Group Medical Classic

Health

Issue Age

18-64 YEARS OLD

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AIA PHILIPPINES FINANCIAL ADVISOR

WHAT THIS PRODUCT IS ABOUT

No business will be successful without the right people who are healthy and get the job done for you. Give your employees medical benefits that are designed to meet their specific needs and enhance their quality of life.

AIA Philippines' Group Medical Classic is a customizable medical insurance plan that offers both health, life and accident protection.

WHAT DOES it PROVIDE?

BASIC MEDICAL / INPATIENT BENEFIT

Covers the employee’s expenses during confinement and pays for the following services:

Room & Board daily charges including ICU

Other hospital services including lab tests, X-ray tests, physical therapy, oxygen, anesthesia, central supplies and medicines during confinement

Surgical Fees

Doctor's Calls
GROUP LIFE INSURANCE

Provides life insurance protection anytime, anywhere and against any cause of loss of life.
ACCIDENTAL DEATH, DISMEMBERMENT AND DISABLEMENT BENEFIT

Provides cash in case your employee passes away, gets dismembered or disabled due to an accident.
TOTAL & PERMANENT DISABILITY INCOME BENEFIT

Pays a monthly income in case of total and permanent disability, up to a maximum of 60 months.

insurance lingo explained

What does “total and permanent disability" mean?

The inability to engage in any gainful occupation, employment or business for which the Member is reasonably qualified by education, training or experience.

What do we mean by “dismemberment"?

Becoming disabled by losing a part of your body as a result of an accident.

ADDITIONAL BENEFITS

You can choose to customize your plan with the benefits below.

OUTPATIENT BENEFIT

<style> .list-addon .description li { list-style-type: circle; border: none; } </style>Refers to all medical services provided without need for in-hospital confinement. Services included:<ul><li>General physician/specialist consultations - One visit per day, subject to the amount of stated in the benefit schedule</li> <li>Treatment - Should be in a clinic and during consultation</li> <li>X-ray and Laboratory Tests - As recommended by a physician for the diagnosis of a sickness or injury
ANNUAL PHYSICAL EXAM

Covers five basic services: Physical Exam, Urinalysis, Fecalysis, Chest X-Ray, Complete Blood Count (CBC).

DENTAL BENEFITS

<style> .list-addon .description li { list-style-type: circle; border: none; } </style> Covers annual dental examination and consultation, emergency outpatient dental treatment, oral prophylaxis, among others.<ul><li>Simple tooth extractions</li> <li>Restorative and prosthodontic treatment planning</li> <li>Temporary fillings</li> <li>Desensitization of hypersensitive teeth</li> <li>Simple adjustment and repair of dentures</li> <li>Re-cementation of loose crowns, bridges, inlays and onlays</li> <li>Dental nutrition and dietary counseling</li> <li>Dental health education</li> <li>Palliative treatment for simple mouth sores and blisters</li> <li>Open incision and drainage (intraoral)</li> <li>Pre-natal check of teeth and gums</li> <li>Temporo Mandibular Joint consultation</li> <li>Gum treatment for cases like inflammation or bleeding</li></ul>
MAJOR MEDICAL

<style> .list-addon .description li { list-style-type: circle; border: none; } </style> Pays for any eligible expense in excess of the basic medical/IP and is subject to maximum limits. Covers the following benefits:<ul><li>Room & board</li> <li>Special hospital services</li> <li>Surgical fees</li> <li>Doctor's calls</li></ul>
MATERNITY BENEFITS

Covers expenses relating to maternity and obstetrical cases including any pre-natal and post-natal treatments, and confinements for complications.

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ELIGIBILITY

GROUPS

Employee-Employer groups with at least 26 regular employees (if with existing provider) or 100 regular employees (if with no existing provider) comprising 100% of the group.

