DESCRIPTION:
ER Care Basic 50 is a one-time use prepaid health voucher that provides up to Php 50,000 outpatient emergency care coverage on emergency cases due to accidents. It is accepted in 500 Insular Health Care-accredited hospitals nationwide (excluding *Top 6 Hospitals). To know more about the complete benefit coverage of ER Care Basic 50 and its terms and conditions, read Insular Health Care's Health Care Agreement.
The Php 50,000 benefit limit covers these items:
✓ Doctor's fee
✓ Laboratory and diagnostic procedures
✓ Emergency room care
✓ Medicines as medically necessary in the emergency room
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.
"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 Basic 50 are new fractures, new burns, new animal bites, and new cuts that need suturing.
This health voucher is applicable to adults, 18 to 64 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.
*Top 6 Hospitals – Asian Hospital and Medical Center, Cardinal Santos Medical Center, Makati Medical Center, St. Luke's Medical Center (QC and BGC) and The Medical City
1. What does ER Care Basic 50 cover?
With a Php 50,000 benefit limit, ER Care Basic 50 covers emergency cases due to accidents. It covers expenses on outpatient emergency room care, and medicines as medically necessary administered in the emergency room.
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 Basic 50 covers accidents that include, but are not limited to:
● Accidents, excluding Cerebrovascular (Stroke)
● Fractures, new
● Burns, new
● New animal bites, including first dose of vaccines
● Cuts, new, needing suturing
● Sports injuries, contact and non-contact sports (except professional sports and high-risk sports)
● Accidental chemical poisoning
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 Basic 50?
Adults, 18 to 64 years old, can get ER Care Basic 50 and register as a Member.
4. When can I start using ER Care Basic 50?
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 Basic 50 in my name?
If you have already used your ER Care Basic 50 health voucher, you can get another ER Care Basic 50 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 Basic 50 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. Is PhilHealth coverage needed to use ER Care Basic 50?
No. PhilHealth coverage is not required since ER Care Basic 50 only covers outpatient emergency care.
9. If I already have an existing Insular Health Care plan with emergency care benefits, can I still register for ER Care Basic 50?
No. You cannot register for ER Care Basic 50 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.
10. Can I register an ER Care Basic 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
11. Can I transfer ER Care Basic 50 to another person?
ER Care Basic 50 is transferable as long as it has not yet been registered. This also lets you purchase the health vouchers as gifts.
12. Can I use ER Care Basic 50 in hospitals not on the health voucher’s provider list?
No. Services can only be availed in IHC-accredited hospitals and clinics.
Check www.insularhealthcare.com.ph/our-partners to see the list of IHC-accredited hospitals.
13. What conditions are not covered by ER Care Basic 50?
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 Basic 50
1. Accidents 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), and Parkinson’s disease.
2. Conditions secondary to all pregnancy and fertility-related illnesses / treatments.
3. Care by non-accredited Physician and/or in a non-accredited hospital.
4. All dental-related conditions and services.
5. Complications from sterilization of either sex or reversal of such, artificial insemination, sex transformations, and circumcision.
6. Rest cures, custodial, domiciliary, or convalescent care.
7. 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.
8. 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.
9. Medical and/or surgical procedures which are not generally accepted as standard treatment by the medical profession like acupuncture.
10. Procurement, lease/rent or use of corrective appliances, artificial aids and durable equipment, and orthopedic prosthesis and implants.
11. Surcharges resulting from additional personal (luxuries/accommodation) request or service including special nursing services.
12. Injuries or illnesses due to military, paramilitary, police service, high risk activities, or suffered under conditions of war.
13. 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.
14. Professional sports and high risk sports.
15. Outpatient/Take home medicines.
16. Valvular Heart Disease and/or Rheumatic Heart Disease.
17. 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.
18. All hospital charges and professional fees after the day and time hospital discharge have been duly authorized.
19. Professional fees of assistant surgeons.
20. 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.
21. 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.
22. Medico-legal consultations and confinements.
23. All expenses incurred in the process of organ donation and transplantation as donor or recipient.