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Application Forms
Medical Application Forms
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Other Forms
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
MCS DIAGNOSTIC CENTER
Hilado St., cor. LN Agustin Dr., (Infront Apollo Rest)
(032) 709 6065
Clinics
MD LINK HEALTHCARE INC
Level 1 Expansion Mall, Robinsons Place, JP Laurel Highway, Batangas
(043) 784 8484
Clinics
MD+ CLINIC AND DIAGNOSTIC CENTER ALABANG
2F Westgate Hub, Commerce Avenue, Alabang
(02) 8823 1111
Clinics
MED 101 DIAGNOSTIC CENTER
74 Villongco Street Brgy. Commonwealth
-
Clinics
MED HELP CLINIC AND DIAGNOSTICS INC
Unit S2 Armal Center Bldg., Caruncho Ave., Pasig City
(02) 7903 6114
Clinics
MEDGRUPPE POLYCLINIC AND DIAGNOSTIC CENTER (PRIME CARE)
2nd level of APM CENTRALE Mall, A. Soriano Ave., North Reclamation Area, Cebu City
(032) 4124399
Clinics
MEDHEALTH DIAGNOSTIC SERVICES INC
UGF 1670 Victoria One Bldg., Quezon Avenue
-
Clinics
MEDHUB LAB MULTISPECIALTY AND DIAGNOSTIC CLINIC
Donato Bldg., 69, Rizal Ave., Banicain,
(047) 304 5195
Clinics
MEDICAL MISSION GROUP HOSPITAL HEALTH SERVICES COOPERATIVE LIGAO
Conception Street, Dunao,
(052) 485 2877
Clinics
MEDICAL MISSION GROUP HOSPITAL HEALTH SERVICES COOPERATIVE OLD ALBAY
G/F AME Bldg., Rizal Street, Old Albay District
(052) 481 5877
Clinics
MEDICAL MISSION GROUP HOSPITAL HEALTH SERVICES COOPERATIVE POLANGUI
G/F Samar Building, Gabon, Polangui
(052) 486 2777
Clinics
MEDICAL MISSION GROUP HOSPITAL HEALTH SERVICES COOPERATIVE TABACO
4th Floor MMMGHHS Albay Medical Arts Bldg., 216 Ziga Avenue, Tayhi
(052) 487 4977
Clinics
MEDICUS ANTIQUE
T.A Fornier St. Atabay
(036) 540 9846
Clinics
MEDICUS CEBU
ZR & DC Bldg. Osmena, Boulevard Cor. J. , Llorente St
-
Clinics
MEDICUS JARO
Jaro Commercial Complex, Lopez Jaena St.
(033) 320 4454
Clinics
MEDICUS ROXAS
Rizal St.
(036) 621 26 55
Clinics
MEDICUS LA PAZ
R & J Building, Huervana St
(033) 320 3720
Clinics
MEDICUS MOLO
M. Locsin St.,
(033) 337 7072
Clinics
MEDICUS PLAZA LIBERTAD
Masonic Temple Bldg., Ortiz St.
(033) 300 0967
Clinics
MEDICUS SAN ROQUE
San Roque Ext., Street Roxas Cit
(036) 522 6508
Clinics
MEDICUS SARA
Castor St., Sara, Iloilo
(033) 392 0015
Clinics
MEDIKO KAPITOLYO MULTI-SPECIALTY AND DIAGNOSTIC CLINIC
Lot 123 Blk Marville L Sumulong Mem. Circle
(02) 8356 0149
Clinics
MEDISCAN DIAGNOSTIC CENTER INC (aka NEW WORLD DIAGNOSTIC-TAFT)
1336 East West Building, Taft Avenue
(02) 8526 6080
Clinics
MEDTRUST DIAGNOSTIC LABORATORY AND PHARMACY
G/F Telesight Building, Mac Arthur Highway,
(045) 409 3052
Clinics
PADRE PIO MULTI SPECIALTY CLINIC AND DIAGNOSTIC CENTER
FD Building, H. Mendoza corner Carandang Street
(048) 433 0890
Clinics
MEDZONE DIAGNOSTIC CENTER
GF Delings Bldg., J. Catolico Ave., Lagao
(083) 552 5795
Clinics
MEGAHEALTH LAGUNA DIAGNOSTIC INC
National Highway, Brgy. Paciano Rizal,
(049) 502 4209
Clinics
MESSIAH CLINICA MEDICA MEDICAL CLINIC
2E & 2D Kingston Plaza, P. Victor cor. P. Burgos, Guadalupe Nuevo
-
Clinics
METRO SPECIALISTS DIAGNOSTIC AND SURGICENTER
2/F, MGC Veranda, 31 Gov. Pascual Avenue Brgy. Tinajeros, Malabon
(02) 8352 3663
Clinics
MEDEXPRESS MEDICAL AND DIAGNOSTIC CENTER (formerly METROPOLITAN DOCTORS MEDICAL CLINIC AND LABORATORY-STATION 2)
Ambulong and Balabag, Boracay Island
(036) 288 6357
Clinics
METRODOCS MEDICAL CLINIC AND LABORATORY
Purok 5, General Luna
036 2882291
Clinics
METROPOLITAN MEDICAL CENTER COMMONWEALTH
LG Floor, Ever Gotesco Commonwealth, Commonwealth Avenue, Batasan Hills 2,
(02) 8254 1111
Clinics
METROSANITAS MEDICAL CLINIC MET LIVE
3rd Floor METLIVE, EDSA Extension corner Macapagal Blvd.
