Total ProtectER is a total protection package composed of a term insurance product with a daily hospital income benefit for a six-month coverage; and a one-time use health care voucher that provides up to Php100,000 worth of coverage for emergency cases due to accidents and viral and bacterial illnesses and specific conditions.
- Php3,000 daily hospital income benefit. This benefit is given if hospital confinement is due to accidental injury or sickness (including COVID-19), within the six-month coverage period. Insured can reimburse Php3,000 hospital income benefit per day, as long as hospital confinement is at least 4 days, maximum of 90 days.
- Php500,000 life insurance coverage. This benefit is given to the beneficiary upon Insured’s death due to natural or accidental causes (including COVID-19) within the six-month coverage period.
- ER Care All-In 100 Adults benefits. Services include outpatient and inpatient emergency care, regular private room use, laboratory and diagnostic procedures, and medicines as medically required. It is accepted in more than 500 IHC-accredited hospitals nationwide excluding Top 6 hospitals*.
- Available for ages 18-64 years old.
- No medical exams required, but Insured should be in good health at point of application.
- Purchase, registration and activation are 100% online.
- Proof of Cover (POC) and voucher will be delivered via e-mail.
THINGS TO NOTE:
HOSPITAL INCOME BENEFIT
Hospital Confinement Due to Injury or Sickness. If an injury or sickness results in the hospital confinement of the Insured Individual, the Company will pay the Hospital Income Benefit in the form of a daily hospital allowance upon receipt of satisfactory proof of the hospital confinement of the Insured Individual. The daily hospital allowance of Php3,000 will be paid during the continuance of the Insured Individual’s hospital confinement subject to a maximum period of 90 days for the six-month coverage and to an elimination period of 3 days.
There shall be a maximum of 15 days per hospital confinement.
- For related confinements, a gap of not more than 90 days between such confinements is considered as one (1) confinement.
- For example: gap between a) discharge from confinement 1 and b) admission for confinement 2 is 30 days. Since 30 days is less than 90 days, this is considered as one confinement only.
Pre-existing conditions and limitations shall apply.
Pre-Existing Conditions and Limitations. During the waiting period of two months within the Insured Individual’s coverage, no benefit shall be provided for hospital confinement resulting directly or indirectly from injury sustained or a sickness or condition which was evident or for which the Insured Individual received medical advice or treatment within six (6) months prior to the effective date of this Rider.
Conditions Not Covered.
- 1. Hospital confinement and the continuation of such confinement during the entire period thereof which is not recommended and/or approved by a legally qualified physician;
- 2. Any confinement for physical check-up for diagnostic purposes;
- 3. Any hospital confinement caused by any of the following:
- 3.1. Injuries or illnesses which are self-inflicted, caused by attempt at suicide, or incurred as a result of or while participating in the commission of a crime;
- 3.2. Pregnancy, childbirth, miscarriage, abortion, or complications of any of these;
- 3.3. Sex transformations, artificial insemination, or treatment of infertility;
- 3.4. Rest cures, custodial, domiciliary, or convalescent cares;
- 3.5. Cosmetic surgery and oral surgery for the purpose of beautification;
- 3.6. Functional disorders of the mind, drug addiction or alcoholism;
- 3.7. Sexually transmitted diseases, AIDS and AIDS related diseases;
- 3.8. Injuries or illness suffered under conditions of declared or undeclared war or strife;
- 3.9. Congenital deformities and defects;
- 3.10.Provoked assault;
- 3.11. Atomic explosion, nuclear fission or radioactive gas; and
- 3.12. Any bodily injury sustained by the Insured Individual while he is in or on any airplane or aerial device except while traveling as a fare-paying passenger in a passenger airplane which is:
- 3.12.1. Operated by a regular passenger airline;
- 3.12.2. Operated by a duly licensed pilot; and
- 3.12.3. Traveling on a scheduled passenger trip over an established passenger route.
Notice and Proof of Disability. The Insured Individual or his authorized representative should notify the Company in writing of the hospital confinement of the Insured Individual within fifteen (15) days from admission. Subject to written proof of hospital confinement, all accrued benefits under this Rider will be paid upon the Insured Individual’s discharge from the hospital.
The Company reserves the right to examine the Insured Individual in the manner and at all times that it may find necessary.
BASIC LIFE INSURANCE
Amount of Insurance. Individual shall be insured for Php500,000 for a period of six (6) months.
Notice and Proof of Death.The Company will pay the designated beneficiary the corresponding Amount of Insurance upon receipt and approval by the Company of due proof/s that the Insured Individual died while insured under this contract and in accordance with its terms.
Beneficiary. The beneficiary designated by the Insured Individual in his application shall receive the death benefit provided that the beneficiary is living at the time of death of the insured individual.
If no qualified beneficiary is designated by the Insured Individual or if no qualified beneficiary survives the insured individual, the following classes of beneficiaries, in this order of preference, shall be deemed named by the insured individual as his contingent beneficiary or beneficiaries: (1) surviving legitimate spouse (2) surviving legitimate, legitimated, and legally adopted children (3) surviving illegitimate children (4) surviving parents (5) surviving siblings of the full blood (6) surviving siblings of the half-blood (7) executors or administrators.
If there be two or more beneficiaries in the same class entitled to the proceeds of the insurance, they shall share equally. Any minor’s share shall be paid to him in the manner provided for by law.
Suicide. The Company shall be liable in case of suicide committed in the state of insanity. If suicide is not compensable, the Company would refund the premium paid for the individual.
ER CARE ALL-IN 100 ADULTS
The Php 100,000 benefit limit covers the ff:
- Doctor’s professional fee
Laboratory and diagnostic procedures
Emergency room care
Regular private room accommodations
Medicines as medically necessary in the emergency room and during confinement
Surgery and surgeon’s fees when medically necessary
se of operating room, recovery room, and ICU, as medically necessary
Hospital cash allowance of Php 1,000 when confined
“Emergency” shall mean the sudden, unexpected onset of illness or injury having the potential of causing immediate disability or death or requiring the immediate alleviation of severe pain and discomfort.
“Accident” shall mean 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. Some examples of accidents covered by ER Care All-In 100 are new fractures, new burns, new animal bites, and new cuts that need suturing.
“Viral and bacterial illnesses” are diseases caused by viruses and/or bacteria. Some examples of viral and bacterial illnesses covered by ER Care All-In 100 Adults are Acute Upper Respiratory Tract Infection, Amoebiasis, Dengue Fever, Typhoid Fever, and Urinary Tract Infection.
This health voucher is applicable to adults, 18 to 64 years old, and is valid for 12 months or up until used. The final medical diagnosis shall be the basis for a Member’s eligibility to emergency care benefits under the Agreement.
*Asian Hospital & Medical Center, Cardinal Santos Medical Center, Makati Medical Center, St. Luke’s Medical Center (QC & BGC) and The Medical City
To know the complete benefit coverage of ER Care All-In 100 Adults, read Insular Health Care’s Health Care Agreement.