AVEGA Availment Procedure

Please be guided by AVEGA’s availment procedure for outpatient, inpatient, and emergency care (accredited and non-accredited hospitals):

Outpatient Care

1. Members must call the clinic/hospital to secure an appointment for doctor consult or laboratory and other procedures.
2. Proceed at the HMO office of the hospital/clinic on the day of your confirmed appointment. Present your AVEGA card and 1 valid ID to the attending staff for membership eligibility validation.
3. If approved, sign the Outpatient (OP) Letter of Eligibility. If declined, you will be assisted by the attending staff to escalate the concern to AVEGA Customer Service.
4. Secure your Referral Control Sheet 1 (RCS1) by presenting your OP Letter of Eligibility to the attending staff. If vailing laboratory and diagnostic procedures, request for RCS2 Form. Sign the RCS1 Form to avail the service.
5. Accomplish PhilHealth requirements, if applicable.

For online RCS requests, partners may send a request directly to [email protected] with the subject "RCS-REQUEST" followed by your account number (e.g. RCS-REQUEST 00-00-00000-00000-00), or via the Agora app at least 2-3 days prior to the availment date. Remember to include the following attachments when submitting your request:

• Standard Excel Template
  
• 1 Government-issued ID
• Copy of your AVEGA ID

Note:

1. Partners must print 2 copies and sign each ERCS form prior to sending them to the facility
2. Partners are still required to present their AVEGA card and 1 valid ID for verification purposes

Kindly send the following information for faster facilitation of ERCS:

A. For Consultation:

• Account Number:
• Name of Member:
• Company:
• Availment type: (Consultation)
• Name of Doctor:
• Facility/Name of Hospital/Clinic:
• Contact Number:
• Soft copy of Avega card (for verification purposes)
• Soft copy of 1 valid ID (for verification purposes)

B. For Diagnostic Procedure:

• Account Number:
• Name of Member:
• Company:
• Diagnosis:
• Procedure:
• Name of Doctor:
• Facility:
• Contact Number:
• Soft copy of doctor's request
• Soft copy of Avega card (for verification purposes)
• Soft copy of 1 valid ID (for verification purposes)

Inpatient Care

1. Proceed to the Admitting Section and Present your AVEGA Card and Admitting Order.
2. Choose a room covered by your benefits plan.
3. The Patient Relations Officer (PRO) will call you to explain the benefits and remotely assist you with your confinement concerns, if there are any.
4. Accomplish PhilHealth requirements.
5. Validate the charges before settling your bill.

Emergency Care (Accredited Hospital)

1. Have your AVEGA Card validated in the ER Section.
2. If declared as an OP Case, sign the RCS and settle non-covered charges.
3. If for confinement, choose a room covered by your benefits plan.
4. The Patient Relations Officer (PRO) will call you to explain the benefits and remotely assist you with your confinement concerns, if there are any.
5. Accomplish PhilHealth requirements.
6. Validate the charges before settling your bill.

Emergency Care (Non-Accredited Hospital)

1. Proceed to the Emergency Room.
2. Avail the treatment procedure at the ER.
3. Accomplish PhilHealth requirements prior to discharge.
4. Settle the hospital bill upon discharge. Make sure to secure all important documents such as Statement of Account and Official Receipt.
5. File for reimbursement not more than 30 days after receiving treatment. You may check the reimbursement process here.

Should you have further questions, you may contact the following:

AVEGA:

1. 24/7 Customer Care Hotlines

• (02) 7902-3430
• (02) 8789-4030

2. Call Support Lines:

• Globe: 0917 840 4894 / 0917 522 3124
• Smart: 0920 970 4724 / 0998 561 3513
• Sun: 0922 891 3957 / 0932 860 2533

3. Text Support Lines:

• Globe: 0917 805 2502 / 0917 315 0082
• Smart: 0920 951 8452 / 0998 561 3512
• Sun: 0922 891 3925 / 0932 860 2532

ActiveLink:

• Helpdesk: [email protected]
• Mobile App Admin Connect