Frequently Asked Questions
Group Term Life Insurance
Who are eligible for Life Insurance?
All regular, full-time and actively at work employees who are at least 18 years old and no more than 65 years old are eligible members.
How much will the amount of the Life Insurance be?
The amount of Life Insurance cover is determined by the employer. Cover may be a fixed amount or multiples of monthly basic salary
Can I increase the amount of cover I currently have?
No, as the amount of cover is determined by the employer and should be consistent with the other levels in the company.
Will the amount of cover build cash values?
No, as this is a term life insurance or purely protection thus, no cash or loan values are accumulated.
What is a No Evidence Limit (NEL)?
No Evidence Limit (NEL), also called Free Cover Limit, is the maximum amount of insurance cover for a member which no evidence of insurability is required to be accepted in the policy.
What will happen if my amount of cover is beyond the No Evidence Limit (NEL)
If the amount of cover is beyond the NEL, the amount in excess will be subject to underwriting. Evidence of insurability, such as submission of an accomplished Medical Health Questionnaire or undergoing medical examination, will be evaluated by Generali’s Medical Director to determine if the member may be accepted as a standard or substandard risk, or to postpone or decline the amount of cover beyond the NEL.
The additional amount of cover beyond the NEL shall take effect on the date of approval of Generali’s Medical Director.
What happens if a member is unable to comply with the evidence of insurability?
In case a member is unable to comply with the evidence of insurability, the obligation of Generali is limited to the current amount of cover that has been approved.
Who will pay for the fees in case a medical examination is required?
Generali will shoulder the medical examination expenses as long as it is done in one of Generali’s accredited clinics.
In case a member requests for repeat/additional tests, these shall be for the account of the member.
What are the covered causes of death?
All causes of death are covered.
For suicide cases, if a member commits suicide within one year from the date of issue/reinstatement of his insurance, provided however, that the employee is then sane, Generali’s liability is just the return of premiums for the period mentioned.
Am I still covered even if I take a leave of absence without pay?
A member remains covered as long as they continue to be employed with their employer and remains to be eligible.
Can I continue my Life Insurance even after I separate from my employer?
You can no longer continue coverage under the Group Life Insurance as coverage is co-terminus with the employment.
However, each member has the privilege to convert his life insurance into an ordinary life insurance policy without showing evidence of insurability within 31 days from the date of separation. Furthermore, amount of cover should not be more than the latest coverage under the group policy and there are no riders to be attached to an ordinary individual insurance plan.
Who may I assign as beneficiaries?
An insured member shall have the right to designate anybody, not disqualified by law, as his beneficiary or beneficiaries
When will the beneficiary/ies receive the death benefit?
The beneficiary/ies will receive the death benefit within 14 working days from Generali’s receipt of complete claim documents
Group Medical Insurance
Who are eligible for Medical Insurance?
All regular, full-time and actively at work employees who are at least 18 years old and no more than 65 years old are eligible.
Eligible dependents of above eligible employees may also be enrolled in the plan. If premium is to be paid by the employer, 100% of the dependents should be enrolled. If premiums will be shared between employee and employer, a minimum of 75% participation of eligible employees should enroll their dependents.
How much will the amount of the Medical Insurance be?
The amount of Medical Insurance cover is determined by the employer.
Can I increase the amount of cover I currently have?
No, as the amount of cover is determined by the employer and should be consistent with the amounts set for other levels in the company.
What if my illness developed certain complications, will such complications be subject to a separate benefit limit?
Any illness which is proven to be related or is a complication of an illness shall share the same benefit limit as its root disease.
How do I know which doctors are accredited?
You may check the list of doctors and their schedules here OR you may call our Alarm Center
Can I get a copy of the list of the doctors and their schedules?
Since the Doctors’ lists and/or schedules are updated regularly by our Providers, it is not advisable to provide members a copy of the doctors’ list. However, you may check the most updated list of doctors and their schedules here OR you may call our Alarm Center.
If I’m in an accredited hospital and want to use the services of my personal doctor who is not accredited with Generali, can I have his medical services reimbursed?
Generali will reimburse the actual customary, reasonable expenses had member availed services with an accredited doctor, up to the limits of the plan.
Can I have my personal doctor accredited with GP?
You may request for doctor accreditation by writing us through your HR. The doctor may be accredited upon compliance to the Generali credentialing criteria, when approved by our medical coordinator and if he/she is amenable to the payment terms & conditions of our contract.
During confinement, what if I want to occupy a room higher than my room & board (R&B) limit?
The member may occupy a room category higher than his R&B limit. Please note that because of socialized pricing in hospitals, staying in a more expensive room will also make the other services more expensive. As a result, the member may incur excess amounts over his plan limits and such excess amounts will have to be paid prior to discharge from the hospital.
