Important Instructions: Prior to availments of medical procedure, qualified recipients must secure physician’s request/instruction. Any out-of-scope procedures requested by physicians will undergo additional evaluation.

1. In-Patient Care which covers:

1. Professional fees of attending doctors, anesthesiologists, surgeons, specialists when necessary
2. Room and Board
3. X-ray, laboratory tests and other diagnostic procedures
4. Anesthesia and its administration
5. Whole blood/human blood products and intravenous fluids
6. Oxygen and its administration
7. Drugs and medicines for use in the hospital
8. Dressings, conventional casts (plaster of paris) and sutures
9. Use of operating and recovery rooms
10. Use of Intensive Care Unit (ICU)
11. Standard Nursing Services
12. Standard Admission kit (including ice, cap, wee bag and name tag)
13. All other items or procedures directly related in the medical management of the patient, as deemed medically necessary by the attending physician except vitamins, food supplements, herbal and probiotics
14. Cardio-pulmonary (CP) clearance before surgery and cardiac monitoring during surgery except CP clearances for all elective surgical cases including OB and Gynecology
15. COVID-19 confirmed

2. Out-Patient Care which covers

1. Medically necessary consultations during regular clinic hours
2. 1 pre-natal and 1 post-natal consultation except laboratory examinations
3. Treatment for minor injuries such as lacerations, mild burns and sprains
4. Eye, ear, nose and throat (EENT) treatment
5. X-ray, laboratory tests, routine, diagnostic and therapeutic procedures
6. Minor surgery not requiring confinement
7. Blood products transfusions (except gamma globulin, immunoglobulin) and intravenous fluids, including blood screening and cross matching if the Member patient is the recipient but excluding expenses for donor screening services)
8. Wart cauterization except genital warts and condyloma acuminata covered for at least ₱2,500.00
9. Eye Laser Therapy (except correction of refraction such as myopia, astigmatism, Lasik & hyperopia) up to ₱5K per member
10. Allergy Testing/ screening and other related examinations for at least ₱1,200.00
11. Tuberculin test covered for at least ₱600.00
12. Sclerotherapy for varicose veins covered for at least ₱5,000 per leg
13. Online consult/ teleconsultation covered through reimbursement only
14. Swab test (RT PCR/Swab Antigen) up to ₱6,000.00 per member with active signs and symptoms as per doctor’s request

3. Out-Patient Care: Special Diagnostic Procedures which covers

1. 12-Lead electrocardiogram (ECG)
2. 24-hour electroencephalogram (EEG) monitoring
3. Adrenocortical function
4. Ambulatory cardiac monitoring (holter)
5. Anti nuclear antibody, c-reactive protein, lupus cell exam
6. Arterial blood gas
7. Audiograms and tympanograms
8. Bone Densitometry Scan (Dexascan)
9. Bone Mineral Density Studies
10. Cardiac Stress Tests (Thallium and Dipyridamole Stress Tests)
11. Computed Tomography Scans
12. Diagnostic Radiographs
1. Biliary tract: cholecystogam and cholangiogram
2. Chest, ribs, stenum and clavicle
3. Digestive: plain film of the abdomen, barium enema, upper gastrointestinal (GI) series, lower GI series, Small Bowel Series
4. Face (including sinuses), head and neck
5. Urinary: Kidney, ureter and bladder (KUB), pyelograms and cystograms
6. X-ray of the extremities and pelvis
7. X-ray of the spine (cervical, thoracic and lumbo-sacral)
13. Diagnostic Ultrasounds: 2D Echo, Doppler ultrasound ( except for maternity cases), digestive and urinary systems, abdomen and deep vein thrombosis ultrasonic scanning; duplex scan, digestive and urinary systems, ultrasound of the lungs
14. Electromyelography and nerve conduction studies
15. Endoscopic procedures
16. Flurorescein angiography
17. Impedance plethysmography
18. Lung function studies
19. Magnetic Resonance Imaging
20. Magnetic Resonance Angiography
21. Mammography and Sonomammogram
22. Microscopic Examinations
23. Myelogram
24. Neuroscan (professional fee on reimbursement basis)
25. Nuclear Radioactive Isotope Scan
26. Perfusion Scan
27. Plasma Urinary Cortisol, Plasma Aldosterone
28. Polysomnograms (Sleep Study/ Recording) covered for at least ₱10,000.00
29. Pulmonary Function Tests
30. Radiocnuclide Ventriculography
31. Radio-isotope Scans and Function Studies
1. Thyroid Scans
2. Liver
3. Renal
4. Gastro intestinal
5. Cardiac
6. Para thyroid bone, pulmonary (perfusion/ ventilation lung scans)
7. Total Body Scans
32. Surface electromyography (SEMG)
33. Thallium scintigraphy
34. Continuous positive airway pressure (CPAP) titration for sleep study
35. 4D Ultrasound except for maternity related cases
36. Esophageal manometry
37. Intensified modulated radiotherapy
38. Botox except for cosmetic or beautification purposes
39. Position Emission Tomography (PET) Scan

