FAQS | Generali Life Assurance Philippines, Inc. (2024)

Generali offers Group Term Life, Group Personal Accident, Group Credit Life and Group Health Insurance. These products are designed for SME and corporations to serve as employee or member benefits.

We also have products for individuals and families. Available thru our retail partners.

SME and corporations avail of the insurance as part of their employee or member benefits program.

For employee benefits, qualified members are all regular, full-time and actively at work who are at least 18 years old and no more than 65 years old.

Member benefits depend on the partnership agreement between Generali and the company/employer.

An employee’s Life Insurance benefit amount is determined by the employer. Benefit may be a fixed amount or multiples of monthly basic salary.

No. The benefit amount is determined by the employer and should be consistent with the other levels in the company.

No. This is a term life insurance or purely protection thus, no cash or loan values are accumulated.

All causes of death are covered.

Suicidal cases are covered after one (1) year from the effective date of his or her insurance as long as the employee is actively at work.

A member remains covered as long as they are employed by their employer and remains to be qualified for the insurance.

No. You can no longer continue your coverage under the Group Life Insurance. Your coverage is tied with your employment.

You may still convert your Group Life Insurance into an ordinary life insurance policy. No need to undergo medical evaluation within 31 days from the date of resignation. Benefit amount should not be more than your latest coverage under the group insurance policy. You cannot also attach riders with your individual insurance policy.

An insured member has the right to assign anybody allowed by law as his beneficiary/ies.

Your beneficiary/ies receive the death benefit amount within 14 working days from receipt of complete claim documents. Claims filing documents and process can be seen here: https://www.generali.com.ph/claims-filing/

Also called as the Free Cover Limit, is the maximum benefit amount, agreed by the Company, that an employee may have even without medical evaluation.

If the benefit amount is beyond the NEL, the excess amount will be subject to evaluation. Submission of accomplished Health Statement Form or undergoing medical examination will be requested from the member.

Results will be evaluated by Generali’s Underwriter if the member may be accepted as a standard or substandard risk, or to postpone or decline the application.

If approved, the new benefit amount will be applied.

In case a member is unable to comply with the requested requirements, the benefit amount is up to the NEL amount or the latest approved insurance coverage only.

All requested medical examinations are covered by Generali as long as these are done in one of our accredited clinics.

Additional medical examination/s requested by the member are not covered.

SME and Corporations avail of the insurance as part of their employee or member benefits program.

For employee benefits, qualified members are all regular, full-time and actively at work who are at least 18 years old and no more than 65 years old.

Member benefits depend on the partnership agreement between Generali and the company/employer.

The Group Health Insurance benefit amount is determined by your employer.

No. The benefit amount is determined by your employer.

Your medical insurance plan is attached to your employment. Once you have resigned, your medical insurance benefits will no longer be valid.

No. These complications are covered under the same benefit limit of the illness.

You may check out the homepage of our website to see our complete list of partner doctors. Just scroll down the homepage to see the Search-A-Provider feature.

Our partner doctors constantly change their schedules based on their patients’ needs that it is best that you directly contact the hospital or clinic for their schedules.

Yes. We will reimburse your expenses based on your medical insurance plan.

Yes. Application to be an accredited provider can be done here: https://www.generali.com.ph/provider-accreditation/

You may occupy a room category higher than your Room & Board limit. However, hospital room categories are based on socialized pricing. This means a higher room category will make the medical services more expensive. As a result, you may need to pay for excess hospital charges over your medical insurance plan limits prior to your discharge.

Injuries sustained in vehicular accidents and other medico-legal cases (e.g. shooting, stabbing et al) are not automatically covered. The member needs to submit a police report and other appropriate documents. Claim is still subject to evaluation.

Expenses for any treatment brought about by a cause or causes enumerated below, shall not be reimbursable:

1. 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.
2. Medical treatment for learning difficulties, hyperactivity, attention deficit disorder, speech impediments, behavioral problems or other development issues.
3. 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.
4. Deliberate self-inflicted injury, needless self-exposure to peril (except in an attempt to save human life), suicide or attempted suicide.
5. 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.
6. 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.
7. 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.
8. Charges for therapy, supplies, or counseling for sexual dysfunctions or inadequacies that do not have a physiological or organic basis.
9. Circumcision, unless deemed medically necessary.
10. Claims resulting from intentional, fraudulent, illegal, criminal, deliberately careless or reckless acts on the Insured Individual’s part and their consequences.
11. 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.
12. Claims arising in the course of travel undertaken against medical advice.
13. 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.
14. 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.
15. 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.
16. Vaccinations or immunizations of any kind and general health check-ups or annual physical examinations, unless specifically covered under the Schedule of Benefits.
17. 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.
18. Any process to determine or correct the refractive errors of the eyes and any costs for glasses or contact lenses.
19. 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.
20. 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.
21. Any claim arising when the Insured Individual ceases active work on account of temporary layoff or absence without leave.
22. 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.
23. 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.
24. 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.
25. 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.
26. 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.
27. 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”.
28. All charges for air ambulance or medical evacuation, except when Part E is applicable.
29. 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.
30. Charges for dental treatment or surgery except dental operation resulting from an injury sustained by the Insured Individual in an accident.
31. 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.
32. Any treatment for tuberculosis, except surgical operations for removal of diseased portions of organs afflicted with tuberculosis, e.g. caecum, kidney, spine.
33. Any communicable disease in epidemic or pandemic proportion as declared by the government.
34. Re-admission due to HAMA (home against medical advice) within two (2) weeks from the date of discharge.
35. Charges resulting from any services or supplies for which no reimbursem*nt or payment is required on account of the Insured Individual receiving them.

