General — Pre-Existing Conditions, Payments & Compliance

A Pre-Existing Condition is any illness or disability that existed before your coverage started. It is medically determined by its natural history. A condition is considered pre-existing if it presented signs or symptoms that you were aware of, or should reasonably have been aware of, regardless of whether you sought treatment or received a formal diagnosis.

Yes. Pacific Cross has a strict list that is always treated as pre-existing (with their complications): (1) Tumors, Cysts, Blood Dyscrasias. (2) Diabetes, Hypertension, Cardiac and Vascular Conditions. (3) Urinary Calculi, Gallbladder Stones. (4) Goiter and Thyroid Disorders. (5) Asthma and COPD. (6) Degenerative Bone/Joint Diseases, Gout, Spinal Column Abnormalities.

For standard individual plans (Select and Blue Royale), these are covered after a one-year waiting period, unless disclosed on application and explicitly accepted early via an Endorsement. Corporate FA Plus plans have more favorable rules — see the Corporate Plans FAQ.

Highly likely. Upon renewal, any utilization related to Pre-Existing Conditions will only be covered subject to payment of an additional premium ("premium loading") determined by Pacific Cross.

Medical Exclusions are specific conditions, treatments, or scenarios permanently excluded from coverage. Any benefits, complications, or sequelae arising from them will not be covered at any time under the Policy.

Generally, no. Cosmetic surgery, contact lenses, and hearing aids are permanently excluded. Reconstructive surgery from a covered accident is the exception. Weight management is also excluded — Blue Royale is the exception, covering Bariatric surgery after 5 years of continuous coverage.

Under standard plans (Select, base Corporate FA Plus), childbirth, delivery, miscarriage, abortion, and related care are permanently excluded. Blue Royale Plans B and C are the exception with a Maternity Benefit after a 12-month waiting period.

Select Plan: permanently excluded. Blue Royale: covered after 5 years of continuous coverage with a lifetime limit. Corporate FA Plus: covered on the first year with inner limits.

STDs are permanently excluded across all plans. HIV/AIDS is generally excluded, but Blue Royale covers it after 5 years of continuous coverage (lifetime limit), and Corporate FA Plus provides an inner limit.

Suicide, attempted suicide, and intentional self-inflicted injuries are strictly and permanently excluded across all plans.

Generally excluded. Under the Select plan, auto-immune conditions become covered after 5 years of continuous coverage, subject to a lifetime limit (up to ₱300,000 for Private tiers).

Cash or Check (payable to "Pacific Cross Insurance, Inc."), Bills Payment (BDO, Metrobank), Web Payment (Credit/Debit Cards, GCash, Maya, DragonPay, 7-Eleven OTC, Cliqq OTC, DA5 OTC), and Credit Card (straight or key-in).

Yes. Pacific Cross offers "Deferred Payment" for: BDO, BPI, Metrobank, EastWest Bank, and Bank of Commerce. For FlexiShield specifically, there is an exclusive 0% Installment Payment Option.

An 8% surcharge is added to your base premium, plus Documentary Stamp Tax (DST). Your first installment will be slightly higher than the second due to the DST. Annual premiums in brochures already include all applicable taxes.

No. Payment receipt does not constitute acceptance. Your coverage is only official once the application has passed medical evaluation, been approved by adjudicators, and the Policy/Membership Card has been issued.

No. Payments are always made directly to Pacific Cross Insurance, Inc. Sean guides you on payment links, ensures synchronization with your application, and monitors the system for timely policy release.

Two methods: (1) No-Cash-Outlay — present your Pacific Cross Health Care Card at any accredited facility for direct settlement up to your limits. (2) Reimbursement — if using a non-accredited doctor or overseas treatment, pay first and submit receipts.

Yes, subject to plan limits. Using accredited networks, Professional Fees are covered "As Charged" based on Accredited Provider Network Rates or the PhilHealth Relative Value Scale (RVS).

Non-accredited doctors' fees are subject to strict inner limits (e.g., capped at ₱4,000/day for visits, ₱180,000 max for surgeon's fee) — not covered "As Charged."

Generally: original official receipts, a medical certificate from your attending physician, relevant utilization/claims reports, and laboratory test results.

Standard clients wait on hold with customer service. Through Sean, you can escalate directly to him — he uses internal direct lines with Pacific Cross officers to investigate and resolve bottlenecks swiftly.

A 14-day test period from the moment you receive your policy contract. You can review terms, conditions, and exclusions, and cancel without penalty if unsatisfied.

This is a legal requirement under the Anti-Money Laundering Act (AMLA, RA 9160). All insurance companies must establish the true identities of clients through Customer Due Diligence.

Pacific Cross may restrict services, prohibit transactions, or terminate the business relationship. You are entitled to receive unused premium portions if terminated for this reason.

You must answer all questions truthfully. Failure to disclose, concealment, or misrepresentation of any significant condition will immediately void all applicable benefits.

You are strictly required to notify Pacific Cross immediately and submit up-to-date medical reports. The company may alter terms or void the application based on new information.

All information is processed in strict accordance with the Data Privacy Act of 2012 and the official Pacific Cross Privacy Statement. Data is used strictly for policy administration and medical/travel services.

You are guaranteed 10 rights: (1) financially sound insurer, (2) access to financial information, (3) informed of license status, (4) duly approved products, (5) benefits/exclusions information, (6) receive the policy, (7) confidentiality, (8) efficient service, (9) prompt fair claims settlement, (10) assistance from Insurance Commission.

A signed application form is valid for 45 days from the date of application. If processing exceeds this window, a new form may be required.

Sean is your authorized broker-agent. Before final submission, he certifies that he has verified your information against your original ID cards, fulfilling the company's due diligence requirements on your behalf.

Sean manually parses documents for accuracy, applies e-signatures, adds attestation paragraphs, embeds agent codes, and uses exact company-approved email templates to ensure your application passes underwriter scrutiny.

Yes. As your advocate and licensed broker, Sean must sign an Agent's Declaration certifying he will make known to the Company any and all factors which might affect your coverage.