ER CARE ALL-IN 80 ADULTS

1. What does ER Care All-In 80 Adults cover?
With a Php 80,000 benefit limit, ER Care All-In 80 Adults 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 Adults 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 Adults 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 Adults?
Adults, 18 to 64 years old, can get ER Care All-In 80 Adults and register as a Member. Upon purchase, you can register online at https://services.insularhealthcare.com.ph/.

4. When can I start using ER Care All-In 80 Adults?
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 Adults in my name?
If you have already used your ER Care All-In 80 Adults health voucher, you can get another ER Care All-In 80 Adults 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 Adults 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 Adults?
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 Adults?
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 Adults?
No. You cannot register for ER Care All-In 80 Adults 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 Adults 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 Adults to another person?
ER Care All-In 80 Adults 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 Adults 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.

14. What conditions are not covered by ER Care All-In 80 Adults?
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.

For more information, see “General Exclusions”.