DESCRIPTION:
This one-time use health care voucher provides up to Php 80,000 worth of coverage for emergency cases due to accidents and viral and bacterial illnesses and specific conditions.
Services include outpatient and inpatient emergency care, semi-private room use, laboratory and diagnostic procedures, and medicines as medically required. It is accepted in more than 500 IHC-accredited hospitals nationwide excluding *Top 6 hospitals.
ER Care All-In 80 Kids is a one-time use prepaid health voucher that provides up to Php 80,000 outpatient and inpatient care coverage of emergency cases due to accidents, viral and bacterial illnesses, and specific conditions. It is accepted in all Insular Health Care accredited hospitals nationwide (excluding *Top 6 hospitals). To know more about the complete benefit coverage of ER Care All-In 80 Kids and its terms and conditions, read Insular Health Care's Health Care Agreement.
The Php 80,000 benefit limit covers these items:
✓ Doctor's professional fee
✓ Laboratory and diagnostic procedures
✓ Emergency room care
✓ Semi-private room accommodations
✓ Medicines as medically necessary in the emergency room and during confinement
✓ Surgery and surgeon's fees when medically necessary
✓ Use of operating room, recovery room, and ICU, as medically necessary.
✓ Special modalities of treatment as medically required in emergency room care and confinement, and subject to Php 5,000 standard limit
✓ 1-year access to over-the-phone/telemedicine access with MyPocketDoctor
Things to Note:
"Emergency" shall mean the sudden, unexpected onset of illness or injury having the potential of causing immediate disability or death or requiring the immediate alleviation of severe pain and discomfort. Some examples of accidents covered by ER Care All-In 80 Kids are new fractures, new burns, new animal bites, and new cuts that need suturing.
"Accident" shall mean a visible, external, sudden and violent event occasioned by a physical or natural cause and occurring entirely beyond the Members' control causing damage to the health of the Member. Some examples of accidents covered by ER Care All-In 80 Kids are new fractures, new burns, new animal bites, and new cuts that need suturing.
"Viral and bacterial illnesses" are diseases caused by viruses and/or bacteria. Some examples of viral and bacterial illnesses covered by ER Care All-In 80 Kids are Acute Upper Respiratory Tract Infection, Amoebiasis, Dengue Fever, Typhoid Fever, and Urinary Tract Infection.
This health voucher is applicable to children, 1-17 years old, and is valid for 12 months or up until used which ever comes first. The final medical diagnosis shall be the basis for a Member's eligibility to emergency care benefits under the Agreement. PhilHealth is required for the availment of this health voucher during hospital confinement
1. What does ER Care All-In 80 Kids cover?
With a Php 80,000 benefit limit, ER Care All-In 80 Kids covers emergency cases due to accidents and viral and bacterial illnesses. It covers expenses on outpatient and inpatient emergency care, room and board, diagnostic procedures as medically necessary during confinement, medicines as medically necessary during confinement, use of operating room, recovery room, and ICU diagnostic procedures, as medically necessary.
2. What are considered emergency cases and accidents?
An emergency case is a sudden, unexpected onset of illness or injury having the potential of causing immediate disability or death, or requires the immediate alleviation of severe pain and discomfort.
Accident means a visible, external, sudden and violent event occasioned by a physical or natural cause and occurring entirely beyond the Members’ control causing damage to the health of the Member.
ER Care All-In 80 Kids covers accidents that include, but are not limited to:
● Accidents, excluding Cerebrovascular (Stroke)
● Fracture, new
● Burns, new
● New animal bites, including first dose of vaccines
● Cuts, new, needing suturing
● Sports injuries, contact and noncontact sports, excluding professional sports and high-risk sports
● Accidental chemical poisoning
ER Care All-In 80 Kids covers diseases that include, but are not limited to:
● Acute Bronchitis
● Acute gastroenteritis with dehydration
● Acute tonsillopharyngitis with moderate dehydration
● Acute Sinusitis
● Acute tonsillopharyngitis
● Acute Upper Respiratory Tract Infection
● Amoebiasis
● Cellulitis
● Dengue Fever
● Acute Pneumonia
● Typhoid Fever
● Urinary Tract Infection
● SVI (systemic viral infection) with fever
● Measles with high-grade fever
● Chicken pox with complications
● Leptospirosis
● Polio
● Cholera
● Diphtheria
● Pertussis
● Tetanus
● Rabies
● Meningitis
● Chikungunya
● Malaria
● Anaphylactic Shock
● Acute Appendicitis
● Acute Gastritis
A Member’s eligibility to emergency care benefits under the Agreement shall be based on the final medical diagnosis.
