BENEFIT COVERAGE
What’s Covered?
You get 40,000 one-time coverage for emergency care and hospitalization, due to:Hospital Access
🏥Access care from 500+ accredited hospitals nationwide, excluding the following premium hospitals: Makati Med, St. Luke’s QC & BGC, Asian Hospital, The Medical City, Cardinal Santos, Manila Adventist, Notre Dame de Charles, Philippine Orthopedic Institute.Coverage Includes
- Room and board (Ward Room)
- Doctors’ Fees
- Lab and Diagnostics
- Special treatments (up to ₱5,000 inner limits)
- Medicines (except vaccines) as medically necessary during ER and confinement except for cases declared as non-coverable subject to standard inner
- Diagnostic and therapeutic procedures as medically necessary during ER and confinement limits
Additional Benefits
✨ ₱50,000 Accidental Death & Disability InsuranceConditions Covered:
- ✔️ Accidents and Injuries:
- Injuries & fractures (except stroke)
- Animal bites (first dose of vaccine only)
- Burns, deep cuts needing suturing
- Accidental chemical poisoning
- ✔️ Acute Illnesses:
- Appendicitis, Bronchitis, Gastritis, Gastroenteritis with dehydration
- Pharyngitis, Pneumonia, Sinusitis, Tonsillopharyngitis with moderate dehydration
- Upper Respiratory Tract Infection, Amoebiasis (initial episode), Anaphylactic Shock
- Cellulitis, Chicken Pox with complications, Chikungunya, Cholera, Dengue Fever
- Diphtheria, Leptospirosis, uncomplicated Malaria, Measles with high-grade fever
- Meningitis, Pertussis, Polio, Systemic Viral Infections (with fever), Typhoid Fever
- Urinary Tract Infection
- ⚠️ Emergency Cases Include:
- Massive bleeding
- Fractures or multiple injuries from accidents
- Convulsions
- Acute appendicitis
- Severe dehydration (e.g., due to fever or diarrhea)
- Fainting (Syncope)
🔒 Not Covered: Pre-existing conditions, injuries from misconduct, hazardous activities, military service, and other illnesses under PhilCare’s general exclusions.
AVAILMENT PROCEDURE
How to Use Emergency and Hospitalization Benefits:
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🏥 Go to the ER of any PhilCare-accredited hospital
💳 Show your Certificate of Coverage and valid ID
📞 Hospital will verify your eligibility with PhilCare
✅ Once approved, your benefits will be applied directly
📌 Once approved, coverage can’t be canceled or reactivated
IMPORTANT NOTES
📝 Refund Policy: You may cancel within 15 days of receiving your Certificate of Coverage if unused. Email prepaidcs@philcare.com.ph.
📩 You will receive a soft copy of the full policy contract within 24 hours from release of your Certificate of Coverage. You may also request it via order@philcare.com.ph.
💡 If you do not agree with the Terms and haven't registered your product yet, you may request a refund, subject to PhilCare’s Return, Refund & Cancellation Policy.
✅ You confirm all personal and health information provided is true and correct. Misrepresentation may lead to cancellation of membership or non-coverage.
🕒 Coverage activation timelines (starting from successful registration):
💵 Some plans may include a co-pay amount that must be settled before coverage kicks in.
🚫 Coverage is subject to general exclusions. View the full list of non-coverable conditions at the provided link.
🔒 PhilCare values your data privacy. All medical information is used solely for healthcare purposes and treated confidentially.
GENERAL EXLUSION AND LIMITATIONS
General Exclusions
No Healthcare Benefits shall be paid for the following services, procedures or conditions unless otherwise specified in the Agreement.1. All forms of behavioral disorders whether congenital or acquired; developmental or psychiatric disorder; psychosomatic illness.
