EMERGENCY BENEFIT COVERAGE
What’s Covered?
You get ₱60,000 one-time coverage for emergency care and hospitalization due to:
- 🏥 Viral and bacterial illnesses
- 🏥 Injuries from accidents (excluding stroke)
Hospital Access
🏥 Access care from 600+ 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 Chartres, and Philippine Orthopedic Institute.
Coverage Includes
- Room and board (Semi-Private 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 limits
- Diagnostic and therapeutic procedures as medically necessary during ER and confinement
Additional Benefits
✨ ₱10,000 Accidental Death & Disability Insurance
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.
HI-PRECISION BENEFITS
Medical Consultation Benefits via Hi-Precision Clinics Only
- Consultation with General Physician and Family Medicine
- Issuance of medical assessment and prescription
- Endorsement for lab tests or procedures to clinics if necessary
- Referrals for specialty consultation if necessary
- Lab interpretation via Family Medicine and General Physician only
- Consultations for pre-existing conditions not requiring emergency attention
Laboratory Procedure Benefits
- Accessible only to Hi-Precision Clinics
- Referrals or requests should only come from Hi-Precision Doctors
- All procedures available in Hi-Precision within ₱10,000 annual inner limits
- Laboratory test results are included
Note: Imaging procedures such as X-ray, ultrasound, ECG, 2D echo, and other similar tests are excluded.
Other Additional Benefits
- ₱10,000 Accidental Death and Disability Coverage
AVAILMENT PROCEDURE
How to Use Emergency and Hospitalization 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 cannot be canceled or reactivated
Medical Consultation through Hi-Precision Clinics
- Check Hi-Precision Clinics near you through the Hi-Precision Clinic location list
- Go to the Hi-Precision Clinic
- Present your Digital Card to Hi-Precision personnel for verification
- Provide the referral letter from Hi-Precision Doctors
- Once verified, proceed with consultation
Laboratory Procedure through Hi-Precision Clinics
- Check Hi-Precision Clinics near you through the Hi-Precision Clinic location list
- Go to the Hi-Precision Clinic
- Present your Digital Card to Hi-Precision personnel for verification and approval
- Once verified, proceed with the laboratory procedure
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 activates within 7 calendar days from successful registration.
- Coverage begins automatically on the activation date. Any conditions or incidents that occur before this date are not covered.
- Coverage is subject to general exclusions.
- PhilCare values your data privacy. All medical information is used solely for healthcare purposes and treated confidentially.
- Terms and conditions apply.
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.