FlexiShield — HMO Top-Up Plan

FlexiShield is a "second-layer" or top-up medical insurance plan that provides an additional Maximum Benefit Limit (MBL) of up to ₱2,000,000 per disability, per year. It acts as an ultimate financial safety net designed to sit securely behind your existing primary HMO plan (whether personal or corporate).

FlexiShield automatically activates to cover excess hospital bills only at the exact moment your primary HMO's absolute maximum limit is completely exhausted.

Applicants must be between 15 days old and 75 years old.

Yes. You must currently have an active, first-layer primary HMO plan (this can be an individual, family, or corporate plan) to be eligible for this product.

Yes. Your primary HMO must have a Maximum Benefit Limit (MBL) or Annual Benefit Limit of at least ₱150,000 per disability, per year. If your primary plan's limit is strictly below ₱150,000, you cannot apply for FlexiShield.

In this top-up plan, your primary HMO's Maximum Benefit Limit acts as your FlexiShield "Deductible." For example, if your company HMO has a limit of ₱165,000 per illness, your FlexiShield Deductible is exactly ₱165,000. FlexiShield only starts paying once that first ₱165,000 of eligible hospital expenses has been entirely settled by your primary HMO.

No, this is a critical rule. If your primary HMO has a total overall limit of ₱150,000 but caps a specific surgery at ₱50,000 (an inner limit), FlexiShield will not step in to pay the surgery excess. FlexiShield only activates when the absolute Maximum Benefit Limit for that specific disability (the full ₱150,000) is completely exhausted.

Your FlexiShield policy does not get cancelled; it remains fully active until the end of your insurance period. However, if you are hospitalized, Pacific Cross will process the claim as if your primary HMO still existed. This means you will have to pay the "Deductible" (e.g., the first ₱150,000) entirely out of your own pocket before FlexiShield kicks in to cover the remaining bills up to ₱2,000,000.

You must provide Pacific Cross with concrete proof that you still have an existing and active first-layer HMO. If the primary HMO was not renewed or dropped, the FlexiShield policy cannot be renewed.

FlexiShield allows you to recover comfortably by covering the expenses for a Private Room billed "As Charged."

Once successfully activated, FlexiShield covers the following "As Charged": Miscellaneous In-Patient Charges (including required diagnostic lab tests, prescribed medicines, blood, anesthesia, and surgical appliances), Intravenous Chemotherapy, Radiotherapy, and Dialysis, Intensive Care Unit (ICU), Coronary Care Unit, and Telemetry, and Operating Theater and Recovery Room.

Coverage depends on the provider network you utilize. Using the Accredited Network (No-Cash-Outlay), professional fees are covered "As Charged" based on Accredited Provider Network Rates or the PhilHealth Relative Value Scale (RVS). Using a Non-Accredited Network (Reimbursement), strict inner limits apply. For example, the Attending Physician's Visit and Specialist's Fee are capped at ₱4,000 per day, the Surgeon's Fee at ₱180,000 per disability per year, and the Anesthesiologist's Fee at ₱90,000.

Yes, there are two major built-in benefits available immediately: (1) Free TeleHealth Services — 24/7 access to remote doctor consultations. (2) Daily Hospital Income (DHI) Benefit — provides cash assistance of ₱1,000 per day (up to 30 days per year) if your hospitalization eventually triggers FlexiShield In-Patient benefits. This cash is paid from Day 1 of confinement, even if the Day 1 expenses were technically covered by your primary HMO. The DHI has its own separate limit and does not subtract from your ₱2,000,000 medical limit.

Yes. The standard pandemic/epidemic exclusion is waived. FlexiShield will cover the excess treatment costs, provided your first-layer HMO covered the COVID-19 treatment up to its own maximum limit first.

Yes, provided three strict conditions are met: (1) They were properly and fully declared upon application. (2) There was no concealment of material information. (3) They were officially accepted by an Endorsement by the Company. Even when accepted, they are only covered after the absolute maximum limit of the primary HMO is exhausted.

No. Pacific Cross does not regard "special arrangements" as an exhausted first-layer benefit. FlexiShield will adhere strictly to its standard policy terms regarding exclusions.

Potentially. Every year upon renewal, any future utilization related to your declared Pre-Existing Conditions will only be covered subject to the payment of an additional premium, which is determined by Pacific Cross underwriters.

If your primary HMO adjusts its limit before you file a claim, your new FlexiShield "Deductible" becomes either the amount originally listed in your FlexiShield Schedule of Benefits, OR your primary HMO's new MBL — whichever is higher. FlexiShield will not activate until this newly established, higher deductible is fully exhausted.

Yes, FlexiShield is divided into two specific tiers based on the coverage limit of your primary HMO: FlexiShield 150 — designed for clients whose primary HMO limit falls between ₱150,000 and ₱199,000; FlexiShield 200 — designed for clients whose primary HMO limit is ₱200,000 and above.

Your final premium is calculated based on which deductible range (Tier 150 or Tier 200) your primary HMO falls into, combined with your current age.

No. FlexiShield works completely alongside PhilHealth. The benefits provided under your FlexiShield plan are strictly in addition to any benefits you recover from PhilHealth or any other separate health insurances you might hold.

Yes. Pacific Cross offers an exclusive 0% Installment Payment Option for the FlexiShield plan.

Yes. If you opt for the standard Semi-Annual payment mode (instead of the 0% installment promo or an annual lump sum), your premium will incur an 8% surcharge as well as an additional Documentary Stamp Tax (DST).

Absolute transparency is non-negotiable. Any failure to truthfully answer application questions, or any concealment or misrepresentation of a significant medical condition, will immediately result in the voiding of all your applicable benefits under the plan.

Yes. Your FlexiShield contract includes a 14-day "Free-Look Period." This serves as a test window that allows you to review the final, delivered policy terms. You can cancel the plan within these 14 days if you are not completely satisfied with the conditions.