ER Shield and ER Vantage Plus are one-time use emergency health plans while Health Vantage is a multiple-frequency of availment emergency plan.

Depending on the program’s service coverage, the following are the covered conditions:

• Accidents, excluding Cerebrovascular (Stroke)
• Acute Appendicitis
• Acute Bronchitis
• Acute Gastritis
• Acute Gastroenteritis
• Acute Pharyngitis
• Acute Sinusitis
• Acute Tonsillitis
• Acute Upper Respiratory Tract Infection
• Amoebiasis
• Cellulitis
• Dengue
• Fracture, new
• Acute Pneumonia
• Sprain
• Typhoid Fever
• Upper Respiratory Tract Infection
• Urinary Tract Infection
• Viral Infection

For conditions that can be covered, ER Shield plan provides coverage up to Php 50,000 for the following:

• Hospital emergency room care
• Treatment for animal bites except cost of vaccines
• Diagnostic and therapeutic procedures that are medically necessary for emergency room care

The ER Shield and ER Vantage Plus are for one-time use only, regardless if the total aggregate benefit limit is consumed or not. The advantage of ER Shield and ER Vantage Plus plans is that, for a very affordable amount, you are assured of assistance, for the big portion of the hospital emergency care expenses, if not all, that you will incur.

Health Vantage plan, on the other hand, has no limit on the number of times you use the plan within a year as long as the aggregate benefit is not yet consumed.

For ER Shield plan, PhilHealth is not required. However, for ER Vantage Plus and Health Vantage, once there is an admission, a PhilHealth coverage is required.

For those who do not have PhilHealth coverage, one may just pay the PhilHealth portion of the hospital bill before discharge.

It is so convenient to have an ER Shield, ER vantage Plus, or Health Vantage plan. The only membership requirement is the age. For ER Shield and ER Vantage Plus, individuals must be 6 months to 65 years old from the plan’s effectivity (7 days from registration date). Registration can be done online. For Health Vantage, individuals must be 6 months to 65 years old to be enrolled under these programs.

No, you can use your ER Shield or your ER Vantage Plus emergency health plan, 7 days from registration date. That is why it is important to immediately register your ER Shield or ER Vantage plan once you get it.

You can start using your Health Vantage plan seven (7) days from date of completion of payment and registration.

There is no limit on the number of plans that you may register in your name within a year. However, you can only register the second plan after the first plan is availed. Meaning there should only be one active plan at any given time.

Yes, you can only enroll once under the Health Vantage program per year, even if your aggregate benefit limit was already consumed.

Yes, you may, as long as you know their personal data required for the registration/application.

You may use the plan within one year from the start of plan effectivity.

As long as it is not yet registered, the ER Shield and ER Vantage Plus are transferable. That is why one can purchase the plans for gifts or corporate giveaways.

Non-emergency, pre-existing, congenital, maternity related and those conditions under PhilCare’s general exclusion list will not be covered.

An illness or condition is considered pre-existing if prior to the effective date of health coverage the pathogenesis of such illness or condition has started, whether the member is aware or not.

Emergency cases are the sudden, unexpected onset of illness or injury, which at the time of contract reasonably appeared as having the potential of causing immediate disability or death or requiring the immediate alleviation of severe pain and discomfort. Emergency cases include but are not limited to the following:

• Massive Bleeding
• Acute Appendicitis
• Fractures/multiple injuries secondary to accidents
• Convulsions
• Illnesses or conditions resulting in moderate or severe dehydration such as diarrhea or fever
• Syncope

