EMERGENCY PREPAID HEALTH PLANS

What are ER Shield, ER Vantage Plus, and Health Vantage Programs?

ER Shield and ER Vantage Plus are one-time use emergency health plans while Health Vantage is a multiple-frequency of availment emergency plan.

·         ER Shield program provides coverage for out-patient hospital emergency care up to Php 50,000 for a Php 800 premium only.

·         ER Vantage Plus program provides coverage for hospital emergency care leading to admission. It could also be used just for hospital out-patient emergency care. There are 3 variants of ER Vantage Plus plan that one can choose depending on his/her needs: ER Vantage Plus 40, ER Vantage Plus 60, and ER Vantage Plus 80. Depending on the age of the enrollee, the ER Vantage Plus costs:

 

·         Health Vantage program also covers outpatient emergency care and emergency care leading to hospitalization up to the plan benefit limit. There are 3 variants of Health Vantage plan: Health Vantage 40, Health Vantage 60, and Health Vantage 80. Depending on the age of the enrollee, the Health Vantage costs:

 

What are the coverable cases for ER Shield, ER Vantage Plus, and Health Vantage?
Depending on the program’s service coverage, the following are the covered conditions:

·         Accidents, excluding Cerebrovascular (Stroke)

·         Acute Appendicitis

·         Acute Bronchitis

·         Acute Gastritis

·         Acute Gastroenteritis

·         Acute Pharyngitis

·         Acute Sinusitis

·         Acute Tonsillitis

·         Acute Upper Respiratory Tract Infection

·         Amoebiasis

·         Cellulitis

·         Dengue

·         Fracture, new

·         Acute Pneumonia

·         Sprain

·         Typhoid Fever

·         Upper Respiratory Tract Infection

·         Urinary Tract Infection

·         Viral Infection

 

Accidents except for cerebrovascular accidents (stroke) and injuries suffered because of member’s misconduct, voluntary participation in hazardous sport or activity and military service or under conditions of war.

 

Are all expenses incurred in the hospital covered?

For coverable conditions, ER Shield plan provides coverage up to Pph 50,000 for the following expenses:

·         Hospital emergency room care.

·         Treatment for animal bites except cost of vaccines

·         Diagnostic and therapeutic procedures that are medically necessary for emergency room care

·         Special modalities of treatment such as Magnetic Resonance Imaging (MRI) is subject to Php 5,000 inner limit.

ER Vantage Plus and Health Vantage plans, depending on the chosen variant, provides coverage of hospital emergency room care plus expenses for the room and board, diagnostic and therapeutic procedures as medically necessary during confinement up to the plan aggregate limit. Special modalities of treatment is also subject to Php5,000 inner limit.

 

What if the total aggregate limit will not be consumed totally can I again use the plan in the future?

The ER Shield and ER Vantage Plus are for one-time use only, regardless if the total aggregate benefit limit is consumed or not.  The advantage of ER Shield and ER Vantage Plus plans is that, for a very affordable amount, you are assured of assistance, if not all, for the big portion of the hospital emergency care expenses that you will incur.

Health Vantage plan, on the other hand, has no limit on the number of times you use the plan within a year as long as the aggregate benefit is not yet consumed.

 

Do I need to have a PhilHealth for ER Shield, ER Vantage Plus, and Health Vantage programs?

For ER Shield plan, PhilHealth is not required. However, for ER Vantage Plus and Health Vantage, once there is an admission, a PhilHealth coverage is required. However, for those who do not have PhilHealth coverage, one may just pay the PhilHealth portion of the hospital bill before discharge.

 

Who are qualified to have an ER Shield, ER Vantage Plus and Health Vantage programs?

It is so convenient to have an ER Shield, ER vantage Plus, or Health Vantage plan. The only membership requirement is the age. For ER Shield and ER Vantage Plus, individuals must be 6 months to 64 years old from the plan’s effectivity (7 days from registration date). Registration can be done via online. For Health Vantage, individuals must be 6 months to 64 years old may be enrolled under these programs. However, the entry age is up to 60 years old only.

 

Once I register an ER Shield or ER Vantage Plus, can I already use it? 

No, you can use your ER Shield or your ER Vantage Plus emergency health plan, 7 days from registration date. That is why it is important to immediately register your ER Shield or ER Vantage plan once you get it.

 

When can I start using my Health Vantage plan?

 

You can start using your Health Vantage plan seven (7) days from date of completion of payment and application form.

 

Can I register/apply an ER Shield, ER Vantage Plus, or Health Vantage plan for another person?

Yes, you may as long as you know their personal data required for the registration/application.

