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Application Forms
Medical Application Forms
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Underwriting Forms
Advisors Declaration (Word)
Attending Physician's Statement - Applicant (Word)
Certification of Customary Signature
Chest Pain Questionnaire
Cholesterol Questionnaire
Corporate Enrollment Template - PCHC
Corporate Enrollment Template - PCII
Certification of Customary Signature
COVID-19 Recovery Questionnaire
Cyst, Lump, Mass & Tumor Questionnaire
Diabetes Questionnaire
Digestive Disorder Questionnaire
Ear Disorders Questionnaire
Eye Disorders Questionnaire
Genito-Urinary Questionnaire
Gynecological Questionnaire
Headache & Migraine Questionnaire
Hypertension Questionnaire
Headache & Migraine Questionnaire
Letter of Undertaking For Excess Hospital Charges PCHC (Word)
Letter of Undertaking For Excess Hospital Charges PCII (Word)
Medical Examination Form (MEF) Critical Cover Extra
Mental Health Questionnaire
Musculoskeletal Questionnaire
New Business and Renewal Pre-Submission Checklist (For Group/Corporate)
New Business and Renewal Pre-Submission Checklist (For Individual/Family)
Respiratory Questionnaire
Secretary's Certificate for Group Accounts - For Group of Companies Having The Same Signatory (Word)
Secretary's Certificate for Group Accounts - For Individual Company (Word)
Seizure-Epilepsy Questionnaire
Sleep Apnea Questionnaire
Thyroid Disorder Questionnaire
Venous Diseases Questionnaire
I want to apply as an agent
Agent's Application Form
Pre-Approval Assessment
Pre-Approval Form (PDF)
Other Company Details
e-Policy Frequently Asked Questions (FAQ)
Data Privacy Statement
Data Privacy Statement
FlexiShield (FAQ)
FlexiShield (FAQ)
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Provider Name
Provider Address
Phone No.
Provider Type
HI-PRECISION DIAGNOSTICS SAN NICOLAS
Units 3&4 Valdez Bldg Valdez Center, Brgy. 1, San Francisco, San Nicolas, Laoag City, Ilocos Norte
(077) 600 3203
Clinics
HI-PRECISION DIAGNOSTICS TABUNOK
South National Highway, Tabunok, Talisay, 6045 Cebu
(032) 236 6277
Clinics
HI-PRECISION DIAGNOSTICS TM KALAW
G/F Rm. 102 San Luis Terraces, 638 T.M. Kalaw St.
(02) 8405 151
Clinics
HI-PRECISION DIAGNOSTICS STA ROSA LAGUNA
Unit 01 15, 16 20, Ground Flr., Laguna Central Bldg., Paseo Outlets, Greenfield City, Tagaytay Balibago Road,
(049) 543 6661
Clinics
HI-PRECISION DIAGNOSTICS SUCAT
Unit A 4B, Jaka Plaza Bldg, Dr Arcadio Santos Ave, San Antonio Valley 1, Paranaque City, 8288
(02) 8836 3431
Clinics
HI-PRECISION DIAGNOSTICS TARLAC
6376 McArthur Highway, Blossomville Subdivision, Brgy. Sto. Cristo
(045) 456 1575
Clinics
HI-PRECISION DIAGNOSTICS TAYTAY