3. Who is qualified for ER Care All-In 80 Kids?
Children, 1-17 years old, can get ER Care All-In 80 Kids and register as a Member.
4. When can I start using ER Care All-In 80 Kids?
From the day you register (“registration date”), the health voucher will be activated after ten (10) calendar days. Your health voucher is valid for 12 months or up until used which ever comes first.
Example: Registration date is Day 0. If you register on August 1, your health voucher will be activated on August 12. It will then be valid from August 12, 2018 to August 11, 2019 or up until used which ever comes first.
5. When can i register my product?
You have to register a name to your prepaid plan within 90 days from purchase date. The serial code will be valid up to then. After which, your serial code will no longer be available for register.
6. How many times can I register ER Care All-In 80 Kids in my name?
If you have already used your ER Care All-In 80 Kids health voucher, you can get another ER Care All-In 80 Kids to be covered again. Note that a person can only be covered by one (1) product offering emergency care benefits at any point in time.
7. If the benefit limit is not be wholly consumed, can I use the health voucher again in the future?
ER Care All-In 80 Kids is for one-time use only, regardless if the total annual benefit limit is consumed or not. The advantage of this health voucher is its high benefit limit, affordability, and convenient registration process. It assures you of assistance for most or all expenses you incur for outpatient emergency care, and allows you to avail and register another one to renew your coverage.
8. What are the special modalities covered by ER Care All 80 Kids?
Special Modalities as medically needed subject to Php 5,000 sublimit:
● Laparoscopic procedures
● Magnetic Resonance Angiography
● Magnetic Resonance Imaging (MRI)
● Computerized Tomography (CT) Scans
● Endoscopic Procedures (Therapeutic)
● Pain Management
● Arthroscopic Procedures, Orthopedic Arthroscopy
● Other medically necessary modalities not mentioned above and those for which there are no comparable, conventional or traditional counterparts
9. Is PhilHealth coverage needed to use ER Care All-In 80 Kids?
Yes. Once there is an admission, PhilHealth coverage is required since it also covers inpatient care. However, for those who do not have PhilHealth coverage, one may just pay the PhilHealth portion of the hospital bill before discharge.
10. If I already have an existing Insular Health Care plan with emergency care benefits, can I still register for ER Care All-In 80 Kids?
No. You cannot register for ER Care All-In 80 Kids if you are already enrolled in IHC’s other health care programs with emergency care coverage, even if your total benefit limit has already been consumed.
11. Can I register an ER Care All-In 80 Kids health voucher for someone else?
Yes, as long as you know the personal data of the individual and obtained his/her authorization to be registered. We have ER Care prepaid health vouchers that can be given as gifts to your loved ones. The data required for registration are as follows:
a. Full name
b. Birth date
c. Home address
d. Email address
e. Mobile number
12. Can I transfer ER Care All-In 80 Kids to another person?
ER Care All-In 80 Kids is transferable as long as it has not yet been registered. This also lets you purchase the health vouchers as gifts.
13. Can I use ER Care All-In 80 Kids in hospitals not on the health voucher’s provider list?
No. Services can only be availed in IHC-accredited hospitals and clinics.
14. What conditions are not covered by ER Care All-In 80 Kids?
Non-emergency and pre-existing conditions, congenital and maternity-related conditions, and other conditions under IHC’s General Exclusions list are not covered by this product.
An illness or condition is considered pre-existing if, prior to effective date of coverage:
(a) Any professional advice or treatment was given for such illness or condition;
(b) Such illness or condition was in any way already known to the Member; or
(c) The pathogenesis of such illness or condition had already started (of which the Member may not be aware of).
