Hospitalization Assistance Pamilya Insurance Plan (HAPI)
The Hospitalization Assistance Pamilya Insurance Plan provides financial support in the form of a daily hospital income benefit for insured individuals during hospital confinement due to sickness or accident. This benefit helps cover lost income and other incidental expenses, ensuring peace of mind for families during medical emergencies.
Eligibility for Coverage
- Only members and his/her legal dependents who are insured under the Basic Life Insurance Plan and in good health shall be eligible for coverage under the HAPI Plan.
Coverage Details
- Legal Spouse who is not more than seventy-five (75) years old
- Common-law partner who is not more than seventy-five (75) years old, both must be single or widowed and has been living together for over five (5) years and has no legal impediments to enter into marriage
- Parents below 75 years old – for single members with biological children
- Children:
- 4 Biological or legally adopted children
- 2 weeks to 18 years old
Benefits
Hospitalization Benefit (Non-Maternity Benefit)
- The hospitalization benefit is a daily cash allowance paid to the member for the number of days a member or his/her legal dependent is unable to work due to bodily injury or sickness requiring hospitalization confinement but not related to pregnancy.
- A member can be granted a sickness benefit for a maximum of EIGHTEEN (18) days per contract year. The sickness benefit extended to qualified legal dependents shall not be paid for more than NINE (9) days per contract year.
- In case the benefit is not availed of in a given year it may not be carried forward to a later contract year.
Hospitalization Benefit (Non-Maternity Benefit)
- The maternity benefit is a daily cash allowance paid to the member for the number of days a member is unable to work but not to exceed FIVE (5) days per contract year due to infant delivery, miscarriage, or pregnancy-related conditions requiring confinement.
- Infant delivery is a form of childbirth through spontaneous normal delivery or through surgical incision on the abdomen or uterus (caesarean delivery), or premature labor and birth (an infant born before the 37th week of gestation).
Premium
- Annual - ₱440.00
- Weekly - ₱10.00
Frequently Asked Questions
- Medical Certificate/ billing statement provided that it is signed by the in-charge; the diagnosis and date of confinement and date of discharge is indicated clearly on the document.
- Claim Form
- Applicants must be at least 18 years old but not more than 70 years old on the enrollment date and should be in good health.
- Hospitalization Benefit (Non-Maternity Benefit)
- Maternity Benefit
- Annual – ₱440.00
- Weekly – ₱10.00
Effective Date of Individual Coverage
- HAPI coverage shall take effect immediately upon payment of the first premium
- A Certificate of Insurance containing the effective date of coverage and a summary of benefits and excerpts of the Rules and Regulations of HAPI Plan of PBC- MBA shall be issued to every member upon approval of the application. A manual of Master Policy shall be issued to each Center or group of members.
Pre-Existing Condition
- is a condition for which the member received medical treatment or has consulted a physician for medical treatment or has been taking medications during the six (6) months prior to the effective date of membership or six (6) months prior to the date of last reinstatement.
Waiting Period
A pre-existing condition is defined as any illness, ailment, or condition for which medical advice or treatment has been received by the member or his/her legal dependent within the twelve (12) months prior to the effective date of coverage or within six (6) months prior to the date of last reinstatement. A pre-existing condition cannot be applied to pregnancy or pregnancy-related conditions.
MBC-MBA shall impose a one (1) year waiting period on benefits for hospitalization as a result of a pre-existing condition, wherein during such period, no benefits shall accrue to the member.
Exclusion
No benefit shall be paid under the HAPI Plan for hospital confinement caused by any of the following:
- Self-inflicted injuries;
- Drug addiction;
- Continued excessive or compulsive use of alcoholic drinks;
- Declared or undeclared war or civil strife; and,
- Acts in violation of the law
Grace Period
Any member who fails to pay the corresponding HAPI premium shall be given a grace period of forty-five (45) days within which to remit the said amount.
In case of hospital confinement of the member or any one of the legal dependents during the grace period, the balance of the contribution in arrears shall automatically be deducted from the benefits payable.
If after the forty-five (45) days grace period no payment has been received, the HAPI coverage shall lapse and in the event of hospital confinement, no benefit shall accrue.
Termination of Coverage
HAPI coverage shall automatically terminate under the following conditions, whichever comes first:
- Upon termination of membership and coverage under the Basic Life Insurance Plan;
- Upon expiration of the grace period if no payment has been received by then;
- Upon attainment of age seventy-five (75) of the member
- For the legal dependents, upon exceeding the age of eligibility
Dependent’s coverage terminates upon the termination of the member’s coverage. Termination of coverage shall be without prejudice to any claim arising prior to such termination.
Claim Settlement
Payment of claims shall be made by PBC-MBA not later than ten (10) working days from date of receipt of complete documents required to validate the claim.
