| BENEFITS | ER BASIC 599 | ER PLUS 699 |
|---|---|---|
| ER Hospitalization due to Accidents & Three (3) Critical Illnesses (Heart Attack, Stroke, and Cancer) | Up to ₱10,000.00 |
Up to ₱20,000.00 |
| ER Hospitalization due to Other Illnesses and Motorcycle Related Accidents (sublimit of ER Hospitalization due to Accidents & Three (3) Critical Illnesses) | Up to ₱5,000.00 |
Up to ₱10,000.00 |
| Confinement Allowance (up to 31 days) | ₱300.00/day | ₱500.00/day |
| Annual Premium | ₱599.00 | ₱699.00 |
TERMS AND CONDITIONS
- Insured can avail one (1) policy only
- Eligibility: Insured must be 1 year old to 70 years old
- Emergency Room Hospitalization due to Illness Classification and Coverage:
(I) Emergency Room (ER) admission of the Insured Person shall be deemed covered when such admission is necessitated by injury resulting from an accident or by a life-threatening illness falling under the Insurer’s defined Top Three (3) Critical Illnesses, namely:
• Heart Attack (Myocardial Infarction);
• Stroke (Cerebrovascular Accident);
• Cancer (Malignant Neoplasm).
(II) All other illnesses that manifest suddenly and unexpectedly, and which require immediate medical attention to prevent death or long-term impairment of the Insured Person, shall be reimbursable up to fifty percent (50%) of the applicable coverage amount, subject to the terms, conditions, and exclusions of the Policy. - Accident Limitation: Motorcycle-Related Accidents
Injuries sustained due to a motorcycle-related accident—whether as a driver, rider, or passenger—shall be covered only up to fifty percent (50%) of the applicable accident-related ER coverage limit, subject to all other policy terms and exclusions.
DEFINITION
ER Hospitalization Reimbursement: Reimbursement of your payments for covered ER charges, up to the policy limit. (Subject to deduction of amounts covered by HMO, PhilHealth, or any other third-party.
Confinement Allowance: Pays allowance benefit for maximum 31 days when insured is confined due to emergency cases, up to the policy limit. (Hospitalization Confinement Requirement: Admitted to the Emergency Room and subsequently confined as in-patient.)
OTHER CONDITIONS
- The policy can be used multiple times and is reimbursable as long as the coverage has not yet been exhausted.
- The medical certificate should expressly state that admission to the Emergency Room is due to a serious or life-threatening situation that requires immediate medical care to prevent death or serious long-term permanent impairment.
- Treatment for Pre-existing Conditions: Pre-existing condition shall mean medical conditions (sickness) which were in any way evident to the Insured before the effectivity of the policy, or the natural history/pathogenesis of such condition can be clinically determined to have started two (2) years prior to the effectivity of the policy, whether or not the Insured is aware of such sickness, or for which the Insured received treatment, or had consulted a physician for treatment, or had been taking medications.
Notwithstanding the foregoing definition, a pre-existing condition may be covered under this Emergency Room Insurance provided that the Insured had completed a waiting period of at least one hundred eighty (180) consecutive days from the effective date of the policy, during which the Insured was not manifestly or apparently ill and had been free from any signs, symptoms, consultations, treatment, or medication related to the same condition. Emergency Room treatment shall only be compensable when the condition is sudden, unforeseen, and of such severity that immediate medical attention is required to prevent death or serious permanent impairment.
EXCLUSIONS
The Policy will not cover any loss or expense caused by or resulting from:
- Treatment for Communicable Disease: Communicable Disease shall mean any communicable disease declared by any government agency, entity or in an executive order causing a state of emergency in any area and necessitating the setting up of appropriate quarantine measure therein excluded in the policy.
- Treatment of self-inflicted injury, suicide or attempted suicide, or affray, abuse of alcohol, drug, addiction or substance abuse, pregnancy or childbirth.
- Motorcycle related injuries or loss of life with expired or invalid driver’s licensed, expired vehicle registration.
- Injury or illness while serving as a full-time active-duty member of police or military unit and treatment resulting from participation in war, riot, civil commotion or any illegal act including resultant imprisonment. Except during off duty or on leave.
- Treatment of injuries that are sustained when taking part in any sports for which the insured are paid, are competing for money prize, and in hazardous sports activities.
- Emergency Medical availment prior to the effectivity of the policy.
- Treatment for Pre-existing Conditions: Pre-existing condition shall mean medical conditions (sickness) which were in any way evident to the insured before the effectivity of the policy or the natural history/pathogenesis of such condition can be clinically determined to have started two (2) years prior to the effectivity of the policy, whether or not the insured is aware of such sickness, or for which the insured received treatment, or have consulted a physician for treatment for have been taking medications.
These are only some of the exclusions. Complete listings are in the issued policy.