 

How long will the ER Shield, ER Vantage Plus, and Health Vantage be effective?

You may use the plan within one year from the start of plan effectivity.

 

Are ER Shield are ER Vantage Plus transferable?

As long as not yet registered, the ER Shield and ER Vantage Plus are transferable. That is why one can purchase the plans for gifts or corporate giveaways. 

 

Can I use the ER Shield, ER Vantage Plus and Health Vantage in hospitals not included in the plan provider list? 

No, services can only be availed in the designated hospitals. We have already made arrangements with the hospitals regarding the procedures for accepting the plans and provision of services.

 

There are more than 550 hospitals nationwide where you may avail the services for ER Shield, ER Vantage Plus, and Health Vantage.

 

What are the non-coverable conditions for ER Shield, ER Vantage Plus, and Health Vantage?

 

Non-emergency, pre-existing, congenital, maternity related and those conditions under PhilCare’s general exclusion list will not be covered.

 

An illness or condition is considered pre-existing if prior to the effective date of health coverage the pathogenesis of such illness or condition has started, whether the member is aware or not.

 

Emergency cases are the sudden, unexpected onset of illness or injury, which at the time of contract reasonably appeared as having the potential of causing immediate disability or death or requiring the immediate alleviation of severe pain and discomfort. Emergency cases include but are not limited to the following: (a) Massive Bleeding; (b) Acute Appendicitis; (c) Fractures/multiple injuries secondary to accidents; (d) Convulsions; (e) illnesses or conditions resulting in moderate or severe dehydration such as diarrhea or fever; and (f) Syncope. 

 

What are the non-covered illnesses and diseases?

The following are the diseases and conditions in which the emergency and hospitalization health plans cannot be used. No health care benefits shall be paid for the following services, procedures or conditions. This is not a complete list of non-covered illnesses and diseases. PhilCare reserves the right to have the final interpretation of all definition, provisions and articles relating to the health plans.

 

A. List of diseases not covered but not limited to:

 

Anal fistulae / Asthma / Auto immune conditions / Cardiovascular diseases / Calculi of the urinary system / Cataracts / Sinus conditions requiring surgery / Cerebrovascular diseases / Cholecystitis/cholelithiasis / Chronic skin conditions / Cirrhosis of the liver / Collagen disease / Degenerative conditions / Diabetes mellitus / Diseased tonsils requiring surgery / Endometriosis / Epilepsy / Gastric or duodenal ulcer / Hallux valgus / Hemorrhoids / Hernia / HIV/AIDS / Hypertension / Neurologic conditions  / Obesity, dyslipidemia  and other metabolic conditions / Pathological abnormalities of nasal septum and turbinates / Thyroid conditions / Tuberculosis / Tumors, whether benign or malignant of all organs and organ systems, including malignancies of the blood or bone marrow / Non-emergency case during point of availment / Pre-existing and congenital conditions Pre-existing and congenital conditions – An illness or condition shall be considered pre-existing if, prior to the effective date of health coverage the pathogenesis of such illness or condition has started, whether or not the member is aware of such illness or condition.

 

B. General exclusions applicable to health care coverage:

·         Care by Non-Affiliated Physician in either Affiliated or Non-Affiliated Hospitals

·         Care by an Affiliated Physician in Non-Affiliated Hospital

·         Additional hospital charges and professional fees resulting from taking a room category higher than that specified in the member’s benefit schedule

·         Additional personal comfort items (e.g., telephone and television, additional food trays, admission kit and such other items of the same nature)

·         Procurement or use of corrective appliances, prosthesis, artificial aids and durable equipment such as but not limited to the following: stents, prolene mesh, pins, screws, plates, wires, VP shunt, clips, hearing aids, intraocular lens, eyeglasses, contact lenses, balloons, valves;  braces, crutches , pace maker

·         All pregnancy-related conditions and complications relating to mother and unborn child, requiring medical and surgical care, regardless of time/date of occurrence (during the actual time of pregnancy or thereafter)

·         All sexually transmitted diseases

·         Blood screening, blood typing, cross-matching for potential donors in relation to blood donation and transfusion

·         All forms of behavioral disorders whether congenital or acquired; developmental or psychiatric disorder; psychosomatic illness

·         Any injury, illness or condition which the member may suffer after he has taken intoxicating drugs or alcoholic beverage as evidenced by clinical history or  alcoholic breath as determined by the examining physician and/or conditions or illnesses resulting from alcoholism and drug addiction

·         Medical or surgical procedures that are experimental in nature and those that are not generally accepted as standard medical treatment by the medical profession, that may include but is not limited to Chiropractic Services, Acupuncture, and Reflexology;

·         Allergens used for hypersensitivity testing regardless if administered as an outpatient or in patient procedure

·         Treatment of injuries or illnesses resulting from the voluntary participation of a member in any hazardous sport or activity that may include but is not limited to:  bungee jumping, scuba diving, hang-gliding, mountain climbing, parachuting, surfing, rock climbing, airsoft, paintballing, boxing, wrestling, martial arts (such as taekwondo, judo, karate, etc.), gymnastics, motor sports (drag racing, jet skiing), wakeboarding, water skiing and all such other voluntary activities which pose a grave danger to life and limb.