(02) 8851 9930
Clinics
MHAM DIAGNOSTICS AND MEDICAL INC
Ground flr., MHAM Bldg., R. Duterte St., Banawa
-
Clinics
MIMMO MOLECULAR IMMUNOLOGY CENTER
Unit 2104 Centuria Medical Makati, Kalayaan Ave., cor. Salamanca St. Poblacion
(02) 8622 3526
Clinics
MJK MEDICAL AND DIAGNOSTIC CLINIC
2nd Floor Metrobank Building, cor. Mabini and A. Flores St., Ermita
(02) 8251 1985
Clinics
MLS PRIME HEALTH MEDICAL AND DIAGNOSTIC CENTER
Door 8, G/F, Carlson Plaza cor. F. Torres LapuLapu Sts.
(082) 226 8096
Clinics
MONTE ZION DIAGNOSTIC AND MEDICAL CENTER CORP – QUEZON CITY
699 G/F ICC – MTC Building, Tandang Sora Avenue, Brgy. Matandang Balara
(02) 8341 1720
Clinics
MOM’S LABORATORY CLINIC
Cor. Pinili Sta. Catalina
-
Clinics
MONTE ZION DIAGNOSTIC AND MEDICAL CENTER CORP – SUBIC
Unit 1 A Lot 4, Greenwoods Park, Rizal Avenue, CBD Area, Subic Bay Free Port Zone
(047) 306 9029
Clinics
MONTEMAYOR FAMILY MEDICAL CLINIC AND DIAGNOSTIC CENTER
182 Calasaio (Eaglesnest cpd.), Brgy. Bued
-
Clinics
MOTIONS VENTURE PHYSIO THERAPY INC – ORTIGAS
Unit 805 Antel Global Corporate Center, Ortigas
-
Clinics
MOTIONS VENTURE PHYSIO THERAPY INC – ANGELES
Unit 9 GF, Cherista Bldg., Friendship Hi way
-
Clinics
MOVE PHYSIOREHAB CENTER PHYSICAL THERAPY CLINIC
0614 2nd St., Camor Ph 2, Mabiga
(045) 436 0385
Clinics
MYHEALTH CLINIC ALABANG
Upper Level, Style Boulevard, Festival Mall, Alabang, Muntinlupa City
(02) 8215 3983
Clinics
MYHEALTH CLINIC CYBERGATE CEBU
3rd Level Robinsons Cybergate Mall, Fuente Osmena, Don Gil Garcia St, Cebu City, 6000 Cebu
(032) 268 8502
Clinics
MYHEALTH CLINIC FILOMENA (MAKATI)
GL, Filomena Building, Amorsolo Street, Legaspi Village
(02) 8784 6930
Clinics
MYHEALTH CLINIC ROBINSONS MANILA
Level 4, Pedro Gil Wing, Robinsons Place Manila, Pedro Gil cor. Adriatico Streets, Ermita, Manila
(02) 8251 9172
Clinics
MYHEALTH CLINIC SM NORTH EDSA
SM North Edsa North Link, North Link Access Road, Bagong Pag asa, Quezon City
(02) 8502 2124
Clinics
MYHEALTH CLINIC SHAGRI-LA PLAZA MALL
Shangri La Plaza, Ground Level Unit 146 EDSA, corner Shaw Blvd, Mandaluyong, 1554
(02) 8 570-4325
Clinics
MYHEALTH CLINIC ROBONSONS GALLERIA CEBU
3rd Floor, Robinsons Galleria Cebu Gen. Maxilom Ave. cor. Sergio Osmena Blvd. Brgy. Tejero
-
Clinics
MYHEALTH CLINIC VENICE
2nd Floor, Venice Grand Canal Mall, McKinley Hills,
(02) 7784 6930
Clinics
NEGROS FAMILY HEALTH SERVICES INC
North Road Daro (In Front of Negros Oriental Provincial Hospital)
(035) 225 3544
Clinics