GF Unit 1 8, 2f unit 9 10, Manila East Road Brgy. Dolores
-
Clinics
HI-PRECISION DIAGNOSTICS PLUS URDANETA
Unit 320 323 SM City Urdaneta Central, McArthur Highway Brgy. Nancayasan
-
Clinics
HI-PRECISION DIAGNOSTICS PLUS AYALA NORTH EXCHANGE
Retail 03 Ground Floor, Ayala North Exchange BPO Tower, Ayala Avenue cor. Salcedo and Amorsolo St.,
(02) 7728 8993
Clinics
HI-PRECISION DIAGNOSTICS V LUNA BRANCH
G/F Garpas Tower No.31 B V.Luna Avenue cor.Mabilis St., Pinyahan,
(02) 3433 8637
Clinics
HI-PRECISION DIAGNOSTICS PLUS ALABANG
Space No. 2214 to 2216 Upper Ground floor, Festival Supermall, Filinvest Corporate City Alabang
(02) 8863 9999 Loc 236, 2125, 399, 806
Clinics
HI-PRECISION DIAGNOSTICS VALENZUELA
Unit 3&4 Arca North Compound, 286 MacArthur Hi way, Karuhatan
(02) 8236 3280
Clinics
HI-PRECISION DIAGNOSTICS TAFT AVENUE BRANCH
1852 Taft Avenue
(02) 8405 0039
Clinics
HI-PRECISION DIAGNOSTICS PLUS CALAMBA
G/F Andenson Building III, National Highway Brgy. Parian
(049) 508 9872
Clinics
HI-PRECISION DIAGNOSTICS PLUS BF HOMES PARANAQUE
64 Aguirre Ave, BF Homes Sucat
(02) 8834 1295
Clinics
HI-PRECISION DIAGNOSTICS PLUS LIPA
ANFA Building, JM Katigbak Street, Mataas na Lupa
(043) 702 4037
Clinics
HI-PRECISION DIAGNOSTICS PLUS KATIPUNAN
Lower G/F The Arton Strip, Katipunan Avenue, corner Highland Drive, Blue Ridge A
-
Clinics
HI-PRECISION DIAGNOSTICS PLUS DASMARINAS PASONG TALA
Lot4A Aguinaldo Highway, Pasong Tala, Zone 4
-
Clinics
HI-PRECISION DIAGNOSTICS PLUS ORTIGAS
Unit G20 23 Ortigas Technopoint One, DoNa Julia Vargas Ave, Ortigas Center
(02) 8633 7931
Clinics
HI-PRECISION DIAGNOSTICS PLUS SAN JUAN
Unit G01 G02 & MO 1 TNA Bldg., 17 J. Abad Santos, Little Baguio
(02) 8871 7459
Clinics
HI-PRECISION DIAGNOSTICS PLUS ROCKWELL
R3 Level 324A Rockwell Power Plant Mall
(02) 8474 0377
Clinics
HI-PRECISION DIAGNOSTICS PLUS SM AURA
364 365 Level 3 SM Aura Premier Mckinley Parkway, Bonifacio Global City
(02) 8294 0015
Clinics
HI-PRECISION DIAGNOSTICS PLUS SM MOA
GF Unit 114, Mall of Asia Arena Annex Bldg., Coral Way cor. JW Diokno Blvd., Mall of Asia Complex, Zone 10, CBP 1A Pasay City
-
Clinics
HI-PRECISION DIAGNOSTICS PLUS SUBIC
1148 1150 Ground Flr., Harbor Point, Rizal Highway, Subic Bay Freeport Zone, Subic Zambales
-
Clinics
HI-PRECISION DIAGNOSTICS PLUS THE FORT
3F Commercenter Bldg., 31st and 4th Ave., Fort Bonifacio Global City
(02) 8550 1735
Clinics
HI-PRECISION DIAGNOSTICS PLUS VERTIS NORTH
Level 3 Ayala Malls, Vertis North EDSA cor. North Avenue
(02) 7756 8606
Clinics
HRD SPECIALTY CLINIC AND DIAGNOSTIC SERVICES INC
250 Herce s Commercial Bldg., cor. Banlic, Mamatid Rd., Cabuyao, Laguna
-
Clinics
