NCIA - Online Helpdesk

Fields marked with * are required. Other details are optional unless your provider requires them.

Member information

Start with your coverage, patient, and contact details.

Choose Provider*

Company Code* Search for your company code or name.

Name of Principal*

Patient's Name (Principal/Dependent)*

Birthday*

HMO Card Number

Contact Number* Use 11 digits starting with 09.

Email Address 1 (Member)*

Email Address 2 (Optional)

Tell us where and why you need care.

Name of Preferred Hospital/Clinic*

Requesting Doctor*

Date of Availment

Type of Availment

Chief Complaints / Symptoms / Diagnosis

Duration of Symptoms / When Did It Start

Supporting documents

Please prepare all required supporting documents before or after submitting your request.
After clicking Submit, a confirmation pop-up will appear prompting you to upload attachments.
If you cannot upload all documents immediately, you may use the link in the confirmation email later.
All succeeding submissions and communications will remain in the same email thread.
Accepted file formats: PDF, JPG, JPEG, PNG.

Supporting documents can be uploaded after you submit.