ER Protect

The charges incurred by the Insured Member in case of treatment of an Emergency Case are payable subject to the following conditions and to the maximum benefit amounts as stated in the Policy Specification Page:

• The charges incurred by the Insured in case of confinement due to Dengue are payable subject to the following conditions and to the maximum benefit amount as stated in the Policy Specification Page:
• Availment of hospitalization reimbursement for the Dengue benefit has a waiting period of thirty (30) days from the effective date of this Policy or the Insured’s coverage, whichever is later. There will be no coverage during the thirty (30)-day waiting period;
• Confinement should be recommended by a qualified physician in the Hospital for a continuous period of at least eighteen (18) hours;
• Only Eligible Expenses that are necessary and reasonable shall be covered. This includes customary Physician’s fees, hospitalization fees, medical supplies and medications incurred in the treatment of the Dengue ailment while confined;
• The medical benefits of this Policy is ‘on top of PhilHealth’. As such, a completely filled out PhilHealth Form should always be filed within an appropriate time during confinement to the appropriate section/person in the hospital. Failure to submit a fully accomplished PhilHealth Form to the appropriate section/person in the hospital within the appropriate time prior to discharge does not constitute the Company’s assumption on the coverage of the amount that PhilHealth covers.

• No payment shall be made under Accidental Death and Dismemberment benefit for any claim resulting from or caused directly or wholly by:
• Bodily or mental infirmity, hernia, ptomaine, or bacterial infection (except phylogenic infection occurring through an accidental cut or wound), disease, or sickness of any kind.
• Poison, gas, or fumes (voluntarily or involuntarily taken), atomic explosions, nuclear fission, or radioactive gas.
• An accident occurring while or because the Insured Individual is affected by alcohol or any unprescribed drug.
• Suicide or any suicide attempt, whether sane or insane.
• Participation in any brawl.
• Any violation or attempted violation of the law, or resistance to arrest.
• Murder or provoked assault.
• War (declared or undeclared), strike, riot, civil war, revolution, any war-like operations, or while under orders for war-like operations or restoration of public order.
• Entering, operating, or servicing, or ascending from any aerial or marine transportation.