Republic of the Philippines
Office of the President
Philippine Charity Sweepstakes Office

Individual Medical Assistance Program (IMAP)

Charity Assistance Department
Radiotherapy Bldg, Lung Center of the Philippines
Quezon Avenue, Quezon City
Contat Numbers 426-3735, 366-3329

PROGRAM DESCRIPTION

The IMAP is the flagship program of the agency which was institutionalized in 1995 to provide timely and responsive financial assistance to individuals with health-related problems. With the Guarantee Letter as the medium used in providing such services addressed to health facilities (Hospitals, Dialysis Centers, etc.), the PCSO assumes the obligation of a specific amount due from the client for the services rendered. The amount of assistance is based on the classification system established under the program.


SERVICES COVERED

  1. Confinement
  2. Medicines
    • Epoietin Injection
    • Cancer Treatment Medications
      • Chemotherapy
      • Hormonal therapy
      • Targeted therapy
      • Immunotherapy
    • Specialty Medicines
      • Hematopoietic Growth Factors
      • Factor VII, VIII and IX
      • IV Immunoglobulin
      • Biologics
      • Post-transplant medicines
      • Psychiatric medicines
      • Anti-viral/Anti-retroviral therapy
      • Non-cosmetic Botox therapy
  3. Dialysis
    • Hemodialysis
    • Peritoneal (Continuous Ambulatory Peritoneal Dialysis [CAPD])
  4. Implant
    • Orthopedic
    • Cochlear
  5. Laboratory/Diagnostic Procedures
  6. Radiation Therapy
    • External Beam Radiation Therapy (EBRT)
      • Cobalt Therapy
      • Linear Acceleration
      • Tomotherapy
      • Intensive Modulation Radiation Therapy (IMRT)
    • Brachytherapy
    • Radioactive Iodine (RAI)
    • Stereotactic Radiosurgery/Gamma Knife
  7. Devices
    • Assistive Devices
      • Hearing Aid
        • Bone Anchored Hearing Aid (BAHA)
      • Wheelchair
      • Prosthesis such as Leg, Arm or Eye
      • Pulmonary Apparatus – Rental of Ventilator/Respirator
    • Medical Devices
  8. Non- and Minimally Invasive Procedures
    • Extracorporeal Shock Wave Lithotripsy (ESWL)
    • Laparoscopic surgery
    • Endoscopic procedures
    • Cataract and other eye-related surgery
  9. Transplant Procedures
    • Kidney Transplant
    • Liver Transplant
  10. Cardiac Procedures
    • Pacemaker surgery
    • Congenital Heart Surgery
      • ASD, PDA, VSD
    • Coronary Artery Bypass Graft
    • Aneurysm surgery
    • Peripheral bypass surgery
    • Percutaneous Coronary Intervention (Angioplasty)
    • Diagnostic procedures:
      • Coronary Angiogram
      • Cardiac Catheterization
  11. Rehabilitative Therapy
  12. Surgical Supplies

