Preferred Hospital Access
Without Top Major Hospitals
With Top Major Hospitals
Top Major Hospitals in Metro Manila:
St. Lukes BGC & QC, Makati Medical Center, Cardinal Santos Medical Center, Asian Hospital and Medical Center, The Medical City Hospitals
except The Medical City Hospital Pasig (Main Branch)
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Confirmation of your Birthdate
Birth Month
January
February
March
April
May
June
July
August
September
October
November
December
Birth Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Birth Year
Gender
Male
Female
Civil Status
Single
Married
Widowed
Valid Government ID
Address
Country
Philippines Afghanistan Albania Algeria Argentina Australia Austria Bangladesh Belgium Brazil Canada China Denmark Egypt Finland France Germany Hong Kong India Indonesia Ireland Israel Italy Japan Malaysia Mexico Netherlands New Zealand Nigeria Norway Pakistan Saudi Arabia Singapore South Africa South Korea Spain Sweden Switzerland Thailand United Arab Emirates United Kingdom United States Vietnam
Province
Select Province
ABRA AGUSAN DEL NORTE AGUSAN DEL SUR AKLAN ALBAY ANTIQUE APAYAO AURORA BASILAN BATAAN BATANES BATANGAS BENGUET BILIRAN BOHOL BUKIDNON BULACAN CAGAYAN CAMARINES NORTE CAMARINES SUR CAMIGUIN CAPIZ CATANDUANES CAVITE CEBU CITY OF ISABELA CITY OF MANILA COMPOSTELA VALLEY COTABATO (NORTH COTABATO) COTABATO CITY DAVAO DEL NORTE DAVAO DEL SUR DAVAO OCCIDENTAL DAVAO ORIENTAL DINAGAT ISLANDS EASTERN SAMAR GUIMARAS IFUGAO ILOCOS NORTE ILOCOS SUR ILOILO ISABELA KALINGA LA UNION LAGUNA LANAO DEL NORTE LANAO DEL SUR LEYTE MAGUINDANAO MARINDUQUE MASBATE MISAMIS OCCIDENTAL MISAMIS ORIENTAL MOUNTAIN PROVINCE NCR, FOURTH DISTRICT NCR, SECOND DISTRICT NCR, THIRD DISTRICT NEGROS OCCIDENTAL NEGROS ORIENTAL NORTHERN SAMAR NUEVA ECIJA NUEVA VIZCAYA OCCIDENTAL MINDORO ORIENTAL MINDORO PALAWAN PAMPANGA PANGASINAN QUEZON QUIRINO RIZAL ROMBLON SAMAR (WESTERN SAMAR) SARANGANI SIQUIJOR SORSOGON SOUTH COTABATO SOUTHERN LEYTE SULTAN KUDARAT SULU SURIGAO DEL NORTE SURIGAO DEL SUR TARLAC TAWI-TAWI ZAMBALES ZAMBOANGA DEL NORTE ZAMBOANGA DEL SUR ZAMBOANGA SIBUGAY
City
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Barangay
Select Barangay
With Physical Card?
Yes - ₱300.00
No - ₱0.00
General Medical Underwriting Questionnaire
B. Medical Conditions
Have you ever been diagnosed with, treated for, or advised to seek treatment for any of the following? *
Application and claims are subject for medical assessment and evaluation.
D. Medications & Follow-up
E. Declaration
By submitting this application, I warrant that all statements and information provided are true, complete, and accurate. I acknowledge that any non-disclosure or misrepresentation of material facts may result in denial of coverage, benefits, or claims under the Ayos Health Plans.
Disclaimer
I give my consent for IOSS Insurance Agency Inc., PhilCare, and its affiliates to collect, use, and process my data and medical records for application, communication, and legitimate business purposes, in accordance with the Data Privacy Act of 2012.
I give my consent for IOSS Insurance Agency Inc. to use my data and medical information with IOSS Insurance Agency Inc., PhilCare, and its affiliates for the purpose of application processing, medical underwriting, claims evaluation, and related legitimate business purposes, in accordance with the Data Privacy Act of 2012.
I give my consent for allowing IOSS Insurance Agency Inc. to receive emails and SMS communications regarding my application, membership, and related updates for legitimate business and marketing purposes.
FAMILY APPLICATION
Family Application
You’ve chosen to apply for family coverage with IOSS Insurance Agency Inc. – Ayos Health Plans Inc. . This application is intended for one (1) Principal Member and their eligible dependents .
Principal Member Requirement:
Enrollment of minor and/or adult dependents is allowed only if one (1) Principal Member is enrolled first under the Ayos Health Card. All dependents will be linked to the approved Principal Member.
Age Eligibility:
Principal Member: 18 years old to 60 years old
Dependents: 15 days old to 65 years old
Please ensure that all information provided is accurate and complete to avoid any processing delays.
Important Reminders:
✅ All uploaded IDs and documents must be valid and clear
❌ Incomplete or incorrect entries may result in processing delays or claim denial
Before submitting, please double-check:
☑️ Correct names, birthdates, and selected plans
☑️ Clear IDs or proof of eligibility for all members (as required)
☑️ Updated contact details
Once submitted, you’ll receive your confirmation email and next steps shortly.
Upload Copy of Existing Digital Ayos Health Card.
Payor Details
By submitting this application, I confirm that I am the designated Payor for the Applicant indicated in this form. I understand and agree that all premiums, fees, and related charges for the Applicant’s membership are my sole responsibility . I further certify that all information provided is true, accurate, and complete, and I commit to settling all payment obligations on time to ensure uninterrupted coverage.
General Medical Underwriting Questionnaire
A. Health Declaration
1. Is the Principal Member or any of the dependents currently experiencing an illness, injury, or medical condition?
Yes
No
If Yes, please specify member name, condition, and date diagnosed
Member
Illness/Injury/Medical Condition
Date Diagnosed
Please specify for each dependent. If not yet filled, the row will show as Minor/Adult Dependent #.
2. Has any family member consulted a doctor, experienced symptoms, or received treatment in the past 12 months?
Yes
No
If Yes, please specify member name, consultation, symptoms, and treatment
Member
Consulted
Symptoms
Treatment
Please specify for each dependent. If not yet filled, the row will show as Minor/Adult Dependent #.
B. Medical Conditions (For Any Family Member)
C. Surgery & Hospitalization
D. Medications & Follow-up
E. Declaration
By submitting this application, I, the Principal Member, warrant that all information provided above is true, complete, and accurate for all family members enrolled. I acknowledge that any non-disclosure or misrepresentation of material facts may result in the denial or limitation of coverage, benefits, or claims under the Ayos Health Plans.
Disclaimer
I give my consent for IOSS Insurance Agency Inc., PhilCare, and its affiliates to collect, use, and process my data and medical records for application, communication, and legitimate business purposes, in accordance with the Data Privacy Act of 2012.
I give my consent for IOSS Insurance Agency Inc. to use my data and medical information with IOSS Insurance Agency Inc., PhilCare, and its affiliates for the purpose of application processing, medical underwriting, claims evaluation, and related legitimate business purposes, in accordance with the Data Privacy Act of 2012.
I give my consent for allowing IOSS Insurance Agency Inc. to receive emails and SMS communications regarding my application, membership, and related updates for legitimate business and marketing purposes.