IMS – Government HMO Enrollment Form

IMS-ANEC Enrollment Form for Government Shield Package (GSP)

If you are bonafide members of IMS-ANEC, government employees nationwide can now secure themselves with reliable healthcare coverage, peace of mind, and extensive agency support. Complete the form below to enroll and secure your protection—ensure all required fields are filled out correctly so we can process your application efficiently.

Government Employee Enrollment Form

Complete the form below to enroll in the Government Shield Package (GSP).

This platform is exclusively for government personnel only. Enrollment of dependents or non-government employees is not allowed.

Disclaimer: This platform is for group enrolment only and not for individual use. While information is collected individually, members may be grouped according to their agencies, districts, or divisions. Membership may be declined for individuals not belonging to a recognized group.

Member Name *

Last Name *

First Name *

Middle Name

Suffix

Government Agency *

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

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

Birthdate *

Plan Availing *

Agent *

Contact Number *

Email *

Employee Number *

Upload Agency's ID *

You may upload an image or take a photo of your government agency ID. Accepted file types: JPG, JPEG, PNG. Maximum file size: 5 MB.

Before proceeding to payment

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

Terms & Conditions for Government Shield Package

That as a bonafide government employee, I shall be provided with access to affordable healthcare under the program Government Shield Package (GSP).
That I understand the program is exclusive to government personnel only.
That I have been informed of the available plan options and have selected the one that suits me best.
That I am enrolling as a government employee and not on behalf of non-government personnel.
That I am not applying for my dependent(s) through this enrollment.
For group enrollments: That all members listed in this application are verified government employees and eligible for coverage.

I agree to the Terms & Conditions

IMS-ANEC Enrollment Form for Government Shield Package (GSP)

Government Employee Enrollment Form

Before proceeding to payment

Plan Details