·         Treatment of injuries or illnesses due to military service or suffered under conditions of war

·         Treatment of injuries or illnesses wherein the care or reimbursement of services is provided by law or a government program, up to the stipulated limits

·         Treatment of any injury which is proven to be attributable to the member’s own misconduct such as negligence, intemperate use of drugs or alcoholic liquor, direct or indirect participation in the commission of a crime, whether consummated or not, violation of a law or ordinance, unnecessary exposure to imminent danger or hazard to health, including fireworks related injuries, infections or complications as a result of tattoos and piercing of the ear or any body part, whether self-inflicted or done by a third party, or attempted suicide or self-destruction, whether sane or insane

·         All cases of assault perpetrated by the Member including domestic violence which result in harm or injury to the Member perpetrator

·         Vaccines, whether elective or administered during an emergency treatment are not covered

·         In-patient pain management necessitating specialized pain management team and/or the use of specialize equipments

·         All diseases declared as epidemic by the Department of Health (DOH) and any other recognized health agencies

·         All hospital charges and professional fees incurred after the day and time the discharge from hospital has been duly authorized

·         All procedures and/ or services considered screening

·         Pre-existing and congenital anomalies and conditions, and their complications

·         Cosmetic procedure and surgery and oral surgery solely for the purpose of beautification except reconstructive surgery to treat functional defects due to disease or accidental injury

 

unli-CONSULT PLANS

What are the benefits of the unli-CONSULT plans?

The PhilCare unli-CONSULT plan allows you to avail of unlimited out-patient consultation services for 12 months from its nationwide network of medical specialists and dentists.

 

Can I use it when I am hospitalized?

No, the consultation plan is only for an out-patient consultation. You can seek out-patient consultation from PhilCare-accredited physicians you can find here:  http://philcare.com.ph/consultationcards/.

 

Is it transferable?

The consultation plan is not transferable once successfully registered. The name that has been entered during registration will be the recognized PhilCare member.

 

How do I register my plan?

Registration can be done via online Click here to Register.  Coverage is effective four (4) calendar days from registration date. By registering, you agree to the terms and conditions governing the use of the Philcare Consultation plan.

 

When will the one year coverage start?

The count of one (1) year starts once plan is activated. Plan is activated four (4) days from registration date.

 

How would I know if I was able to successfully register?

Once the PhilCare system receives your registration, you will receive an email confirmation informing you if your registration is successful or not and will advise you is there is a concern in the data you entered.

When can I avail the consultation service?

After four(4) calendar days from date of successful registration, you can already avail of consultation services.

 

What is the procedure for availment of the consultation services?

Set an appointment with the doctor via phone call prior your day of visit to make sure that he will be holding his clinic on the day you desire to have your consultation and also that you will be accommodated. You have to present a Letter of Authorization (LOA), personalized member card and one (1) valid ID to the doctor on the day of availment.

Note that consultation must be availed within the LOA validity period which is with three (3) calendar days start from day of issuance and must be provided by the doctor indicated in the LOA.

 

How do I get a LOA?

The beauty of the consultation plan, it is very convenient for you to get a LOA. You just self-generate it from the PhilCare website. You can do it in your most convenient time and day.

Here are the steps to get a LOA:

Step 1 : Go to www.philcare.com.ph/consultationcards and click request for LOA. Input your certificate number provided to you upon online registration. Include also your birthdate and birthplace.
Step 2: Select your choices of area, hospital/clinic, specialization and doctor
Step 3: Download and print the LOA and your personalized membership card

 

Can I avail of medical services without an LOA?

No, you cannot avail of the consultation service without a LOA. The LOA is the document that would inform the doctor that you have been authorized by PhilCare to have a consultation service.

You have to submit the 2 copies of the LOA to the doctor. He will forward one copy to PhilCare for his professional fee to processed and paid. And the other copy of the LOA for his reference.

 

Do I need to generate a LOA every time I will avail of a consultation service?