INSUREDS

Regular, full-time, and actively-at-work employees

Ages 18 to 64

INELIGIBLE GROUPS

Construction Workers

Labor Unions

Hospitals, Sanatoriums, Clinics, Doctor or Nurse groups

Individuals deployed by manpower agencies

Groups which involve special hazards/risks (Commercial airline personnel, nuclear/chemical/electrical plants, security guards/policemen/firemen/military, manufacturers of ammunition or explosives, among others.)

*This list is non-exhaustive. AIA Philippines reserves the right to decline coverage to groups which are ineligible for medical coverage per AIA Philippines underwriting guidelines.

THE FINE PRINT

All benefits are subject to their respective maximum limits, also known as Inner Limits, set in the Schedule of Benefits. The final interpretation of any specific provision or its applicability is subject to terms and exclusions stated in the Master Policy issued by AIA Philippines Life & General Insurance Company as accepted by the Assured Company.

For Basic Medical, employees' expenses during confinement are up to a maximum amount per any one disability. If there is an intervening period of at least 30 days between confinements, the succeeding confinement will be considered a new disability and the Basic Medical benefits will be refreshed.

All Basic Medical Benefits are subject to an Annual Benefit Limit (ABL) while Major Medical benefits are subject to Maximum Benefit Limit (MBL), per any one disability.

DETAILED TERMS AND CONDITIONS

- COLLAPSE + EXPAND

INNER LIMITS

Maximum amounts payable per type of benefit per any one disability.

SCHEDULE OF BENEFITS

List of benefits and corresponding premiums covered under an insurance plan.

GENERAL EXCLUSIONS

Suicide within the first 12 months of coverage.

Pre-Existing Conditions for which the Member received medical treatment, diagnosis, consultation or prescribed drugs during the ninety (90) days preceding the effective date of his coverage, unless the Member affected by these conditions has been insured under the Policy continuously for twelve (12) months, subject to conditions specified in the Policy Schedule.

Pre-existing conditions are defined as illnesses or conditions that, prior to the Effective date of member’s coverage:

a) any professional advice or treatment was given for such illness or condition;

b) such illness or condition was in any way evident to the Member; or

c) the development of such illness or condition started whether or not the Member is aware of such illness or condition.

- Investigation and treatment relating to pregnancy

- Conditions related to sexually transmitted diseases, AIDS and AIDS Related Complex.

- Alternative therapies such as (but not limited to) Acupuncture, Acupressure, Chiropractic, Reflexology, etc.

- Outpatient prescribed medicines, Vitamins/Supplements, etc.

- Treatment of injuries/illnesses caused directly or indirectly by engaging in any extreme and professional sports except for activities under company-sponsored sports activities.

- Infectious diseases (i.e. Avian Flu, Meningococcemia, etc.) that are declared epidemic or pandemic by the Department of Health, World Health Organization or any recognized health authority.

ANY ONE DISABILITY

All disabilities arising from the same cause, including any and all complications therefrom, as well as concurrent disabilities from different causes during the same hospital confinement, except after the specified intervening period from the latest discharge or treatment, subsequent disability shall be treated as a new disability.

INTERVENING PERIOD

Specified period following the latest discharge from hospital or the last treatment date.

ANNUAL BENEFIT LIMIT

Annual maximum amount that is payable for Basic Medical benefits, regardless of Any One Disability.

MAXIMUM BENEFIT LIMIT

The maximum benefit amount that an insured can avail of, per any one disability.

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Group Medical Classic

18-64 YEARS OLD

AIA PHILIPPINES FINANCIAL ADVISOR

WHAT THIS PRODUCT IS ABOUT

Talk To Us

WHAT DOES it PROVIDE?

BASIC MEDICAL / INPATIENT BENEFIT

GROUP LIFE INSURANCE

ACCIDENTAL DEATH, DISMEMBERMENT AND DISABLEMENT BENEFIT

TOTAL & PERMANENT DISABILITY INCOME BENEFIT

insurance lingo explained

ADDITIONAL BENEFITS

OUTPATIENT BENEFIT

ANNUAL PHYSICAL EXAM

DENTAL BENEFITS

MAJOR MEDICAL

MATERNITY BENEFITS

ELIGIBILITY