DOCUMENTARY REQUIREMENTS

General Requirements:
  • Duly accomplished PCSO IMAP Application Form (available for download at www.pcso.gov.ph, or at the PCSO Lung Center of the Philippines Satellite Office, PCSO Branch Offices and ASAP Partner Hospitals)
  • Valid IDs (Patient and Representative), which are any Government Issued Identification cards such as Passport, Driver’s License, GSIS UMID, SSS ID, PRC ID, NSO Authenticated Birth Certificate, NSO Authenticated Marriage Certificate, Digitized Voter’s ID, Philippine Health Insurance (PHIC) ID, Senior Citizen’s ID, Government Issued Office ID, DSWD – 4P’s ID, and Student ID
Specific Requirements:
  1. Confinement
    • Original Certified True Xerox copy of Medical Abstract with printed name, signature & license number of the attending physician/ doctor
    • Original copy of Statement of Account/Hospital Bill with printed name and signature of the Billing Officer/Credit Supervisor
      • Should reflect PhilHealth deductions, discounts such as Senior Citizen, PWD, etc., private insurance, deposits and payments
    • Endorsement from the Medical Social Services of the hospital for those admitted in the Charity/Service wards (NOT APPLICABLE FOR ASAP PARTNER HOSPITALS)
    • If Discharged: Validly executed Promissory Note (NOT APPLICABLE FOR ASAP PARTNER HOSPITALS)
    • For Medico-Legal Cases: Photocopy of Police Report
  2. Medicines
    1. Enrolment System for Dialysis (HD/PD) (Epoietin/PD Solution)
      Initial Application:
      • Original Medical Abstract with printed name, signature & license number of the nephrologist/attending physician
      • Original Prescription with signature, name and license number of nephrologist/attending physician
      • Official quotation from hospital/dialysis center accepting PCSO GL
      • Photocopy of relevant Laboratory Results (taken within the last three (3) months)
      • Certification of PhilHealth membership and availment status from dialysis center
      • PCSO Index Card (if with previous assistance)
      Succeeding Applications (For 2nd to 6th tranches):
      • Photocopy of the first set of documents (Initial Application)
      • Original Prescription with signature, name and license number of nephrologist/attending physician
      • Original Certification of ongoing treatment including date of last treatment from the dialysis center
      • PCSO Index Card
    2. Enrolment System for Cancer Drugs (IV or Oral)
      Initial Application:
      • Original Medical Certificate with printed name, signature & license number of the oncologist/attending physician
      • Original Prescription with signature, name and license number of the oncologist/attending physician
      • Original Treatment Protocol with printed name, signature and license number of the oncologist/attending physician
      • Photocopy of histopathology report/biopsy report)
      • If under the Roche, Novartis or other Pharmaceutical Company Access Program: Photocopy of Tracker
      • PCSO Index Card (if with previous assistance)
      Succeeding Applications:
      • Photocopy of the first set of documents (Initial Application)
      • Original Prescription with signature, name and license number of oncologist/attending physician
      • Progress Notes indicating date of last treatment with name, signature and license number of oncologist/attending physician
      • PCSO Index Card
    3. Specialty Medicines
      • Original Medical Abstract/Medical Certificate with printed name, signature and license number of the attending physician
      • Original Prescription with printed name, signature and license number of the attending physician
      • Photocopy of relevant Laboratory Results (taken within the last three (3) months)
      • If under the Roche, Novartis or other Pharmaceutical Company Access Program: Photocopy of Tracker
      • PCSO Index Card (if with previous assistance)
  3. Dialysis Procedure – Under Enrolment System for Dialysis
    1. For Members of PhilHealth
      • Original Medical Abstract with printed name, signature and license number of the attending physician
      • Official quotation from Dialysis Center/ Hospital accepting PCSO GL
      • Certification of Exhaustion of PhilHealth benefit for Dialysis Center/ Hospital
      • PCSO Index Card (if with previous assistance)
    2. For Non-Members of PhilHealth
      • Original Medical Abstract with name, signature and license number of the attending physician/nephrologist
      • Official quotation from Dialysis Center/ Hospital accepting PCSO GL
      • Certification of Non-Philhealth Member from the Dialysis Center/ Hospital
      • PCSO Index Card (if with previous assistance)
  4. Implant
    1. Orthopedic Implant
      • Original Medical Abstract with printed name, signature and license number of the attending physician with schedule of operation/surgery
      • Request from the attending physician with specifications of implant
      • Official sealed quotation from three (3) Suppliers accepting PCSO GL
        • For implants with only one existing supplier, a certification of sole distributorship is required
      • For Medico-Legal cases: Photocopy of Police Report
    2. Cochlear Implant
      • Original Medical Certificate with printed name, signature and license number of the attending physician with schedule of operation/surgery
      • Audiological Evaluation (Hearing Test) with name, signature and license number of audiologist
      • Official sealed quotation from a Supplier accepting PCSO GL
  5. Laboratory/Diagnostic Procedures
    • Original Medical Abstract with name, signature and license number of the attending physician
    • Laboratory/Diagnostic Request with name, signature and license number of physician
    • Official quotation from the service provider/ hospital indicating PhilHealth deductions and discounts, if applicable
  6. Cobalt/Radiotherapy/Brachytherapy/RAI/Gamma Knife Radiosurgery
    • Original Medical Abstract/Certificate with name, signature and license number of the attending physician
    • Official quotation with breakdown of expenses from service provider/hospital accepting PCSO GL, indicating PhilHealth deduction and discounts, if applicable
    • Photocopy of Histopathology/Biopsy report with name, signature and license number of pathologist
  7. Assistive Devices
    1. Hearing Aid
      • Original Medical Abstract/Certificate with name, signature and license number of the attending physician
        • Should state the need for and the specifications of the hearing aid
      • Audiological Evaluation (Hearing Test) with name, signature and license number of audiologist from the hearing aid center
      • Official sealed quotation from three (3) Suppliers accepting PCSO GL
        • For hearing aid with only one existing supplier, a certification of sole distributorship is required
    2. Wheelchair
      • Original Medical Abstract/Certificate with name, signature and license number of the attending physician
        • Should state the need for and the specifications of the wheelchair
      • Official sealed quotation from three (3) Suppliers accepting PCSO GL (IF SUPPLIER IS NOT TAHANANG WALANG HAGDAN)
      • Whole-body picture of patient
    3. Prosthesis
      • Original Medical Abstract/Certificate with name, signature and license number of the attending physician
      • Official sealed quotation from three (3) Suppliers accepting PCSO GL
        • For prosthesis with only one existing supplier, a certification of sole distributorship is required
      • Request or Prescription from the doctor stating specifications of the needed prosthesis
    4. Mechanical Ventilator Rental
      • Original Medical Certificate with printed name, signature and license number of the attending physician with schedule of operation/surgery
      • Official sealed quotation from three (3) Suppliers accepting PCSO GL
      • Photocopy of Arterial Blood Gas (ABG) result (within the last three (3) months)
  8. Medical Devices
    • Original Medical Abstract/Certificate with name, signature and license number of the attending physician
    • Request from the attending physician with specifications of medical device
    • Official sealed quotation from two (2) Suppliers accepting PCSO GL
      • For devices with only one existing supplier, a certification of sole distributorship is required
    • Photocopy of relevant Laboratory/Diagnostic Result
  9. Non- and Minimally-Invasive Procedures (ESWL, Laparascopic Surgery, Endoscopic Procedures, Cataract and Eye Surgery)
    • Original Medical Abstract with name, signature and license number of the attending physician
    • Official quotation with breakdown of expenses and PhilHealth deduction
    • Photocopy of relevant laboratory/diagnostic result (taken within the last three (3) months)
  10. Transplant
    • Original Medical Abstract with name, signature and license number of the attending physician
    • Official quotation from the hospital with breakdown of expenses
    • Certification from transplant unit of the hospital that the patient is eligible for transplant
    • Proof of counterpart from the patient/patient’s family
  11. Rehabilitative Therapy (PT/OT/Speech)
    • Original Medical Abstract with name, signature and license number of the attending physician
    • Official quotation with breakdown of expenses from service provider accepting PCSO GL
  12. Surgical Supplies
    • Original Medical Abstract with name, signature and license number of the attending physician
    • Official quotation with breakdown of expenses from service provider accepting PCSO GL