Non-coverable accidents include, but are not limited to: self-inflicted injuries; injuries from professional sports and high-risk sports; injuries or illnesses due to military, paramilitary, or police service; injuries from high risk activities or suffered under conditions of war; and accidents that are secondary to or contracted due to degenerative diseases such as Alzheimer’s Disease and Parkinson’s Disease.
General exclusions applicable to ER Care All-In 80 Kids
1. Viral and bacterial illnesses that are complications of or contracted due to a compromised or impaired immune system. The following are examples but not limited to:
a. Patients with malnutrition
b. Patients with uncontrolled diabetes mellitus
c. Recipients of organ transplant
d. Patients with hematologic malignancies
e. Patients undergoing radiation, chemotherapy, and immunosuppressive therapy
f. Patients with HIV/AIDS infection
g. Patients with foreign objects/implants such as venous or urinary catheters
h. Patients with auto-immune diseases such as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis, Multiple Sclerosis, and Guillain-Barre Syndrome
2. Viral infections like:
a. Hepatitis B, C, D, and E
b. Herpes infections like Epstein-Barr and Cytomegalovirus
3. Accidents and viral / bacterial illnesses that are secondary to or contracted due to having a degenerative disease such as but not limited to Alzheimer’s disease, Amyotrophic lateral sclerosis (ALS), Parkinson’s disease.
4. Conditions secondary to all pregnancy and fertility-related illnesses / treatments.
5. Lithiasis/stones of the gallbladder and genitourinary system.
6. Sexually transmitted infections such as, but not limited to, syphilis, gonorrhea, chlamydia, human papillomavirus (HPV) infection, and HIV/AIDS.
7. Pre-existing conditions except Hepatitis A.
8. Chronic viral and bacterial illnesses.
9. Congenital illnesses acquired through viral and bacterial infections.
10. Care by non-accredited Physician and/or in a non-accredited hospital.
11. All dental-related conditions and services.
12. Complications from sterilization of either sex or reversal of such, artificial insemination, sex transformations, and circumcision.
13. Rest cures, custodial, domiciliary, or convalescent care.
14. Complications arising from cosmetic surgery, dental/oral surgery and dermatological procedures for the purpose of beautification, including reconstructive surgery to treat a dysfunctional defect due to a disease or accident.
15. Psychiatric disorders, psychosomatic illnesses, hyperventilation syndrome, stress related conditions, adjustment disorders, alcoholism and its complications or conditions related to substance or drug abuse, addiction, and intoxication.
16. Medical and/or surgical procedures which are not generally accepted as standard treatment by the medical profession like acupuncture..
17. Procurement or use of corrective appliances, artificial aids and durable equipment, and orthopedic prosthesis and implants.
18. Surcharges resulting from additional personal (luxuries/accommodation) request or service including special nursing services.
19. Injuries or illnesses due to military, paramilitary, police service, high risk activities, or suffered under conditions of war.
20. Injuries or illnesses which are self-inflicted, caused by attempt at suicide or incurred as a result of or while participating in a crime or acts involving the violation of law, administrative order or ordinances.
21. Professional sports and high-risk sports.
22. Outpatient/Take home medicines.
23. Valvular Heart Disease and/or Rheumatic Heart Disease.
24. All hospital expenses and professional fees incurred by a Member when discharged against medical advise and those subsequent expenses incurred by the said Member for the same condition and its complications after such discharge during the contract period.
25. All hospital charges and professional fees after the day and time hospital discharge have been duly authorized.
26. Professional fees of assistant surgeons.
27. Use of emergency room facilities on non- emergency cases or by reason of conditions/ injuries not falling under the term “Emergency” as defined under this Agreement.
28. Diseases declared by the Department of Health as “epidemic”.
29. Miscellaneous Fees not related in the diagnosis and treatment of a member's condition such as, but not limited to, “nursing fee”, waste/biologic hazard disposal fee, management fee, local taxes, and other analogous fees.
30. Medico-legal consultations and confinements.
31. All expenses incurred in the process of organ donation and transplantation as donor or recipient.