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What is a pre-existing illness?

 

You have a pre-existing illness or condition if, prior to the Effective Date of the HMO agreement or the approval date of reinstatement (in case of lapse), any of these apply:  

 

  • You received any professional advice or treatment for the illness or condition; 
  • You were aware, in any way, of the illness or condition;  
  • The pathogenesis (disease progression) of the illness or condition had started, whether you were aware or not.  

Please note the coverage for pre-existing conditions:  

  

FAMILY   

  

 

Member   
 

Pre-existing coverage   
 
Existing dependents   
 

Up to Aggregate Benefit Limit (ABL), subject to Family ABL balance   
 

Newly enrolled dependents   
 

1st year: up to Php 20,000 per year, subject to Family ABL balance   

2nd year: Up to ABL, subject to Family ABL balance   

    

INDIVIDUAL   

  

Member   
 

Pre-existing coverage   
 

EXISTING   
 

Up to MBL
 

Partners   
 

Dependents (Individual Plan)   
 

NEWLY ENROLLED   
 
 

Up to MBL
 

Partners   
 

Dependents (Individual Plan)   
 

1st year: Up to Php 20,000 per illness, per year   

2nd year: Up to MBL 


PRE-EXISTING CONDITIONS include, but are not limited to:

  • Endometriosis
  • Hemorrhoids
  • Diseased Tonsils requiring surgery
  • Pathological abnormalities of nasal septum and turbinate
  • Thyroid Conditions
  • Cataracts, glaucoma, and pterygium
  • Sinus condition requiring surgery
  • Epilepsy
  • Asthma
  • Cirrhosis of the liver
  • Tuberculosis
  • Anal fistulae
  • Cholecystitis/cholelithiasis
  • Calculi of the urinary system
  • Gastric or duodenal ulcer
  • Hallux Valgus
  • Tumors, whether benign or malignant, of all organs and organ systems including malignancies of the blood and bone marrow
  • Diabetes mellitus and other endocrine conditions
  • Hypertension
  • Collagen disease
  • Cardiovascular diseases
  • Hernia
  • HIV/AIDS
  • Chronic skin conditions
  • Obesity, dyslipidemia, and other metabolic conditions
  • Autoimmune Conditions
  • Degenerative Conditions
  • Neurologic Conditions
  • Cerebrovascular Disease

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