Do I get 100% reimbursement for charges during emergency confinement in a non-accredited hospital?
If a member is treated in a non-accredited hospital, Generali will reimburse the actual, customary, and reasonable expenses had member availed of services in an accredited hospital with an accredited doctor, subject to the limits of the plan.
Who is responsible for the filing of my PhilHealth with the hospital? What happens when I fail to file my PhilHealth?
It is the member’s responsibility to file the Philhealth form. If you fail to file it, you will shoulder the amount corresponding to your Philhealth benefit.
What if I get into a vehicular accident, will Generali cover the cost of my medical expenses?
Injuries sustained in vehicular accidents and other medico-legal cases (shooting, stabbing et al) are not automatically covered. The member needs to submit a police report and other pertinent documents subject to our evaluation. Generali will not cover your medical expenses if it is proven that the injury is sustained due to causes that are exclusions/limitations of the plan (i.e. while in violation of any law).
What is the turn-around time for submission and processing of reimbursement?
Submission of the duly accomplished Generali claim form and other requirements is within 90 days from the date of discharge from the hospital or from the date of treatment. Generali will process and send the reimbursement to the employee within 14 working days from receipt of complete claim documents.
What is the purpose of the network card?
The membership card serves as member identification during availment with our Providers (hospitals, clinics and doctors), which is required to validate if member is eligible for coverage. Once the membership card is swiped in the POS terminal, it will generate a print-out called LOE (Letter of Eligibility).
What do I do if I lose my network card?
If a member loses his network card, he may coordinate with his employer’s HR representative for the card replacement. Generali will replace the card subject to a fee of Ph100.
Can I still use my network card even if I am already separated from my employer?
A member’s medical plan is co-terminus with his stay in the company. The member should surrender his card and his dependents’ card, if applicable, before separation/resignation as part of the clearance requirement.
What is an Alarm Center?
The Alarm Center (AC) is the call center servicing arm of the Generali Provider Network headed by a Doctor and manned by agents who are registered nurses or paramedical staff. They are responsible in assisting the members during a medical availment.
What do I do if I want to report any feedback or concern regarding my availment?
You may send your feedback or concern through your employer. For urgent concerns, the member may call or send us a message through Generali’s Alarm Center 24/7 Personalized Service Medical Hotline Nos. for immediate assistance. Contact details are also indicated at the back of the network cards. The member should give complete information so that Generali can address the matter as quickly as possible.
Am I still covered even if I take a leave of absence without pay?
A member remains covered as long as he continues to be employed with his employer and remains eligible.
Can I continue my Medical Insurance even after I separate from my employer?
You can no longer continue coverage under the Group Medical Insurance as coverage is co-terminus with your employment.
What are the standard exclusions or limitations of a medical insurance plan?
Expenses for any treatment brought about by a cause or causes enumerated below, shall not be reimbursable:
- Those for services and supplies deemed not medically necessary, as determined by the Company for the diagnosis, care, or treatment of the disease, illness or injury involved; any confinement for diagnostic purposes or physical check-up unless specified in the Schedule of Benefits; charges for room, board, general nursing care and special hospital services which are not related to the diagnosis and treatment of the condition for which the hospital confinement is required by the attending physician or surgeon; and any charges for personal comfort items, newspaper, telephone calls, television, radio, copies of hospital records, registration fees and other similar charges. This exclusion applies even if the services and supplies are prescribed, recommended, or approved by the Insured Individual’s attending physician. In addition, any charges for care, treatment, services, or supplies that are not prescribed, recommended, or approved by the Insured Individual’s attending physician or treatment provided or prescribed by an unlicensed or unqualified physician or surgeon are also excluded.
- Medical treatment for learning difficulties, hyperactivity, attention deficit disorder, speech impediments, behavioral problems or other development issues.
- All charges for the diagnosis or treatment of any mental health, behavioral, psychiatric or psycho-social illnesses, alcoholism, drug and substance abuse/dependency including any medical condition and/or bodily injury directly or indirectly arising therefrom. Medical treatment for any addictive and/or compulsive disorder. Medical treatment due to the Insured Individual being under the influence and/or suffering from the effects of alcohol, intoxicants, drugs or narcotics.
- Deliberate self-inflicted injury, needless self-exposure to peril (except in an attempt to save human life), suicide or attempted suicide.
- Costs for any drugs or medications that are not prescribed and not provided as part of a hospital admission. Costs for any dietary supplements, vitamins, diet pills, homeopathic remedies, herbal medicines and other minerals or organic substances, even if ordered or prescribed by a physician.