Yes, a new LOA should be downloaded for every consultation service. An approval code will be indicated by the system per LOA extracted. The approval code indicates that PhilCare allows you to have the consultation service.

 

Is there a limit on how many consultations I can avail within a day?

There is no limit on how many consultations you can avail in a day. You just need to generate separate

LOAs for the consultation services you would need.

 

Can I get LOA from PhilCare offices and PhilCare clinics?

We design that LOA should be self-generated for it to be very convenient for you.
Please call our Customer Service Hotline at +63 (02) 462-1800; for outside Metro Manila (toll-free for PLDT): 1-800-1888-3230 for assistance if there is a concern on downloading an LOA.
PhilCare offices and clinics will only issue an LOA if the PhilCare website system is down, otherwise LOA must be self-generated.

 

Can I avail of any consultation service?

Enjoy the perks of all-around health and wellness by using it for regular check-ups or monitoring of existing conditions except for ENT-consultations, consultations relating to maternity-related cases and cases related to all forms of behavioral disorders, developmental, psychiatric disorder and psychosomatic illness, whether congenital or acquired.

 

What is the procedure I need to follow for the dental consultation?

For the dental services availment, you just download and print the personalized consultation card and present this together with one valid ID to the dental clinic on the day of availment.

Same as for medical consultation, we advise you to set an appointment with the dentists.

 

Can I also request for other services example laboratory examinations etc.?

The consultation plan covers only the consultation fee. Other services will not be paid by PhilCare

 

Do I need to pay any additional amount to the doctor if I just requested for consultation services?

No, PhilCare will already take care of the consultation fee. You should not pay any excess charges relating to the consultation service.

 

CORPORATE PROGRAMS

 

What products are specifically made for businesses and corporate clients?

 

PhilCare offers various health programs for businesses

·         SME Pro– This is a medical program package with group life insurance benefit designed specifically for small business (5-19 employees).

·         SME Luxe – This is a comprehensive program that will cater to corporate clients with 20-99 employees. 

For more information, you may contact us at (02) 802-7333 loc 19216 or 19224 or e-mail [email protected]

 

AVAILMENT

Who and where are the accredited clinics and hospitals of PhilCare?

Download PhilCare’s mobile app HeyPhil in Google Play to search for accredited clinics and hospitals. You may also click the following link to view your list of accredited clinics and hospitals:  List of Accredited Clinics or Hospitals . 

 

What are non-covered diseases under my plan?

Non-covered diseases under your plan are based on your health plan

 

How to replace lost PhilCare ID card?

For individual members, please pay P40.00 and the corresponding delivery charge based on your location (Metro Manila – Php65.00, Luzon – Php75.00, Visayas – P95.00, Mindanao – Php110.00) in any of our payment centers (linked to payment center) and submit an affidavit of loss and a copy of the deposit slip through fax at (02) 8027311 local 19235 or email [email protected]. Indicate “Lost ID card replacement” as subject heading in the fax or email to be sent. Once received, please expect your card replacement after 3 working days.

 

For members who are part of corporate accounts, please coordinate with your HR Department for your card replacement and submit an updated Membership Update Form and Affidavit of Loss. Your HR representative will directly coordinate with PhilCare for the processing of your ID card replacement. Once received, please expect your card replacement after 10 working days.

 

How would I know my PhilCare number?

Your PhilCare certificate number can be found in front of your health plan with “Cert# 00000000”. You can also validate it by calling our Customer Hotline at (02) 462-1800. Outside Metro Manila, please contact us at 1-800-1888-3230 toll-free for PLDT subscribers.

 

How do I make appointment online?

Online appointments are not yet available however, you may contact our PhilCare clinics so you may call prior to consultation or availment.  PhilCare Owned Clinic Network - schedule and contact information.

 

I would like to check on how much I can still use on the account?

You may refer your inquiry to our Customer Hotline at (02) 462-1800. Outside Metro Manila, please contact us at 1-800-1888-3230 toll-free for PLDT subscribers. We can provide you the amount based on your utilization however, please take note that this is not in “absolute amount” since there may be recent availments which are have not yet been reflected in our system during the time of your call.

 

Where can I access PhilCare forms?

You may access the forms through the following link: 

 

Can I continue my existing PhilCare health plan should I retire or resign from the company I work for?

Yes, you can still apply for health plan but it will fall under the Individual plans. To request for quotation, please contact us (02) 802-7333 local 19216 or 19224 or send an email to [email protected].

 

Can I enroll a health planfor someone else as my gift to that person?

Yes, we have clinic bundle plans and ER prepaid plan products that can be given as a gift to your loved ones.