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Coverage Details
Every MyVA plan carries the same comprehensive coverage through PhilCare. The only difference between plans is how many family members are included. Here's exactly what's covered.
₱200,000
Maximum benefit limit, per illness, per year (MBL)
Covered
Pre-existing conditions, fully covered and waived
1,700+
Accredited hospitals & clinics in the PhilCare network
Annual Physical Exam
| Medical history & physical examination | Covered |
| Chest X-ray | Covered |
| Routine urinalysis & fecalysis | Covered |
| Complete blood count (CBC) | Covered |
| ECG (members 35+ or if indicated) | Covered |
| Pap smear (female members 35+ or if indicated) | Covered |
| Pre-employment exam | Reimbursable up to ₱350 upon regularization |
Preventive Health Care
| Health education & counseling on diet or exercise | Covered |
| Periodic monitoring of health problems | Covered |
| Family planning counseling | Covered |
Out-Patient Care
| Consultations during regular clinic hours (excl. prescribed medicines) | Covered |
| Pre- and post-natal consultations | Covered, excl. lab & diagnostics |
| EENT treatment by affiliated physician/specialist | Covered |
| Minor injuries (lacerations, mild burns, sprains, etc.) | Covered |
| Dressings, conventional casts & sutures | Covered |
| X-ray, lab, diagnostic & therapeutic procedures | Covered, up to a specified amount |
| Minor surgery not requiring confinement | Covered |
| Speech therapy (reimbursement only) | Up to ₱10,000 / member / year |
| Animal-bite treatment & vaccines | Covered; vaccines up to ₱20,000 / member / year |
| Allergy testing & screening | Up to ₱2,500 / member / year |
In-Patient Services
| Room & board (private room, per plan accommodation) | Covered |
| Operating room, ICU, isolation & recovery room | Covered, subject to MBL |
| Professional fees (physicians, surgeons, anesthesiologists) | Covered, subject to MBL |
| Standard nursing services | Covered |
| Medicines for in-patient use | Covered, subject to MBL |
| Blood products, transfusions & IV fluids | Covered, subject to MBL |
| X-ray, lab & diagnostics incidental to confinement | Covered, subject to MBL |
| Anesthesia, oxygen & their administration | Covered, subject to MBL |
| Standard admission kit & liaison-officer assistance | Covered |
Emergency Care
| In affiliated hospitals (ER fees, physician services, medicines, oxygen, IV, dressings, X-ray/lab) | Covered, subject to MBL |
| Room upgrade if a room is unavailable | Covered, subject to MBL |
| In non-affiliated hospitals | Reimbursed up to ₱30,000 / case / member / year |
| Outside the Philippines | Reimbursed up to ₱30,000 / case / member / year |
| Areas without an affiliated hospital (50-km radius) | Covered, subject to MBL |
| Ambulance (Metro Manila, coordinated via AeroMed) | Covered |
| Ambulance (provincial areas) | Up to ₱2,500 per conduction (reimbursement) |
Diagnostic & Therapeutic Procedures
A broad range of diagnostic and therapeutic procedures are covered, as prescribed by an affiliated physician and subject to the MBL, including:
- ECG & Holter monitoring
- EEG monitoring
- CT scans
- MRI & MRA
- Ultrasound (2D-echo, abdominal, etc.)
- Mammogram & sonomammogram
- Cardiac stress tests
- Endoscopic procedures
- Pulmonary function tests
- Radioisotope scans
- Dialysis
- Chemotherapy (IV & oral)
- Radiotherapy
- Physical & occupational therapy
Some procedures carry specific inner limits (e.g. certain special modalities up to ₱5,000 / procedure / member / year). Full schedule available on request.
Additional Benefits
| Work-related conditions (per ECC-covered conditions) | Covered |
| Motor vehicular accidents | Covered, subject to MBL |
| Congenital diseases (excl. PT & developmental disorders) | Up to ₱40,000 / member / year |
| Scoliosis (acquired cases only) | Up to ₱40,000 / member / year |
| Epilepsy / seizure disorder (if acquired) | Covered |
| Hepatitis B & C (if acquired, not STD-related) | Covered |
| Sports-related injuries (excl. extreme sports) | Covered |
| Unprovoked assault, incl. domestic violence | Covered |
| Maternity assistance (female members, 280-day waiting period) | Up to ₱5,000 (reimbursement, once / year) |
Dental Benefits
Availed only through PhilCare-accredited dental clinics. No reimbursement.
- Annual dental exam & consultation
- Oral prophylaxis (once a year)
- Simple tooth extractions
- Temporary fillings (as needed)
- Restorative & prosthodontic treatment planning
- Desensitization of hypersensitive teeth
- Simple denture adjustment
- Recementation of loose crowns, inlays, onlays
- Gum treatment (inflammation, bleeding)
- Emergency out-patient dental treatment
- Dental health education & counseling
- Two light-cure fillings per tooth
PhilHealth membership is required to cover the PhilHealth portion of any bill. Non-PhilHealth members are responsible for paying that portion. Charges incurred by a newborn are not covered. This page is a summary; the full PhilCare schedule of benefits governs actual coverage. Benefits are subject to change at any time.
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