session coverage and limitations follow the same structure as IndieGO 40.

This product is focused on dengue-related confinement. Coverage applies when the insured is admitted for dengue treatment and medically necessary services are provided.

Conditions and services not related to dengue, as well as items listed under PhilCare’s general policy exclusions and partner insurer terms, are not covered.

ER coverage applies to medically necessary outpatient emergency care for acute illnesses and accidental injuries within the benefit limits. Unlimited OP consults and diagnostics apply at participating clinic networks under PhilCare, MedHub, and Healthway.

Exclusions

Pre-existing conditions are generally covered, except:

• Maternity-related cases
• Behavioral, developmental, or psychiatric disorders
• Psychosomatic illnesses (whether congenital or acquired)
• Consultations with medical specializations not listed under the covered services

Coverage is triggered by dengue-related confinement for pediatric members, following medically necessary protocols and DOH-recommended diagnostics.

Non-dengue illnesses, excluded items under PhilCare’s standard policy, and exclusions under the partner insurer’s AD&D coverage are not included.

Applies to family members enrolled under the product for dengue-related confinement only, following PhilCare’s medical necessity rules.

Non-dengue illnesses, general policy exclusions, and AD&D exclusions as per partner insurer are not covered.

Coverage applies to outpatient consultations and diagnostics within the PhilCare/Healthway network, following standard medical necessity guidelines. DigiMed usage is for non-emergency, outpatient-level conditions.

Exclusions

Pre-existing conditions are generally covered, with the following exceptions:

• Maternity-related cases
• Behavioral, developmental, or psychiatric disorders
• Psychosomatic illnesses (whether congenital or acquired)
• Consultations with specialties not listed in the covered services