4. Out-Patient Care: Other Special Procedures which covers

1. Anti-neoplastic chemotherapy up to 10 sessions subject to ABL
2. Arthrocentesis up to 6 sessions subject to ABL
3. Arthoscopic procedures up to ₱ 20K
4. Coronary Angiogram covered for at least ₱30,000.00
5. Angiography up to ₱40K
6. Angioplasty covered for at least ₱30,000.00
7. Basic Physical/ occupational therapy up to 10 sessions for ₱1K per session
8. Coronary Artery Bypass Graft covered for at least ₱30,000.00
9. Open Heart Surgery covered for at least ₱30,000.00
10. Cryosurgery covered for at least ₱40,000.00
11. Dialysis up to 10 sessions subject to ABL
12. Oral anti-neoplastic chemotherapy up to ABL
13. Endoscopic procedures
14. Fluroscein angiogram covered for at least ₱30,000.00
15. Gamma knife surgery (based on cobalt/radiotherapy)
16. Hemorrhoidectory (conventional)
17. Hemorrhoidectory (Scalpel)
18. Hemorrhoidectory (Stapled) covered for at least ₱10,000.00
19. Herniorrhaphy (except cost of mesh) excluding congenital hernia
20. Hysteroscopic myoma resection covered for at least ₱40,000.00
21. Hysterospically guided D&C
22. Laparoscopic Procedures covered for at least ₱40,000.00
23. Laparoscopic cholecystectomy covered for at least ₱40,000.00
24. Lithotripsy covered for at least ₱40,000.00
25. Mammotomy up to ₱5,000.00
26. 4D ultrasound except for maternity related cases
27. Esophageal manometry up to ₱5,000.00
28. Intensified modulated radiotherapy up to ₱5,000.00
29. New/Special modalities not mentioned for which there are no comparable, conventional or traditional counterparts are covered up to MBL and for at least ₱10,000.00 when there are comparable, conventional or traditional counterparts
30. Organ Transplant (except cost of organs & procedure for donor
31. Percutaneous Ultrasonic Adrenalectomy covered for at least ₱40,000.00
32. Percutaneous Ultrasonic Nephrolithomy covered for at least ₱40,000.00
33. Phlebotomy
34. Positron Emission Tomography (PET) Scan up to ₱20,000.00
35. Stereotactic Brain Biopsy covered for at least ₱40,000.00
36. Speech therapy
37. Testing involving Nuclear Technologies (Thallium Stress Testing, Radionuclide, Thyroid Scan, Pyrosphosphate Scintigraphy, Positron Emission Tomography, Radio Isotope Scanning)
38. Transurethral Microwave Therapy of Prostate covered for at least ₱40,000.00
39. Therapeutic Radiology up to 10 sessions subject to ABL
1. Brachytherapy
2. Cobalt
3. Linear accelerator therapy
4. Radioactive cesium
5. Radioactive iodine
40. Thoracentesis up to 6 sessions subject to ABL
41. Video Gastroscopy
42. CT Pulmonary Angiography
43. Photodynamic therapy

5. Common Laboratory Procedures supported by doctor's request

1. Physical Examination and history taking
2. Complete blood count
3. Urinalysis
4. Fecalysis
5. Chest X-ray
6. Electrocardioagram (ECG) covered for at least 35 years and above
7. Pap smear covered for at least 35 years and above
8. Eye examination/ eye refraction test
9. Prostate Cancer screening (Prostate Specific Antigen) covered for male members 50 years old and above or if indicated by physician
10. Mammography covered for female members
11. Fasting blood sugar (FBS)
12. Lipid profile (HDL, LDL, VLDL) if indicated by a physician
13. Cholesterol
14. Triglycerides
15. Serum Glutamic-Oxa loacetic Transaminase (SGOT)
16. Serum Glutamic Pyruvic Transaminase (SGPT)
17. Blood Urea Nitrogen (BUN)
18. CREA
19. Uric Acid
20. Thyroid Tests including Total/Free Thyroxine (TSH,T3, FT4)