NC SABULAO POLYCLINIC AND DIAGNOSTIC CENTER
National Highway, Songco
(055) 261 2982
Clinics
NEW WORLD DIAGNOSTICS INC BAESA
Unit 5 Olympia Commercial Plaza, 131 Quirino Highway Baesa
(02) 8330 0258
Clinics
NEW WORLD DIAGNOSTICS INC BINONDO
Mezzanine Floor, Strata Gold Condominium #738 Ongpin Street,
(02) 8251 4433
Clinics
NEW WORLD DIAGNOSTICS INC D TUAZON (MAIN)
250 D. Tuazon St. Brgy. Maharlika
(02) 8790 8888
Clinics
NEW WORLD DIAGNOSTICS INC DAGUPAN
#45 burgos St., Downtown
-
Clinics
NEW WORLD DIAGNOSTICS INC DAVAO BRANCH
584 F. Quirino Avenue, 6 A Poblacion
-
Clinics
NEW WORLD DIAGNOSTICS INC GREENHILLS (LAB EXPRESS)
GF Gsquare, Wilson St.,
(02) 8790 8888
Clinics
NEW WORLD DIAGNOSTICS INC LAS PINAS
Imperial Appliance Plaza, Alabang Zapote Road, Brgy. Talon Uno
(02) 8790 8890
Clinics
NEW WORLD DIAGNOSTICS INC MALABON
Units 101 102 Mezzanine Floor, Panco Square #67 Mc Arthur Highway, Brgy. Potrero
(02) 8243 6407
Clinics
NEW WORLD DIAGNOSTICS INC MAKATI
Rm. 104 Campos Rueda Bldg., 101 Urban Ave. Brgy. San Lorenzo
(02) 8887 5498
Clinics
NEW WORLD DIAGNOSTICS INC MANILA
Mirasol Bldg., Apacible St. cor. Taft Ave.
(02) 8521 0320
Clinics
NEW WORLD DIAGNOSTICS INC NOVALICHES
188 General Luis St., Brgy. Nagkaisang Nayon
(02) 8366 9946
Clinics
NEW WORLD DIAGNOSTICS INC MERALCO
33 Meralco Avenue Brgy. San Antonio
(02) 8790 8820
Clinics
NEW WORLD DIAGNOSTICS INC PARANAQUE
#35 Presidents Ave., BF Homes, ParaNaque
(02) 8790 8888
Clinics
NEW WORLD DIAGNOSTICS INC SM NORTH EDSA
G/F Philippine College of Surgeons Bldg. 992 EDSA,
(02) 8928 8179
Clinics
NEW WORLD DIAGNOSTICS INC TAGAYTAY
Unit 2, PetroChemical Bldg., Tagaytay Nasugbu Road, Maharlika, Tagaytay
(02) 8790 8888
Clinics
NORD HEALTH HORIZON DIAGNOSTIC CENTER
Unit 3 G/F Nord Medical Hub, 101 BS Aquino Drive, Villamonte
(034) 707 2406
Clinics
NOZOMI MEDICAL LABORATORY AND DIAGNOSTIC SERVICES INC
399 Jasmin St., Capitol Site,
(032) 253 5405
Clinics
O’CARE DIAGNOSTIC MEDICAL CENTER INC
3rd Floor STWLPC, 338 Senator, Gil Puyat Avenue Brgy. 12
(02) 7745 2886
Clinics
OAMCP MEDICAL CLINIC
2462 Urdaneta Street, Guadalupe Nuevo,
(02) 7903 0763
Clinics
OCCUMEDICA HEALTH CARE SYSTEM CORP BINAN BRANCH
3rd Floor, Central Mall (Save More), Malvar Street, corner National Highway
(02) 8710 0833
Clinics
OCCUMEDICA HEALTH CARE SYSTEM CORP CARMONA BRANCH
1045 ME Governor s Drive, Oregano Street Brgy. Maduya
(046) 430 3456
Clinics
OCW MEDICAL CLINIC INC
3/F Regent Bldg, 1415 Ge. Luna St.
