Things You Should Know about Pacific Cross FlexiShield
With the rising costs of hospitalization, your current HMO plan may not be enough. Now, more than ever, it is important to be prepared and get the medical protection you deserve especially when you need it most.
Pacific Cross FlexiShield is perfect for Individuals and Families who are already covered with a first layer HMO plan and are looking into getting additional medical protection that they can depend on should they exhaust their HMO coverage.
Q1: What is a Second Layer Plan or Top Up Health Insurance?
A1: When illness strikes, your HMO covers your medical bills. However, some medical conditions, especially those that require confinement, can become quite costly to treat. When hospital bills exceed your HMO limit, you are forced to pay the extra amount out of your own pocket. A Second Layer Plan or Top Up Health Insurance is an additional coverage that will help you when you exceed your HMO’s maximum benefit limit (MBL).
Q2: What is FlexiShield?
A2: FlexiShield is a second layer plan that allows you to have ample financial resources should you exhaust your HMO’s maximum benefit limit.
Q3: Why do you still need FlexiShield when you already have an active HMO plan?
A3: The rising costs of hospitalization and medical treatments are one of the pressures you have to deal with in today’s times. When you need it the most, your current HMO plan may not be enough. Worrying about whether you have enough medical coverage can add anxiety to an already stressful situation. FlexiShield will help you carry the financial burden of expensive medical treatments. Since FlexiShield was purely designed as a top-up coverage to your existing HMO plan, the premium is more affordable compared to a stand-alone medical plan, which will also only respond in excess of your HMO coverage.
Q4: What are the benefits of FlexiShield?
A4: With FlexiShield, you can enjoy these and more:
• Additional medical coverage on top of your existing HMO at an affordable premium
• Up to PHP 2,000,000 Coverage
• Daily Hospital Income for non-hospital expenses (i.e., cash assistance per confinement day up
to a maximum of 30 days)
• Coverage for Members of Corporate accounts, Individuals and Families who are covered by an
HMO Plan as the first layer medical coverage
Q5: How does FlexiShield work?
A5: The FlexiShield medical coverage will take effect upon exhaustion of first layer HMO Plan’s MBL basedon the Terms and Conditions of the first layer HMO Plan. Coverage based on special arrangement between the Policyholder and/or Insured and the first layer HMO Plan shall not be regarded as an exhausted first layer HMO benefit. Pacific Cross shall not provide coverage out of the first layer HMO Plan’s utilization of inner limits or due to its limited coverage for specific medical conditions.
Q6: Is there an age limit in availing of FlexiShield Medical Insurance Plan?
A6: It covers Members of Corporate accounts, Individuals and Families aged 15 days old to 65 years old.
Q7: What are the general exclusions?
A7: The usual Medical Condition-based General Exclusions have been reduced to fully provide a second layer coverage to remaining hospital expenses exceeding the exhausted MBL of the first layer HMO Plan. For example, if congenital and auto-immune conditions are eligible under the first layer and when the first layer MBL for this condition is exhausted, FlexiShield will cover. Pandemic exclusion: COVID-19 will be covered if this is covered under the first layer HMO Plan where its MBL has been exhausted.
Q8: How do I get a FlexiShield Medical Insurance Plan?
A8: You can get in touch with our Sales Representatives through telephone number +63 2 8230-8511 or e-mail firstname.lastname@example.org. We will be more than happy to answer your questions or give you a free presentation online or in person, whichever you prefer.
Q9: How do I pay my FlexiShield Premium?
A9: Mode of payment is Annual. Pacific Cross offers several convenient ways for you to pay your premium. You can pay in cash or credit, via the Pacific Cross website, online banking and payment channels, andover the counter Payment Facilities.
Q10: Can FlexiShield be offered for those without HMO?
A10: No, FlexiShield is purely a top-up coverage that will only be available for those who have an active HMO plan. The product design considered the existence of an active HMO and not just the Deductible amount.
Q11: Since this is a top-up plan, in terms of claims, what documents are needed, as the primary HMO carrier will need all the original documents?
A11: Copies of claims documents will be reasonably acceptable, especially if the HMO covered part of the hospital bill. It is also reasonable that an original official receipt will be required by Pacific Cross for portions that were not covered by the HMO. For the complete list of requirements, please refer to the FlexiShield Claims Reimbursement Checklist.
Q12: Can a dependent (parents/child/sibling) of an HMO principal account holder avail of FlexiShield?
A12: Yes, a dependent can avail as long as the dependent’s HMO coverage passes the eligibility requirements of FlexiShield.
Q13: Can the FlexiShield plan be availed of by clients who have an existing pre-paid HMO Prepaid Card?
A13: No, because the benefits of pre-paid cards are not on a per disability per year basis and are below the minimum PHP 150,000 benefit limit.
Can clients with HMO and Select Plan switch to FlexiShield?
A14: No, because Select is already a stand-alone plan, prepared to cover with or without an HMO.
Q15: What are the requirements for Group applications?
A15: FlexiShield is an Individual/Family Type of Policy. Applications in group will be accepted but underwriting assessment will be done individually so the available FlexiShield application form should be filled out.
Can a client request for cancellation of FlexiShield anytime within the policy period, most especially if their first layer plan is terminated?
A16: Yes, the client can request cancellation anytime during the policy period subject to cancellation provision. Kindly refer to the Cancellation by the Policyholder provision in which premium refund shall be based on Short Period Rate Scale and there should not be a filed claim at any time during the Policy Period. Moreover, if the first layer HMO plan is terminated, this second layer Policy will still be in force until the end of the Period of Insurance but only for medical conditions that the first layer HMO plan would have covered prior to its termination and as such, Pacific Cross will pay the eligible In-Patient medical expenses after application of the Deductible.
Q17: If the company (providing the first layer HMO plan) decides to change the medical provider in the middle of the policy, does the client need to submit new requirements?
A17: No need to submit new requirements. Claims will be adjudicated based on the existing first layer HMO coverage at the time of claim. This is the reason for our basic claims requirements that include the first layer HMO’s full information such as table of benefits and Agreement/Contract. New information about the HMO coverage shall be submitted every renewal.
Q18: FlexiShield is to be terminated due to the non-renewal of the first layer HMO Coverage, can the client apply for a take-over account to standard plan with Pacific Cross?
A18: No. However, you can apply for a new application wherein you will be subjected to different health declaration questions and will undergo a different underwriting approach. Waiting period for Pre-Existing Conditions and Qualifying Period will be waived.
Q19: If a client is covered under a Pacific Cross group BC Flexi Plan, will he/she be required to submit additional requirements if he/she wants to avail of FlexiShield?
A19: No. Pacific Cross will no longer require further Information about the first layer HMO from the applicant.