HI-PRECISION DIAGNOSTICS CABANATUAN CITY
The Cresent Bldg., Km 114 Maharlika Highway Brgy. Zulueta
(044) 940 9404
Clinics
HUMAN INDEX DIAGNOSTICS AND WELLNESS SOLUTIONS
RGH Bldg., Jose Catalico Ave.,
(064) 229 9335
Clinics
ICARE SPECIALTY HEALTH CLINICS INC
3rd Flr., Fibertex Bldg., Don Mariano Subd., Ortigas Ext.,
(02) 7793 0100
Clinics
IDABAW DIAGNOSTIC CENTER INC
San Pedro St. Brgy. Lagao
-
Clinics
IHEARBETTERNOW HEARING AND ENT CENTER LAPU LAPU CITY
Unit RM 2 28, 2nd floor, City Time Square Mactan, Basak Marigondon Rd
-
Clinics
ILOCOS SCANNING AND IMAGING CENTER
Lorma Medical Center
(072) 888 7931
Clinics
I-MED HEALTH CARE
Mac Arthur Highway corner Masikap Street,
(044) 322 3230
Clinics
INTER-INDUSTRIAL PHYSICIAN MEDICAL SERVICES INC
Nuestra SeNora dela Paz St. San Antonio Valley 1, Sucat, ParaNaque
(02) 8825 4117
Clinics
INTERNATIONAL HEALTH SCREENING CORPORATION
Units 401 402 4th Floor Altoha Building, 2100 Madre Ignacia Street, Malate
(02) 5310 1508
Clinics
JARO MEDICAL AND DIAGNOSTIC CENTER
GF GRJ Jaro Bldg., Km27, Aguinaldo Highway, Dasmarinas City, Cavite
(046) 890 4872
Clinics
JBM PHYSICAL MEDICINE AND REHABILITATION CENTRE INC
St. Vincent Polyclinic, Paseo Del Congreso, San Gabriel,
(044) 896 1847
Clinics
JDC ACCELERATED WELLNES AND PAIN CLINIC LAS PINAS
29 BF Resort Village Brgy., Talon Dos
(02) 7001 6228
Clinics
JDC ACCELERATED WELLNES AND PAIN CLINIC PASIG
The Oasis Hub B, Bldg M, Unit 511, Ortigas Avenue Extension
(02) 7910 0155
Clinics
JDC ACCELERATED WELLNES AND PAIN CLINIC MAIN
Unit 201, #7 Biglang Awa St., District 2 Brgy. 094
(02) 7885 9878
Clinics
JLOPEZMD MEDICAL GROUP INC (GENSENS INC)
23/F Centuria Medical Makati, Century City, Kalayaan Ave., cor. Salamanca St., Brgy. Poblacion
(02) 8363 3022
Clinics
JDC ACCELERATED WELLNESS AND PAIN CLINIC QUEZON CITY
Unit 105, Culmat Bldg., E. Rodriguez Sr. Ave., New Manila Brgy. Mariana
(02) 7002 3314
Clinics
KERALTY CLINICA CONSOLACION
Cansaga, National Highway, Consolacion, 6001
(032) 505 5599
Clinics
KERALTY CLINICA MACTAN
Unit 1 4, AT & Sons Building, Iba, Basak
(032) 505 5599
Clinics
KERALTY CLINICA OAKRIDGE
Oakridge IT Center 1, Oakridge Business Park, 880 AS Fortuna St., Banilad
(032) 505 5599
Clinics
THE MEGACLINIC (formerly THE MEGACLINIC)
Fifth Level, SM MegaMall Building A, Mandaluyong City
(02) 8637 9661
Clinics
CARE + CENTER CLINIC ( FORMERLY KERALTY FESTIVAL)
Upper Ground Floor, X site Wing, Festival Mall, Alabang, Muntinlupa
(02) 8637 9661
Clinics
TOPHEALTH MEDICAL CLINICS INC
2nd Floor, SM City San Lazaro, Felix Huertas corner A.H. Lacson Avenue, Manila
(02) 8353 4461 to 62
Clinics
CARE + CENTER CLINIC (FORMERL KERALTY GATEWAY)
Level 2 Gateway Tower, Araneta, Socorro 3, Quezon City