(02) 8536 4866
Clinics
OLAYN MEDICAL LABORATORY INC
2422 Taft Ave, Malate, Manila
(02) 8242 1017
Clinics
ONE ALPHA LABORATORIES INC
Megatower Residences, Salud Mitra,
(074) 661 2225
Clinics
OLANO MABALAY PAIN AND WELLNESS PHYSICAL THERAPY CLINIC
188 Susano Road, Brgy. San Agustin
(02) 8879 1935
Clinics
OMNICARE HEALTH SYSTEMS INC
Evia Center, Vista City, Brgy. Daang Hari, Almanza Dos Brgy. Madaang Hari
(02) 8834 1480
Clinics
OPATPH
5th Level, East Wing, Shangri la Plaza Mall, EDSA corner Shaw Boulevard, Mandaluyong City
(02) 7753 6540
Clinics
PMP PAIN CENTER CORPORATION CEBU (Formerly PAINMANAGEMENTPLUS PHYSIOTHERAPY SERVICES)
OP 123 A One Paseo Commercial, Paseo Saturnino St., Banilad, Cebu City
(032) 239 2825
Clinics
PA PEREZ PHYSIOTHERAPY CENTER
7th Floor , Rm 714, NORD Medical Hub Brgy. Villamonte
-
Clinics
PMP PAIN CENTER CORPORATION SAN JOSE DEL MONTE (Formerly PAINMANAGEMENTPLUS PHYSIOTHERAPY SERVICES)
Block 5 Lot 36 Vermillion St., Pecson Ville, Tungkong Mangga Subdivision
-
Clinics
PANAY MEDICAL VENTURES EYE INSTITUTE CENTER
Donato Pison Ave. Mandurriao,
(033) 321 7633
Clinics
PANAY MEDICAL VENTURES REHABILITATION CENTER INC
Donato Pison Ave. Mandurriao
(033) 321 7633 local 4401
Clinics
PANDI PHYSICAL THERAPY CENTER
Unit 3 Tyson Bldg., Kabesang Pinong St., Pandi Bulacan
(044) 309 5159
Clinics
PARIAN DIAGNOSTIC LABORATORY MEXICO
JP Risal Parlan, Poblacion, Mexico
(045) 966 3542
Clinics
PARIAN DIAGNOSTIC LABORATORY SAN FERNANDO
Eastgate City Walk Bldg. Brgy. San Jose
(045) 966 3800
Clinics
PASCIFIC INC
1720 Centuria Medical Makati, Kalayaan Ave., Brgy. Poblacion
-
Clinics
PATIENT FIRST MEDICAL CENTER KAMIAS BRANCH
1418 Kamias Rd. Cor. Anonas Ext. Sikatuna Village Quezon City
(02) 3433 7362
Clinics
PARIAN DIAGNOSTIC LABORATORY TELABASTAGAN
Lodestone Cove Bldg., #16 MAH, Telabastagan,
(045) 458 1429
Clinics
PATIENT FIRST MEDICAL CENTER KDC PLAZA
Units 101 and 408 KDC Plaza, 2212 Chino Roces Avenue, Barangay Pio Del Pilar, Makati City 1230
(02) 8840 2218
Clinics
PEAK FORM BGC
Unit 807 Unit 807 The Infinity Buildong, 26th Street,
(02) 8478 9408
Clinics
PEAK PHYSICAL THERAPY AND SCOLIOSIS CENTER
One Orchard Condo, Ground Floor Space A, Orchard Road, Eastwood City, Bagumbayan
-
Clinics
PEAK FORM PASAY
Unit 101, The Biopolis Building, Diosdado Macapagal Avenue,
-
Clinics
PENINSULA MEXICO DIAGNOSTIC CLINIC CORP
G/F Peninsula Bldg., JASA Road Avenue, Lagundi,
-
Clinics
PHIL NIKKEI JIN KAI POLYCLINIC AND DIAGNOSTIC CENTER INC
Angliongto Ave.,
(082) 286 4341
Clinics
PHILIPPINE ONCOLOGY CENTER CORPORATION BETHANY CANCER CENTER
Basement Northwing, Bethany Hospital, Inc.,Widdoes , Street Brgy. 2
(072) 252 7333
Clinics
M DIAGNOSTICS (formerly PHILIPPINE AIRPORT DIAGNOSTIC LABORATORY)
CBL Area, Domestic Rd.,
(02) 8251 5868
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.