Escalation Grid
HMO
PhilCare ER Vantage Plus Adults 40k
OVERVIEW
Get some peace of mind knowing you or your loved ones have
emergency and hospitalization coverage for viral & bacterial illnesses
and injuries resulting from accidents (except for stroke) with the help of
PhilCare, one of the leaders in health & wellness innovations for over
30+ years.
● With PhilCare’s ER Vantage, enjoy one-time availment coverage for up
to ₱ 40,000 for the following cases:
○ Acute cases of bacterial and viral infections such as appendicitis,
bronchitis, gastritis, gastroenteritis, pharyngitis, urinary tract
infections sinusitis, tonsillitis, upper respiratory tract Infection,
amoebiasis, cellulites, dengue fever, pneumonia and typhoid
fever
○ 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.
○ Hospital emergency care for animal bites except vaccines
● One time fee includes one-time coverage for:
○ Emergency room fees
○ Doctor’s professional fees
○ Laboratory and diagnostic procedures
○ Ward room and board
○ Access to 500+ PhilCare-accredited hospitals nationwide
○ Plus, ₱ 50,000 accidental death and dismemberment coverage
● The following are also covered as long as deemed as medically
necessary during ER and confinement
○ Medicines (except vaccines) except for cases declared as
non-coverable
○ Special modalities of treatment, subject to standard ₱ 5,000 inner
limit
○ Diagnostic and therapeutic procedures for emergency room care
● Eligibility: 18 to 64 years old
● Now available as a printable eVoucher! Emailed to you within 24 hours
upon receipt of payment, eVouchers allow you to print your health plan
at home and redeem upon activation.
● No hospital deposit required
● No medical examination required
● Hassle-free online registration
● For a list of PhilCare’s 500+ accredited hospitals, visit Philcare’s
website(https://shop.philcare.com.ph/index.php?route=er-hospitals)
● This voucher does not include medical consultations.
● PhilHealth is required upon admission.
● For more details, please see FAQs below.
● Note: This card cannot be activated along with other vouchers such
as ER Vantage, Health Vantage, ER Shield at the same time with the
same person.
Commonly Asked Questions
● Are there exclusions?
– ER Vantage Plus does not cover consultations. Pre-existing, congenital
and maternity related conditions, and cases and conditions declared
under the standard general exclusions are not covered. Pre-existing and
congenital conditions are illnesses and conditions that are already
present 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. Your final medical diagnosis is the
basis for PhilCare’s approval of coverage.
● Can I still use the remaining balance if availment is below the benefit
limit?
– No, ER Vantage Plus eVoucher is only for one-time use regardless if the
total benefit limit is consumed or not.
● Is there a limit on the number of times I can register a prepaid health
card in my name?
– There is no limit to the number of PhilCare ER Vantage Plus vouchers
that you may register in your name within a year. However, you can only
register the second voucher after the first voucher has been used. There
should only be one active voucher at any given time.
● Do I need to have PhilHealth coverage?
– PhilHealth coverage is required once admitted. However, for those who
are not covered by Philhealth, one may pay the PhilHealth portion of
the hospital bill before being discharged from the hospital.
● What are eVouchers?
– Conveniently emailed to you within 24 hours upon confirmation of
payment, eVouchers allow you to print your health plan at home. Your
eVoucher will automatically be activated 7 days from successful
registration. Simply present the ER Vantage Plus eVoucher with a valid
ID to the emergency room staff at any PhilCare-accredited hospital.
● How do I use my eVoucher?
To register:
● Register online at www.philcare.com.ph/prepaid-card/register/register/
● Your eVoucher will be activated 7 days from registration. Once
activated, eVouchers are non-transferable.
To avail:
● Present your eVoucher with a valid ID. Your eVoucher must be
surrendered upon availment
● Take note that e-pins expire and must be registered 3 months from
the date of purchase.
● For a list of PhilCare’s 500+ accredited hospitals nationwide, visit
Philcare’s website(https://shop.philcare.com.ph/index.php?route=er-hospitals)
● When will my eVoucher be activated?
– Your eVoucher will automatically be activated 7 days from successful
registration.
● Is my health card transferable?
– Once activated, your coverage is non-transferable.
● How do i know if my hospital/doctor is accredited?
– For a list of PhilCare’s accredited hospitals nationwide, visit Philcare’s
website(https://shop.philcare.com.ph/index.php?route=er-hospitals)
Philcare ER Shield
ER Shield is a single-use health plan that provides coverage for outpatient emergency care for viral and bacterial illnesses and treatment of injuries resulting from accidents (except for stroke) in 500+ designated PhilCare-accredited hospitals.
