HMO approval

Start your HMO request with the right details.

Share the essentials before your preferred visit so the PremiumHealth team can review what is needed. Coverage and approval are confirmed only after the team responds.

Start request

Submit early. We recommend sending your request at least two business days before your preferred visit when possible.

Secure document review. Submit the HMO card, valid ID, and doctor's request through the protected form below. Wait for the team's confirmation before treating coverage or a visit as confirmed.

What happens next

A clear request is the best place to start.

01. Tell us the basics

Include the patient, HMO membership, requested service, and preferred visit date.

02. Upload the required documents

Send a clear HMO card, valid ID, and doctor’s request in the protected form. The documents are available only to authorized staff.

03. Wait for confirmation

The PremiumHealth team will reply with the next appropriate step or request any missing details.

Privacy note

Keep your records protected.

The HMO form intentionally accepts the documents needed to review this request. Upload only the requested files and do not add separate medical history or test-result details.

Use only the requested files

Submit the HMO card, valid ID, and doctor's request through the protected form. They are available only to authorized staff.

HMO approval request

Fields marked required are needed to review your request. Submission is not an approved LOA or confirmed visit.

Visit and HMO details

Service for approval required

HMO provider required

Preferred visit date required

Preferred branch or location (optional)

Loading current HMO providers and services…

Patient and membership details

First name required

Middle name (optional)

Last name required

Date of birth required

HMO member or card number required

Mobile or phone required

Email address required

Patient relationship required

Principal member's full name (if applicable)

Company or plan (optional)

Doctor and supporting documents

Upload clear copies only. Each file must be a JPG, PNG, WEBP, or PDF and 5 MB or smaller.

Requesting doctor's name (optional)

The documents are sent to a restricted PremiumHealth inbox and are not given public links.

HMO health card required

Valid government ID required

Doctor's request or test referral required

The request should be from the HMO-accredited doctor where your HMO requires it. Do not add a separate diagnosis or medical-history note to this form.

Need help first? Call +63 917 322 7781 or email premiumhealthdiagnostic@gmail.com.