2. All Sexually Transmitted Diseases such as but not limited to herpes, gonorrhea, syphilis and conditions such as vulvar warts
3. Injuries resulting from direct participation in riots, strikes, and other civil disturbances.
4. All diseases declared as epidemic or pandemic by the Department of Health or any recognized health agencies.
5. Cosmetic procedure and surgery and oral surgery solely for purpose of beautification, including but not limited to wart removal through excision or electrodessication/ cauterization, mesotherapy, liposuction, except reconstructive surgery to treat functional defects due to disease or accidental injury.
6. Weight reducing programs, surgical operation or procedure for treatment of obesity, including but not limited to gastric stapling.
7. Dental examination, extraction, fillings and general dental attention and conditions and all complications arising there from, including oral surgery and prosthodontics procedures following accidental injury to teeth for purposes of beautification. Exceptions are treatment to the extent necessary for repair and or restoration of function of the Member caused solely by accidental injuries. 8. All pregnancy-related conditions and their complications, requiring medical and surgical care, regardless of time/date of occurrence (during the actual time of pregnancy or thereafter). MATERNITY-RELATED or PREGNANCY-RELATED. Any cause or condition arising out of or during any one pregnancy, childbirth, miscarriage or abortion or any complications arising from the same.
9. Circumcision, sterilization of either sex or reversal of such, artificial insemination, sex transformation or diagnosis and treatment of infertility.
10. 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.
11. Routine physical examinations required for obtaining or continuing employment, requirement in school, insurance, government licensing, health permit and other similar purposes.
12. Procedure and/or services considered screening.
13. Treatment for injury and its complications resulting from self-inflicted injuries including infections as a result of tattoos, piercing of the ear or in any body part, whether self-inflicted or done by a third party or attempted suicide or self-destruction, whether sane or insane.
14. Treatment of any injury received wherein there is negligence, unauthorized use of prohibited or regulated drugs, alcoholic liquor intake, direct or indirect participation in the commission of a crime whether consummated or not, violation of a law or ordinance or unnecessary exposure to imminent danger, knowingly or unknowingly, or hazard to health, by the Member.
15. Any injury, illness or condition which the Member may suffer after he/she has taken intoxicating drugs or alcoholic beverage as evidenced by clinical history or alcoholic breath as duly determined by the examining physician/medical personnel and/or as indicated in the police report and other official medical documents conditions or illnesses resulting from alcoholism and drug addiction.
16. Treatment of injuries or illnesses caused directly or indirectly by engaging in any professional sport or hazardous activity such as but not limited to scuba diving, surfing, water skiing, mountain climbing, rock climbing, mountaineering, parachuting, airsoft, drag racing, paintballing, wakeboarding and bungee jumping.
17. Treatment of injuries or illnesses due to military service or suffered under conditions of War .
18. Treatment for Chronic Dermatoses
19. Services obtained for non-emergency conditions from physicians and hospitals in any of the following circumstances: a. non-affiliated physicians in non-affiliated hospitals or non- affiliated clinics b. non-affiliated physicians in affiliated hospitals or affiliated clinics c. affiliated physicians in non-affiliated hospitals or non-affiliated clinics or other healthcare facility.
20. Additional hospital charges and physician’s professional fees resulting from: a. room-upgrading beyond twenty-four (24) hours during Emergency Conditions; b. extension of hospital stay despite release of discharge order from Member’s Attending Physician; c. fees of the assistant surgeons for surgeries with less than 250 RUV units/resident doctors who assisted the Attending Physician in the process of rendering the medical services shall not be chargeable to PhilCare except for hospitals that do not have resident physicians to assist during surgeries subject to the prior approval of PhilCare; d. use of extra bed, TV, electric fan, DVD/VCD and other similar items unless such appliances and items are necessarily and ordinarily included in the Member’s Room and Board Accommodation; e. extra food, toilet articles like face towel, soap, toothbrush and the like; f. difference in Room and Board Accommodation, the incremental rate differences for professional fees, diagnostic and laboratory examination, and other ancillary medical services brought about by obtaining a room and board accommodation higher than the Member’s Room and Board Accommodation limit; g. services of a private or special nurse; h. all other items not medically necessary in the medical management of the Member.