- Any charges incurred resulting from venereal disease, sexually transmitted diseases, gender reassignment or any other form of sexual related condition, and any related condition. Any charges for medical treatment for Human Immunodeficiency Virus or HIV related illness, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related complex (ARC) including any similar infections, illnesses, injuries or medical conditions arising from these conditions, or charges for the examination, immunization, and detection of AIDS or ARC or other related viruses.
- Any charges incurred resulting from or attributed to contraception, sterilization or its reversal, infertility, artificial insemination, fertilization or any form of assisted reproduction, impotence, pregnancy, resulting childbirth, miscarriage or caesarean section or elective termination of pregnancy unless covered under Benefit Parts B1 and B2 specified in the SCHEDULE OF BENEFITS.
- Charges for therapy, supplies, or counseling for sexual dysfunctions or inadequacies that do not have a physiological or organic basis.
- Circumcision, unless deemed medically necessary.
- Claims resulting from intentional, fraudulent, illegal, criminal, deliberately careless or reckless acts on the Insured Individual’s part and their consequences.
- Injury sustained while an Insured Individual is in or about any air or marine transportation except while travelling as a fare-paying passenger in a passenger aircraft or sea vessel used by a regular passenger, operated by a duly licensed operator (i.e. pilot, ship captain) and travelling on a scheduled passenger trip over an established passenger route.
- Claims arising in the course of travel undertaken against medical advice.
- Any consequences of experimental and/or unproven treatment. Those for what are considered alternative treatments, including but not limited to acupressure, acupuncture, aromatherapy, hypnotism, massage therapy, Rolfing, chiropractic therapy, art therapy, hydrotherapy, music therapy, dance therapy, horseback therapy and other forms of alternative treatments.
- Those, as determined by the Company, to be for custodial care or convalescence or for nursing services unless it forms an integral part of medical treatment received as an in-patient and is under the control or supervision of a specialist and undertaken in a recognized rehabilitation unit.
- Any treatment which is purely for physical therapy or for recuperative purposes or confinement in a hospital or sanitarium or convalescent home for rest cure, accommodation and treatment costs in a nursing home, hydro, spa, nature clinic, health farm or a similar type of establishment and any charges for home nursing or other home health services.
- Vaccinations or immunizations of any kind and general health check-ups or annual physical examinations, unless specifically covered under the Schedule of Benefits.
- Plastic surgery, cosmetic surgery, reconstructive surgery or remedial surgery, removal of fat or other surplus body tissue and any consequences of such medical treatment, weight loss or weight problems, eating, snoring and sleeping disorders, whether or not for psychological purposes. Cosmetic or reconstructive surgery will be considered payable when it is medically required as a direct result of an accident which occurs during the period of insurance and which is covered by this Rider.
- Any process to determine or correct the refractive errors of the eyes and any costs for glasses or contact lenses.
- Claims arising as a result of the Insured Individual’s participation in professional sport (not including recreational or amateur participation) or any hazardous sport or activity such as, but not limited to the following: motor sports, aerial sports, scuba diving below thirty (30) meters or where a scuba diving certificate is not held, any sport involving animals, speed competition, skiing off-piste and racing of any form (other than on foot). If a hazardous sport or activity is not specified in this list, the Insured Individual must contact the Company to ascertain if such sport or activity may be considered as covered under this Rider.
- Any claim arising when the Insured Individual is performing military service or police duty, or is participating as a member of any military, naval or aerial organization, or is under military authority or is engaged in activities involving the use of firearms or physical combat or in an area of military conflict.
- Any claim arising when the Insured Individual ceases active work on account of temporary layoff or absence without leave.
- Any claims whatsoever resulting from war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, military or usurped power or taking part in civil commotion or riot of any kind. Bodily injury or illness caused by an act of terrorism, except where such injury/illness is sustained as an innocent bystander, excluding any act of terrorism which involves the use of nuclear weapons or devices, chemical or biological agents. For the purposes of this Policy, an act of terrorism means an act, including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of person whether acting alone or on behalf of or in connection with any organization(s) or government(s), committed for political, religious, ideological or similar purposes or reasons including the intention to influence any government and/or to put the public or any section of the public in fear.
- Any claim in any way caused or contributed to by the use or release or the threat thereof of any nuclear weapon or device or chemical or biological agent.
- Any expense not specifically stated in this Rider as being insured and any expenses which exceed the Insured Individual benefit limits, annual maximum limits or overall maximum benefit of the Insured Individual.
- Any costs which in the opinion of the Company’s physicians are unnecessary or are over and above what the Company considers to be actual, necessary, usual, reasonable and customary for the services provided.