A. List of diseases not covered but not limited to:

• Anal fistulae
• Asthma
• Auto immune conditions
• Cardiovascular diseases
• Calculi of the urinary system
• Cataracts
• Sinus conditions requiring surgery
• Cerebrovascular diseases
• Cholecystitis/cholelithiasis
• Chronic skin conditions
• Cirrhosis of the liver
• Collagen disease
• Degenerative conditions
• Diabetes mellitus
• Diseased tonsils requiring surgery
• Endometriosis
• Epilepsy
• Gastric or duodenal ulcer
• Hallux valgus
• Hemorrhoids
• Hernia
• HIV/AIDS
• Hypertension
• Neurologic conditions
• Obesity, dyslipidemia and other metabolic conditions
• Pathological abnormalities of nasal septum and turbinates
• Thyroid conditions
• Tuberculosis
• Tumors, whether benign or malignant of all organs and organ systems, including malignancies of the blood or bone marrow
• Non-emergency case during point of availment
• Pre-existing and congenital conditions

B. General exclusions applicable to health care coverage:

• Care by Non-Affiliated Physician in either Affiliated or Non-Affiliated Hospitals
• Care by an Affiliated Physician in Non-Affiliated Hospital
• Additional hospital charges and professional fees resulting from taking a room category higher than that specified in the member’s benefit schedule
• Additional personal comfort items (e.g., telephone and television, additional food trays, admission kit and such other items of the same nature)
• Procurement or use of corrective appliances, prosthesis, artificial aids and durable equipment such as but not limited to the following: stents, prolene mesh, pins, screws, plates, wires, VP shunt, clips, hearing aids, intraocular lens, eyeglasses, contact lenses, balloons, valves; braces, crutches, pacemaker
• All pregnancy-related conditions and complications relating to mother and unborn child, requiring medical and surgical care, regardless of time/date of occurrence (during the actual time of pregnancy or thereafter)
• All sexually transmitted diseases
• Blood screening, blood typing, cross-matching for potential donors in relation to blood donation and transfusion
• All forms of behavioral disorders whether congenital or acquired; developmental or psychiatric disorder; psychosomatic illness
• Any injury, illness or condition which the member may suffer after he has taken intoxicating drugs or alcoholic beverage as evidenced by clinical history or alcoholic breath as determined by the examining physician and/or conditions or illnesses resulting from alcoholism and drug addiction
• Medical or surgical procedures that are experimental in nature and those that are not generally accepted as standard medical treatment by the medical profession, that may include but is not limited to Chiropractic Services, Acupuncture, and Reflexology;
• Allergens used for hypersensitivity testing regardless if administered as an outpatient or inpatient procedure
• Treatment of injuries or illnesses resulting from the voluntary participation of a member in any hazardous sport or activity that may include but is not limited to: bungee jumping, scuba diving, hang-gliding, mountain climbing, parachuting, surfing, rock climbing, airsoft, paintballing, boxing, wrestling, martial arts (such as taekwondo, judo, karate, etc.), gymnastics, motorsports (drag racing, jet skiing), wakeboarding, water skiing and all such other voluntary activities which pose a grave danger to life and limb.
• Treatment of injuries or illnesses due to military service or suffered under conditions of war
• Treatment of injuries or illnesses wherein the care or reimbursement of services is provided by law or a government program, up to the stipulated limits
• Treatment of any injury which is proven to be attributable to the member’s own misconduct such as negligence, intemperate use of drugs or alcoholic liquor, direct or indirect participation in the commission of a crime, whether consummated or not, violation of a law or ordinance, unnecessary exposure to imminent danger or hazard to health,including fireworks related injuries, infections or complications as a result of tattoos and piercing of the ear or any body part, whether self-inflicted or done by a third party, or attempted suicide self-destruction, whether sane or insane
• All cases of assault perpetrated by the Member including domestic violence which result in harm or injury to the Member perpetrator
• Vaccines, whether elective or administered during an emergency treatment are not covered
• Inpatient pain management necessitating specialized pain management team and/or the use of specialize equipments
• All diseases declared as epidemic by the Department of Health (DOH) and any other recognized health agencies
• All hospital charges and professional fees incurred after the day and time the discharge from hospital has been duly authorized
• All procedures and/ or services considered screening
• Pre-existing and congenital anomalies and conditions, and their complications
• Cosmetic procedure and surgery and oral surgery solely for the purpose of beautification except reconstructive surgery to treat functional defects due to disease or accidental injury