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 Doctor Anywhere to provide 24/7 access to a telemedicine.

1. Convenience – you don’t need to leave your home/office to have a medical consultation, no lining up or waiting for the doctor;
2. Prevention – because of easy access, early intervention can be done preventing further development of your illness;
3. Cost savings – save on travel and other health expenses;
4. Thorough consultation – with telemedicine, medical management revolves around you, the patient.

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.

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.

If you’re a first-time caller, please expect the following:

1. Eligibility check – our Telemedical Assistant will ask several questions pertaining to your eligibility;
2. Profile creation – a file will be created for you to keep all your records in one name;
3. Past medical history – our nurse will obtain pertinent information so our doctors can keep track of your medical history;
4. 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.

Yes. You can call to seek more information about your condition or send a copy of your lab results for medical interpretation.

Our partner’s policy does not allow doctors to see patients outside the telemedicine center.

If needed, an e-prescription is sent to your registered email address after the consultation. Please make sure you register an active email address.

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.

Yes, if they are eligible dependents and are registered members of Generali.

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.

Your benefits are ready for viewing thru the GenConnect mobile app.

You may also refer to it thru the Member Portal. Member Portal is available via our website. Just hover on the Log In text, found at the upper right corner of this site, and choose As A Member. If you already have a GenConnect account, you may proceed with logging in using the same credentials. Otherwise, please register to access the portal.

GenConnect and Member Portal credentials are the same.

We have the Member Portal as your quick reference on who are your enrolled beneficiaries and/or dependents.

Member Portal is available via our website. Just hover on the Log In text, found at the upper right corner of this site, and choose As A Member. If you already have a GenConnect account, you may proceed with logging in using the same credentials. Otherwise, please register to access the portal.

Your virtual card functions the same as a physical card. You may present your virtual card in your GenConnect app together with your Letter of Approval (LOA) and valid Government I.D to any of our accredited providers.

Please note that you do not need a physical card anymore when availing of your benefits.

You may coordinate with your HR representative for the card replacement. We will replace the card subject to a fee of Php100.

You may reach out to your company HR for your individual member number (also known as Certificate Number). You will use this number when registering to our for members’ mobile app, GenConnect and Member Portal.

The Alarm Center (AC) is our 24/7 Customer Care center servicing arm of the Generali Provider Network manned by agents who are registered nurses or paramedical staff. They are responsible in assisting the members during a medical availment.

You may request for an LOA thru any of the following channels:

1. Via the mobile app, GenConnect. GenConnect is available for download via Apple Store or Google PlayStore
2. Send us an email. Please use the subject LOA Request: <Name of Member> x <Company Name>
   For Consultations and/or Diagnostic Procedures: outpatientloa@generali.com.ph
   For Hospital Admission: inpatientloa@generali.com.ph

We highly encourage members to request an LOA before going to a medical facility. This is to avoid waiting time in the hospital or clinic.

It is the member’s responsibility to file the Philhealth form. If the member failed to file it, he will shoulder the amount based on your Philhealth benefit.

Your reimbursem*nt will be based on your medical insurance plan.

Depending on your claim (life or medical), below are the ways to file a claim:

Submit request and relevant documents via any of the following avenues, as indicated below. Please make sure to provide clear copies of the supporting documents. This is for the processor’s better reference for evaluation.

For medical reimbursem*nts, soft copies of claims documents – such as Official Receipt, Breakdown of Procedures – are already accepted. However, please keep the original documents. This might be asked by our Claims Team if further evaluation is deem needed.

For life claims, soft copies of necessary documents — such as Death Certificate, Certificate of Employment of the Insured Member – can initially be submitted for faster evaluation. But, original copies must be sent prior to the release of claims payment.

Generali is moving to online – based claims payment or the Auto – Credit Arrangement (ACA). This will ensure faster crediting and foster paperless transactions. Hence, members filing for claims need to provide their bank account details for enrolment in the ACA.

Bank account details will only be needed for first – time members filing for claims. Please ensure this has been provided upon filing for a seamless claims processing. Attached herewith is the Bank Account Form for reference.

We assure that information provided will be kept secured and confidential.

The Auto-Credit Arrangement (ACA) Form is available here. https://www.generali.com.ph/downloadable-forms/

Submission of the accomplished Out-Patient claim form and supporting documents must be within 90 days from the date of hospital discharge or availment. We will process and send your reimbursem*nt within 14 working days from receipt of complete claim documents.

You may send your feedback or concern through your HR. You may also send us an email at customercare@generali.com.ph. For any urgent concern, you may call or email our 24/7 Customer Service, Alarm Center, at (632) 8580 6600 or acinquiry@generali.com.ph.

Please note that this list shall be updated from time to time and is incorporated by way of reference into the Policy contract. If you are the Insured/Policyholder, it is your responsibility to check periodically to ensure that you are aware of the updated Fully Embargoed and Comprehensive Sanctioned Countries/Territories.