Emergency Care Benefits

If the emergency care treatment will be provided to the Member, he shall be entitled to the benefits listed below

Emergency Care Benefits:

  • Doctor's services
  • Emergency room fees
  • Medicines used for immediate relief during treatment (excluding prescribed out patient medicines)
  • Oxygen, intravenous fluids and blood products
  • Dressings, conventional casts (plaster of Paris) and sutures
  • X-ray, laboratory, and diagnostic examinations, and other medical services related to the emergency treatment of the patient.
  • Ambulance Service up to P2,500.00 per member per year if medically necessary from hospital to hospital on a reimbursement basis

IN NON-ACCREDITED HOSPITALS
Reimbursable up to 80% of hospital bills & professional fees based on HMO rates up to P15,000.00 per member per case.


OUTSIDE THE PHILIPPINES
Reimbursable up to 100% of hospital bills & professional fees based on HMO rates up to P15,000.00 per member per case. (at prevailing exchange rates)

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AREAS WITHOUT ACCREDITED HOSPITAL
Reimbursable up to 100% of hospital bills & professional fees based on HMO rates up to the plan limit.


INVOLUNTARY ROOM UPGRADE (IF EMERGENCY CASE LEADS TO CONFINEMENT)
Involuntary room upgrade to the next higher room category (except for Suite room) is allowed in case of non-availability of member’s assigned room within the first 24 hours. After twenty-four (24) hours, the MEMBER must transfer to his/her designated room category, otherwise incremental charges shall be billed to the MEMBER from day two (2) of confinement onwards.