-
Clinics
KINETICARE SCOLIOSIS AND PAIN MANAGEMENT CENTER
Unit 3 Plaza Felecidad, Sto. Rosario Street Brgy. Sto. Domingo
-
Clinics
KLINIKA MASINAG MULTISPECIALTY AND DIAGNOSTIC CLINIC
146 GSB Building, Sumulong Highway Brgy. Mayamot
(02) 8994 9033
Clinics
KONSULTA MEDICA AND DIAGNOSTIC CENTER
RT35 Maharlika Liveliohood Complex
-
Clinics
LA SANTE MEDICAL AND DIAGNOSTIC CENTER INC
Unit 103/104 Aussie Tower, 1419 M.H. Del Pilar Street, Ermita
(02) 7576 5872
Clinics
LABLIFE MEDICAL DIAGNOSTIC CENTER
116 113th Avenue, Murphy, Cubao, Quezon City
(02) 7255 5658
Clinics
LAGUNA TECHNOMED MEDICAL CLINIC AND LABORATORY
Unit 10 & 15 Technopark Square, BiNan, Laguna
(049) 502 5036
Clinics
LACEDA MEDICAL CLINIC
Bldg. 494 Remyfield Compound, CBD area,
(047) 250 2380
Clinics
LARIDA MEDICAL CLINIC
Basillote Compound, Rizal St., Dumlog Talisay,
(032) 514 0054
Clinics
LIFEGEN LABORATORY AND DIAGNOSTIC CENTER
211 Aguirre Avenue, Phase 3, Brgy. BF Homes
(02) 8365 9382
Clinics
LIFELAB DIAGNOSTIC INC
2/F TSI Bldg., Ouano Ave., North Reclamation Area
(032) 253 5405
Clinics
LIFELINE MEDICAL CENTER
2420 Rizal Avenue East,
(047) 223 9076
Clinics
LOPEZ MEDICAL AND X-RAY CLINIC INC
2F Casa Bella Building, 1046 Quezon Avenue cor. Roces Avenue,
(02) 8372 5026
Clinics
LORMA LIFECHECK CLINIC
National highway, Sevilla
(072) 607 3419
Clinics
MV SANTIAGO MEDICAL CENTER FCIE BRANCH
First Cavite Industrial Estate,
(046) 402 1302
Clinics
M3 DIALYSIS CENTER INC BACOLOD
B.S. Aquino Drive,
(034) 435 5036
Clinics
M3 DIALYSIS CENTER INC ILOILO
Mabini Liberation St.
(034) 703 2325
Clinics
M3 DIALYSIS CENTER INC TINDALO
Tindalo Lopez Jaena St.
(034) 703 2325
Clinics
MAAYO MEDICAL CLINIC CORPORATION
U.N. Avenue corner Plaridel St.,
(032) 888 2662
Clinics
MAGNIFICAT DIAGNOSTIC INC
2A F Residences, Malinao St., Brgy. Highway Hills
(02) 8451 2573
Clinics
MADRID POLYCLINIC AND DIAGNOSTIC CENTER
No. 10 15th Avenue, Murphy, Cubao, Quezon City, 1109
(02) 8912 1235
Clinics
MAKILING MEDICAL CLINIC AND DIAGNOSTIC CENTER INC
Lot 5, Blk 3 Km. 53 Pan Philippine Highway, Milagrosa, Calamba, Laguna
(02) 8887 6219
Clinics
MAKATIMED ARANETA CITY
GF Tower 1C, Manhattan Plaza, Gen. Romulo Ave., Araneta City Brgy. Socorro
(02) 8888 8999 local 8401 - 8402
Clinics
MALOLOS HEALTH PROVIDERS INCORPORATED
169 Paseo Del Congreso,
(044) 791 0089
Clinics
MANAGED CARE PHIL INC
G/F Summit One Tower 530 Shaw Blvd,
(02) 8531 5692
Clinics
MANILA HEARING AID CENTER INC – ATC
L34 Service Town, Alabang Town Center
(02) 8809 3902
Clinics
MANILA HEARING AID CENTER INC – CALAMBA
Unit 339, 3rd Floor, Manila South Road, Brgy. Real
-
Clinics
MANILA HEARING AID CENTER INC – CHINESE GENERAL HOSPITAL