6. Emergency Care which covers:

1. Doctor’s services
2. Emergency room fees
3. Medicines used for immediate relief during treatment
4. Whole blood/human blood products
5. Oxygen and IV fluids
6. X-ray, laboratory tests and other diagnostic procedures
7. Room upgrading provision in case of unavailability of entitled room (emergency cases only) covered up to 48 hours excluding Suite room

7. Preventive Care which covers:

1. Anti-tetanus, rabies, venom covered up to ₱18,000.00
2. Immunization, excluding cost of vaccines

8. Dental Benefits which covers:

1. Dental Consultation (dental exam, TMJ, ortho aesthetic)
2. Routine oral prophylaxis (simple scaling) covered for at least twice a year
3. Simple tooth extraction
4. Temporary fillings
5. Treatment of lesion, wounds and burns
6. Adjustment of dentures
7. Recementation of jacket crowns, inlays and onlayss
8. Emergency desensitization of hypersensitive teeth
9. Relief of acute dental pain (except prescribed medicines)
10. Pre-natal check of teeth and gums
11. permanent filling covered for at least 2 teeth

9. Other Special Benefits

1. Ambulance Service (hospital transfer) covered through reimbursement for at least ₱5,000.00 per conduction
2. Ambulance service (if hospital has own ambulance facilities)
3. Benign prostatic hepertrophy
4. Congenital conditions covered for at least ₱25,000.00
5. Cataract extraction (except for cost of lens)
6. Hernia (acquired)
7. Medicines covered for only in-patient and ER cases
8. Medico legal cases without violation subject to exclusion conditions and submission of police report
1. Motor vehicular accidents
2. Motorcycle accident
3. Unprovoked assault
4. Scoliosis, whether congenital pre-existing, developmental or acquired
5. Slipped disc, spondylosis, and spinal stenosis
6. Sports related injuries covered professional and extreme sports
7. Work related conditions based on conditions covered by ECC
8. Covid 19

General Exclusions

1. Intentionally self-inflicted injury, suicide, death, self-destruction or any attempted threat while sane or insane
2. Illness, injury or death attributable to the member’s own misconduct, gross negligence, intemperate or under the influence of drugs, alcohol, vicious or immoral habits, participation in the commission of a crime, violation of law or ordinance
3. Unnecessary exposure to needless perils including firecracker injuries, hazardous sports and activities (such as aqualung diving, boxing, climbing, flying except air travel, football, hang-gliding, hunting, hurling, ice hockey, motor competitions, motorcycling in any form, parachuting, polo, pot-holing, power boating, racing, show jumping, skydiving, use of woodworking machinery, water ski-jumps and tricks, winter sports, wrestling and yachting beyond 5 kilometers of a coastline)
4. Murder or assault, homicide or any attempt thereof or physical injuries, occasioned by provocation of the member
5. Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel
6. Any dental work (except if dental benefits are covered under this Policy as indicated in the Covered Medical Reimbursements), treatment or surgery; oral surgery, procedure for treatment of error of refraction, fitting of eye glasses or hearing aids; cosmetic including treatment of warts, plastic or reconstructive surgery, except to the extent that any of them are necessary for the repair and alleviation of damage to the member caused solely by accidental bodily injury covered under this Policy
7. Any Treatment in connection to pregnancy or resulting to childbirth or miscarriage or complications therefrom (except if maternity benefits are covered in this Policy as indicated in the schedule of benefits); sterilization of either sex or reversal of such; artificial insemination, sex transformation or care for infertility; treatment of venereal diseases and other sexually transmitted diseases and acquired immune deficiency syndrome (AIDS)
8. Any charges where expenses are provided or covered by law or government including Philhealth or treatment where charges are provided free of charge by any local or national government or treatment for any communicable disease declared by any government agency or entity as causing a state of emergency in an area

PSMBFI IMAP – 12/16/2025