ER Shield is for age 6 months to 65 years old and is valid for 1 year upon activation date. Benefits starts 7 days after activation date. The Certificate of Coverage is non-transferable once activated.
Outpatient Emergency Care:
ER Shield * gives you one-time coverage up to Php 50,000 for emergency care expense for viral and bacterial illnesses, treatment of injuries resulting from accidents (except for stroke) in 500+ designated PhilCare-accredited hospitals nationwide. Inclusive of doctors’ fees, laboratory and diagnostic procedures, and medicines (as medically necessary and excluding vaccines). Excluding nine (9) premium hospitals (Makati Medical Center, St. Luke’s Medical Center in QC and Global, Asian Hospital, The Medical City, Cardinal Santos Medical Center, Manila Adventist Medical Center, Notre Dame de Charles Hospital and Philippine Orthopedic Institute). The Coverage is inclusive of the following benefits:
- Special modalities of treatment as medically necessary during ER and subject to P5,000 inner limit.
- Diagnostic and therapeutic procedures as medically necessary for emergency room care.
- Hospital emergency care for animal bites except vaccines.
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; (f) illnesses or conditions resulting in moderate or severe dehydration such as diarrhea or fever; and (h) Syncope. Pre-existing conditions and those conditions under the general exclusions of PhilCare are not covered.***
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 [email protected].
Emergency and Hospitalization Availment:
- Simply present this COC together with a valid identification to the emergency room personnel at the identified PhilCare-accredited hospital.
- ER personnel will facilitate the approval of your availment thru reaching our contact center to verify your membership eligibility and health coverage. The final medical diagnosis is the basis for PhilCare’s approval of coverage.
- Once approval has been provided, request for cancellation of approval to reactivate membership is not allowed.
By buying, registering or availing coverage of any of the above products, I certify that I have read, understand and agree to these Terms and Conditions. I would receive the soft copy of the full policy contract within 24 hours from the receipt of the Certificate of Coverage that includes the full details of the product that I have purchased including its terms and conditions. I may also opt to request for a full policy contract by sending an email to [email protected]. If I disagree with these Terms and Conditions and I have not registered the product, I can request for a refund, subject to the PhilCare Returns & Refund or Replacement, or Cancellation Procedures (https://shop.philcare.com.ph/return-refund-terms).
I certify that the information given and to be given by me or on my behalf is true and correct and that any material misrepresentation or falsity therein shall be construed as an act to defraud PhilHealthCare Inc. (PhilCare), and serves as sufficient ground for any and all of the following actions: the rejection or cancellation of my application or membership, non-coverage of medical expenses at accredited providers, collection of receipt from me in case of payment of medical expense advanced by PhilCare. I hereby authorize PhilCare to inquire about and investigate all declared information from whatever sources PhilCare may consider appropriate.
I agree that receipt of the corresponding membership fees by PhilCare does not constitute acceptance of my application until the corresponding application has been approved. For ER Shield and ER Vantage Plus, and Health Vantage approval of application is seven (7) calendar days from notice of successful registration. For Dengue Assist, approval of application is automatic thirty (30) calendar days from notice of successful registration. Coverage shall automatically begin, regardless of the status of receipt of notice advising the member of successful registration and coverage period. Any incident, illness or condition that occurs prior to the start of coverage, even if it continues up to or past the Effectivity Date, will not be covered.
I agree to the coverage of illnesses as stated in the general exclusions applicable to health care coverage found in https://shop.philcare.com.ph/non-covered-illnesses-and-diseases. PhilCare shall have the final decision to determine coverage of illness based on but not limited to registration date, start date of coverage, final diagnosis, general exclusions, evaluation of the case as emergency in nature, hospital billing, and professional fees.
I hereby agree to PhilCare in retrieving and processing any and all medical information drawn or obtained pursuant to its services based on my coverage, provided, that (a) such information shall only be utilized in accordance with lawful and official business purposes of PhilCare; (b) such information shall not be disclosed to non-essential personnel or entities; and (c) all reasonable efforts shall be taken to maintain the confidentiality of said information.
IMPORTANT NOTES:
* See FAQs for more details.
** Check the list of Non-Covered Illnesses and Diseases
***The Certificate of Coverage (COC) is issued together with the soft copy policy (provided within 24 hours from COC receipt). To request for a full hard copy policy contract, please send an email to [email protected].