Room 913 Medical Arts Building, 286 Blumentritt Road, Sta. Cruz
(02) 8711 4141 local 1913
Clinics
MANILA HEARING AID CENTER INC – CUBAO
G/F Alimall Phase 1, Araneta Center
(02) 8911 1528
Clinics
MANILA HEARING AID CENTER INC – FORT
2/F Mercury Drug Bldg., 32nd Avenue, Bonifacio Global City
(02) 8403 2441
Clinics
MANILA HEARING AID CENTER INC – MAKATI
3/F Mercury Drug, Ayala Mall Entrance, Ayala Center
(02) 8817 2756
Clinics
MANILA HEARING AID CENTER INC – PAMPANGA
Level 1 Expansion, Marquee Mall,
-
Clinics
MANILA HEARING AID CENTER INC – QUEZON AVE
14 IPO Bldg., Quezon Avenue
(02) 8712 3630
Clinics
MANILA HEARING AID CENTER INC – SM BLOCK
5/F SM The Block, EDSA
(02) 8442 0047
Clinics
MANILA HEARING AID CENTER INC – SM CEBU
2/F SM City, North Reclamation Area,
(032) 231 8445
Clinics
MANILA HEARING AID CENTER INC – SM DASMARINAS
Unit C 053 Lower G/F Governor’s Drive,
(046) 416 1932
Clinics
MANILA HEARING AID CENTER INC – SM MEGAMALL
5/F SM Megamall Bldg. A, EDSA
(02) 8633 6039
Clinics
MANILA HEARING AID CENTER INC – SM FAIRVIEW
Lower G/ F New Annex Bldg., Quirino Highway, Novaliches
(02) 8709 8327
Clinics
MANILA HEARING AID CENTER INC – SM MOA
2/F WZ 229 North Parking Bldg., SM Mall of Asia, SM Central Business Park Bay City,
(02) 8556 0589
Clinics
MANILA HEARING AID CENTER INC – SM NORTH TOWERS
MU 239 North Z Towers, SM City North EDSA, North Avenue, Brgy. Bagong Pag asa
-
Clinics
MANILA HEARING AID CENTER INC – TAFT
4F Manila Astral Tower, cor. Taft Avenue and Padre Faura, Ermita,
(02) 8521 5726
Clinics
MANILA HEARING AID CENTER INC – TAFT ANNEX
Unit 311 3/F West East Center, 1332 1336, Taft Avenue, Brgy. 676
(02) 8244 7210
Clinics
MANILA LITHOTRIPTERS INC
2/F Lemon Tree Bldg. #18 Scout Magbanua Street
(02)7340 9260
Clinics
MARIKINA MULTISPECIALTY HEALTHCARE SERVICES INC
Jocevil Bldg., 865 JP Rizal St., Brgy. Concepcion Uno
(02) 8721 6130
Clinics
MARILAO MEDICAL AND DIAGNOSTIC CLINIC INC
G/F Vendasa Building, Villaroica Road, Sta. Rosa 1
-
Clinics
MARILAO MEDICAL AND DIAGNOSTIC CLINIC INC PASAY BRANCH
Antonio Arnaiz corner FB Harrison Street
-
Clinics
MARY MEDIATRIX MEDICAL CENTER OUTPATIENT SATELLITE
268 Santiago St., Brgy. Poblacion
(043) 781 6497
Clinics
MAYO HEALTHCARE SPECIALISTS
G/F AUM Bldg., Roxas Ave., Brgy. Poblacion
(063) 224 1954
Clinics
MAYON CLINICAL LABORATORY AND MEDICAL SERVICES
857 Lot 3 Mayon Street Brgy Amoranto Brgy. Amoranto
(02) 8708 3520
Clinics
MBD MEDICAL AND DIAGNOSTIC CLINIC
335 Sto. Rosario St., Brgy. Plainview Brgy. Plainview
-
Clinics
MB MEDICAL LABORATORY AND SUPPLIES INC
Unit 3, VCBG Building, GSIS Matina
(082) 285 7967
Clinics
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Help

