IMS – DEPED HMO Enrollment Form

IMS-ANEC Enrolment Form for Teachers Shield Package

For schools or organizations enrolling multiple teachers under one application. Please provide the group details, coordinator information, and the full list of teachers so we can process your group enrollment efficiently. Ensure all required fields are completed to secure coverage for all members of your group.

Bank Deposit Payment Notice

For deposit transactions, kindly request your official IMS Account Number by contacting:

📧 customer.service@ims.com.ph
📱 0906-0181090

Please ensure you use the correct account number before making any payment.

Group Enrollment Form

Complete the form below to submit a group enrollment for multiple teachers under your school or organization.

This platform is intended for school or organization coordinators submitting a group enrollment. All members must belong to a recognized group.

Disclaimer: Ensure all required fields are completed for all members. Membership may be declined for individuals not belonging to a recognized group.

Coordinator Name *

School *

If your school is not listed, please send an email to ims.dm@ims.com.ph with your school details.

School Delivery Address (Where the Physical Card Will Be Sent) *

Contact Number *

Email *

Plan Availing *

Agent *

Division Code *

Station Number *

Upload Coordinator ID *

Group Members

Member Name *

Format: LASTNAME, FIRSTNAME MIDDLENAME

Birthdate

Employee Number

Before proceeding to payment

I hereby agree to the terms and conditions set forth under this order.

Terms & Conditions for Teachers Shield Package

That as a bonafide member of IMS-ANEC, I shall be provided with access to affordable healthcare under the program Teachers Shield Package (TSP).
That I understand, the program is exclusive to teacher-members of IMS-ANEC only.
That I was given options as to the program that suits me best from the list of TSP variants provided to me by IMS representatives.
That I am enrolling as a government employee/teacher.
That I am not applying for my dependent.

I agree to the Terms & Conditions

IMS-ANEC Enrolment Form for Teachers Shield Package

Bank Deposit Payment Notice

Group Enrollment Form

Group Members

Before proceeding to payment

Plan Details

Choose Your Payment Method

Bank Deposit