- Treatment, services or supplies or any other medical care which are furnished or for which benefits are payable under any other policy, certificate or rider in force, or under any extension of benefits provisions of any other policy, certificate or rider which has been cancelled; provided, however, that if the benefits payable under such other policy, certificate or rider are less than the total expenses incurred by the Insured Individual, the Company shall reimburse an amount equal to the benefits provided under this Rider. In no instance, however, shall the total payments from this Rider or plan exceed the total incurred expense.
- The costs associated with locating a replacement organ or any costs incurred for the removal of the organ from the donor, transportation costs of the organ and all associated administration costs. All costs associated with organs not specified within the meaning of words “organ transplant”.
- All charges for air ambulance or medical evacuation, except when Part E is applicable.
- Durable Medical Equipment (DME), defined as medical equipment used in the course of treatment of any disability or illness including, but not limited to, crutches, knee braces, wheelchairs, hospital beds, prostheses, artificial limbs, hearing aids, whirlpools, portable whirlpool pumps, massage devices, over bed tables, elevators, communication aids, vision aids, and telephone alert systems etc. that are purchased or rented, except rental of wheelchairs or iron lungs. Also excluded are any batteries or acquisition, shipping and handling charges associated with DME.
- Charges for dental treatment or surgery except dental operation resulting from an injury sustained by the Insured Individual in an accident.
- Any treatment or surgical operations for congenital deformities or defects, such as harelip, clubfoot, hernia, heart defect, birthmark, abnormal bone or muscular growth, cerebral palsy and others.
- Any treatment for tuberculosis, except surgical operations for removal of diseased portions of organs afflicted with tuberculosis, e.g. caecum, kidney, spine.
- Any communicable disease in epidemic or pandemic proportion as declared by the government.
- Re-admission due to HAMA (home against medical advice) within two (2) weeks from the date of discharge.
- Charges resulting from any services or supplies for which no reimbursement or payment is required on account of the Insured Individual receiving them.
24/7 Call – A Doc
What is Telemedicine?
Telemedicine is a healthcare delivery model established over 40 years ago, beginning as a way for hospitals to extend care to patients in remote areas. Through technological advances, it has transformed into an efficient and convenient model of care.
Generali has partnered with Medgate to provide 24/7 access to a telemedicine.
Advantages of telemedicine?
- Convenience – you don’t need to leave your home/office to have a medical consultation, no lining up or waiting for the doctor;
- Prevention – because of easy access, early intervention can be done preventing further development of your illness;
- Cost savings – save on travel and other health expenses;
- Thorough consultation – with telemedicine, medical management revolves around you, the patient.
What medical specialists does your 24/7 Call-A-Doc service have on board?
Most medical specialties are available at our partner’s Telemedicine Center, some of which are OB-Gyne, Pediatrics, Family Medicine, Endocrinology, General Practitioner and many more.
How can I avail of the service?
You may access the 24/7 Call-A-Doc thru the GenConnect mobile app. Click on the Talk to a Doctor to call directly any of the hotline numbers listed or to schedule a call back.
What can I expect when I call the hotline numbers?
If you’re a first-time caller, please expect the following:
- Eligibility check – our Telemedical Assistant will ask several questions pertaining to your eligibility;
- Profile creation – a file will be created for you to keep all your records in one name;
- Past medical history – our nurse will obtain pertinent information so our doctors can keep track of your medical history;
- Consultation – our doctors will ask questions based on your illness where the Initial assessment is made. These steps will ensure that you receive the most appropriate care from our doctors. This whole process will take about 10 minutes, depending on your condition.
Can I use this service for second opinion or interpretation of lab results?
Yes. You can call to seek more information about your condition or send a copy of your lab results for medical interpretation.
Can I see the doctor or have a face-to-face consultation?
Our partner’s policy does not allow doctors to see patients outside the telemedicine center.
Does the 24/7 Call-A–Doc service issue a Prescription? Will it be honored in any pharmacy?
If needed, an e-prescription is sent to your registered email address after the consultation. Please make sure you register an active email address.
Is 24/7 Call-A-Doc for emergency situations? What possible illnesses can be treated through telemedicine?
No. 24/7 Call – A – Doc is for outpatient, non-emergency cases only. Most outpatient, non- emergency illnesses can be managed by telemedicine. If your condition requires a face-to- face consultation or ER visit, the doctors or telemedical assistant will refer you accordingly.
Can I use it for our family members?
Yes, if they are eligible dependents and are registered members of Generali.
Medical information is considered “private”; how do you ensure privacy of information?
Medical information access is limited exclusively to the telemedicine doctors and through our partner’s state-of-the-art systems, ensuring data privacy with encryption protocols.