21. Custodial, Domiciliary, Convalescent and Intermediate care. These pertain to care in a skilled affiliated facility or an institution that meets certain standards for medical car and includes nursing care and therapeutic services following hospital confinement.
22. Medical Certificates.
23. Professional fees of medico-legal officer/s.
24. All expenses incurred in the process of organ donation and transplantation if the Member is the donor and its complications.
25. Benefits covered by PhilHealth and all other government funded healthcare entitlements as provided for by law.
26. Cost of the medical services and professional fees in excess of the MBL and applicable inner limits of the Plan.
27. Purchase of lease of any Durable Medical Equipment, oxygen dispensing equipment, and oxygen except during covered in-patient care.
28. Procurement or use of corrective appliances, prosthesis, artificial aids and durable equipment such as but not limited to the following: (a) stents; (b) prolene mesh; (c) pins, screws, plates, wires; (d) VP shunt, clips; (e) hearing aids; (f) intraocular lens, eyeglasses, contact lenses; (g) balloons, valves; (h) braces, crutches; (i) pace maker.
29. Hepatitis B, C and D.
30. Allergens used for hypersensitivity testing regardless if administered as an out-patient or in-patient procedures.
31. Blood screening, blood typing, cross-matching for potential donors.
32. Executive check-ups and confinement which are for purely diagnostic purposes except as specified in the Agreement.
33. All cases of assault perpetrated by the Member including domestic violence which result in harm or injury to the Member perpetrator.
34. Charges by Physicians and health professionals, whether or not affiliated by PhilCare, on the difference between their charged rate and PhilCare standard professional fees for specific medical services.
35. Take-home medicines, preventive and/or non-therapeutic drugs, such as but not limited to vitamins, supplements, hormonal preparations, medicines or drugs during confinement which are not available in the Philippines, immunizing agents and all other medicines/drugs not approved by the Bureau of Food and Drugs (BFAD).
36. Out-patient medicines, with the exception of intravenous chemotherapy medicine and those administered during an emergency treatment.
37. Vaccines, whether elective or administered during an emergency treatment. Client may examine and cancel this health plan within a period of 15 days from receipt of the Certificate of Coverage, provided that the product hasn’t been utilized or availed for its purpose. The membership coverage shall be terminated thereafter. Refund provisions apply in accordance to PhilCare’s Termination Policy. Please email your request at prepaidcs@philcare.com.ph
38. Diagnosis and treatment of Error of Refraction conditions such as myopia, astigmatism, and the like, including laser treatment for the purpose of corrective eye refraction.
39. Out-Patient Pain Management is not covered except in cases of emergency. In-patient Pain management necessitating specialized pain management team and/or the use of specialized equipment.
40. Complications arising from non-covered procedures and surgery.
41. 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.
General Limitations
The rights of a Member and obligations of PhilCare are subject to the following limitations unless specified in an endorsement which is made part of the Agreement:1. If a major disaster or epidemic causes unavailability of facilities or personnel, or if circumstances not within the control of PhilCare such as temporary lack of hospital facilities, complete or partial destruction of facilities, war, riot, civil insurrection, labor disputes, or similar causes occur, then PhilCare shall not be liable for any delay or failure to provide services to the Member. PhilCare shall, however, exert its best effort to provide services to the Member, as the circumstances permit.
2. In cases where the working diagnosis is a non-covered condition and the final diagnosis still has to be established, the Member shall shoulder the cost of services related to the condition. PhilCare shall reimburse according to its standard rates all expenses related to the condition if the final diagnosis turns out to be a covered condition.
3. Hospital Service is subject to all rules and regulations of the hospital selected, including the rules and regulations governing admission. PhilCare shall not be held liable in case there is no room available in accordance with the Member’s Room and Board benefit provision. In cases where services are denied by the hospital/clinic health facility, PhilCare shall not be held liable for any claims, charges, or damages caused to the member.
4. In no event shall the cost of covered conditions and their complications during the one-year term of the Agreement exceed the benefit limit.