BENEFIT COVERAGE
What’s Covered
ER Shield
You get ₱50,000 one-time coverage for emergency care benefits not leading to confinement, due to:
- 🏥 Viral and bacterial illnesses
- 🏥 Injuries from accidents (🚫 excludes stroke)
Accredited Hospitals
- 🏥 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, and Philippine Orthopedic Institute.
Coverage Includes
- ER Fees
- Doctors’ Fees
- Lab and Diagnostics
- Special treatments (up to ₱5,000 inner limits)
- Medicines during ER (except vaccines)
Conditions Covered
-
✔️
Accidents and Injuries:
- Injuries & fractures (except stroke)
- Animal bites (first dose of vaccine only)
- Burns and 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.
Unli-Consult
✅ Unlimited consultations for 1 year with PhilCare-accredited doctors nationwide
(Family Medicine, Internal Medicine, Cardiologists, Nephrologists,
Pulmonologists, Gastroenterologists, and Dentists)
✅ Unlimited DigiMed consultations via HeyPhil 3.0 App
Dental Services
- 🦷 Dental consultation
- 🦷 Simple gum treatment (lesions, wounds, burns)
- 🦷 Unlimited temporary fillings
- 🦷 Re-cementation of loose crowns, inlays, onlays, and fixed bridges
- 🦷 Simple repair and adjustment of dentures
- 🦷 Unlimited simple tooth extractions
- 🦷 Desensitization of hypersensitive teeth
- 🦷 Annual prophylaxis (light cases only)
Exclusions
- ⚠️ Maternity-related cases
- ⚠️ Behavioral, developmental, or psychiatric disorders
- ⚠️ Psychosomatic illnesses (whether congenital or acquired)
- ⚠️ Consultations with medical specializations not listed under the covered services
AVAILMENT PROCEDURE
How to Use Emergency Benefits
- 🏥 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
For Medical Consultations
- Visit the Consultation Cards page to create a self-issued Letter of Authorization (LOA) and your personalized membership card.
- Present the LOA, personalized membership card, and one (1) valid photo ID to your chosen medical specialist.
For Dental Consultations
- Download and print your Certificate of Coverage (COC) from the Consultations page.
- Present the COC together with one (1) valid ID of the cardholder on the day of your dental consultation.
HeyPhil DigiMed Consultation
- Download the HeyPhil App 3.0 from the Play Store or App Store
- Log in or register a new account
- Select “Online Consultation” > “DigiConsult”
- Complete your Patient Profile and click Submit
- Enter your concern or chief complaint
- Upload a prescription or lab result photo (if any), or proceed without uploading
- Click “Request Consultation” to enter the queue
- Expect a call from an unknown number for your session
- Join your DigiMed tele-consultation
- Receive your e-prescription and diagnosis via email
- Rate your experience after the session
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
- Emergency Plans – activates within 7 calendar days
- VidaCare – activates within 7 calendar days
- Consultation Plans – activates within 3 days
- DigiMed and MindCare – activates within 24 hours
- Dengue RX and Dengue Assist – activates within 30 days
Coverage begins automatically on the activation date. Any conditions or incidents that occur before this date are not covered.
💵 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 EXCLUSIONS AND LIMITATIONS
General Exclusions
No Healthcare Benefits shall be paid for the following services, procedures, or conditions unless otherwise specified in the Agreement:
- Behavioral, developmental, psychiatric, or psychosomatic disorders.
- Sexually transmitted diseases such as herpes, gonorrhea, syphilis, and vulvar warts.
- Injuries from riots, strikes, and civil disturbances.
- Diseases declared epidemic or pandemic by health authorities.
- Cosmetic and beautification procedures unless reconstructive due to accidental injury.
- Weight reduction programs and obesity-related procedures.
- Dental procedures except those needed after accidental injury.
- Pregnancy-related conditions and complications.
- Circumcision, sterilization, artificial insemination, infertility treatment, and sex transformation.
- Experimental medical treatments and alternative therapies.
- Routine physical examinations for employment, school, licensing, or permits.
- Screening procedures.
- Self-inflicted injuries, tattoos, piercings, attempted suicide, and related complications.
- Injuries related to negligence, illegal drugs, alcohol, crimes, or dangerous activities.
- Alcoholism and drug addiction-related illnesses.
- Professional sports and hazardous activities.
- Military service and war-related injuries.
- Chronic dermatoses.
- Non-emergency services from non-affiliated providers.
- Additional hospital charges beyond covered limits.
- Custodial, domiciliary, convalescent, and intermediate care.
- Medical certificates.
- Professional fees of medico-legal officers.
- Organ donation and transplant donor-related expenses.
- Benefits already covered by PhilHealth or government healthcare programs.
- Charges exceeding MBL and inner limits.
- Durable medical equipment and oxygen outside covered confinement.
- Corrective appliances and prosthesis such as stents, braces, eyeglasses, hearing aids, and pacemakers.
- Hepatitis B, C, and D.
- Allergens for hypersensitivity testing.
- Blood screening and blood typing for donors.
- Executive checkups and diagnostic confinement.
- Assault-related injuries caused by the member.
- Professional fee excess charges.
- Take-home medicines, vitamins, supplements, and non-therapeutic drugs.
- Outpatient medicines except emergency treatment and IV chemotherapy.
- Vaccines, whether elective or emergency-administered.
- Error of refraction conditions such as myopia and astigmatism.
- Outpatient pain management except emergencies.
- Complications from non-covered procedures.
- Conditions covered by law or government programs.
General Limitations
- PhilCare is not liable for delays caused by disasters, epidemics, war, riots, labor disputes, or unavailable facilities/personnel.
- Members shoulder costs if the working diagnosis is initially non-covered until final diagnosis confirms eligibility.
- Hospital services are subject to hospital rules and room availability.
- Total covered costs cannot exceed the benefit limit during the one-year term.