FAQs

How can I get a Pacific Cross Medical Insurance Plan?
Fill out the Contact Form on our website (Click Contact us above), or e-mail us at info@pacificcross.com.ph. Our Account Executives will be more than happy to answer your questions or give you a free presentation online or in person, whichever you prefer.
How do I pay for my Pacific Cross Medical Plan’s Premium/Membership Fee?
Pacific Cross offers you several convenient ways to pay your premium: You can pay in cash or credit, via our website (Click Buy/Pay Medical), online banking or over-the-counter payments, either annually or semi-annually.
How can I get a Pacific Cross Travel Insurance Plan?
You can get a quote, and eventually buy our Travelsafe Insurance online through our website (Click Buy Travel Plans). Premiums will vary depending on certain factors such as your itinerary and the specific plan selected among others.
Do your Medical and Travel Plans provide coverage for COVID-19?
Pacific Cross Medical Plans provide reimbursement for COVID-19 vaccine acquisition and administration availed of overseas or within the Philippines, while Pacific Cross Travel Plans provide coverage for COVID-19 In-Patient Care. 

Important Note:  This answer is intended for overview purposes only. Details may vary across plans. Coverage is always subject to plan provisions and limitations.
Do I need to undergo a physical examination before I can get a Pacific Cross Insurance Plan?
No. Applicants normally do not need to undergo a physical exam. All you have to do is answer the application form and medical questionnaire as truthfully as possible. Failure to answer the questions in the declaration in full, concealment, or misrepresentation of any significant condition will affect your Policy/Agreement and the payment of your claims.

Important Note:  This answer is intended for overview purposes only. Details may vary across plans. Coverage is always subject to plan provisions and limitations.
What is a Pre-Existing Condition?
A Pre-Existing Condition is any disability which existed before the commencement of cover as it presented signs or symptomswhich you were aware or should reasonably have been aware of. Pre-Existing Conditions are also those that are knownto you because you have felt its signs and symptoms regardless if this prompted you to seek for treatment, medication,advice, or diagnosis. When you answer our Medical Questionnaire, please ensure that you tell us about all your medicalconditions and symptoms happening at any time in the past and/or present, known and/or suspected, whether or nottreatment or professional advice was sought. Based on your provided details and submitted medical reports, declaredpre-existing conditions may be covered immediately subject to the Company’s underwriting guidelines.

Important Note:  This answer is intended for overview purposes only. Details may vary across plans. Coverage is always subject to plan provisions and limitations.
What are Exclusions?
Exclusions are certain conditions that are permanently excluded from being covered. For full details, please refer to your Policy/Agreement.

Important Note:  This answer is intended for overview purposes only. Details may vary across plans. Coverage is always subject to plan provisions and limitations.
Can I avail of 24/7 Telemedicine Consults?
Yes. Pacific Cross, together withour Telehealth Provider, allow you to have access to licensed doctors through your mobile phone, no appointment needed. This partnership provides you with immediate and easier healthcare access, especially amidst today's difficult times when obtaining quality medical care can be a challenge. As needed, our telehealth partner may provide important medical documents (e.g., e-prescriptions, e-laboratory requests, e-medical certificates).You can also get in touch with our telehealth partner for mental health first-aid support.

Important Note:  This answer is intended for overview purposes only. Details may vary across plans. Coverage is always subject to plan provisions and limitations.
Siren

Emergency Assistance

If you are hospitalized or in need of Emergency Services, please get in touch with us through the contact details below. Please provide the following information when you (or your authorized representative) call/message us:

• Authorized representative's name, telephone number and relationship to the patient
• Patient's name, age, gender and employer
• Name, location and telephone number of hospital or treating doctor, if applicable.


WHILE IN THE PHILIPPINES

  • Pacific Cross Member Hotline: +632 8230-8511
  • Pacific Cross E-mail: client_services@pacificcross.com.ph
  • Pacific Cross Viber and WhatsApp (messaging only): +63 998 964-6649

WHILE TRAVELING ABROAD

  • Pacific Cross Member Hotline: +632 8230-8511
  • Pacific Cross E-mail: client_services@pacificcross.com.ph
  • Pacific Cross Viber and WhatsApp (messaging only): +63 998 964-6649
  • Pacific Cross Viber (messaging only): +63 947 150-5762
  • Pacific Cross WhatsApp (messaging only): +16692023690
  • Pacific Cross Click-to-Call Link: https://emaph.3cx.asia:5001/pacificcrossph
IMPORTANT: These contact details are strictly for emergency situations only (e.g., Emergency Medical Evacuation, Medical Repatriation, etc.). Any non-emergency inquiries (e.g., questions about claims and coverage) will be redirected to other Customer Service Representatives for further assistance.