A0W5D10

BEREDICO, LEONARDO E

1/23/2023 - 1/22/2024

AGE ELIGIBILITY

Unli-Consult for 65+ is for age 66 years old and above. This Certificate of Coverage is non-transferable once
activated.

BENEFIT COVERAGE

Unli-Consult for 65+ gives you a one (1) year unlimited medical consultations with specific PhilCare-accredited
physicians nationwide and dental consultations with PhilCare’s network of dentists and one (1) year unlimited
HeyPhil Digimed consultation. The Coverage is inclusive of the following benefits:

Medical Consultations:
Unli-Consult for Adults covers consultations with the following Physicians :
§ Family Medicine Specialists
§ Internal Medicine
§ General Physician
§ Cardiologists
§ Pulmonologists
§ Gastroenterologists
§ Nephrologists

Dental Service:
§ Annual dental examination/annual oral examination
§ Unlimited orthodontic or aesthetic consultation
§ Gum treatment for lesions, wounds, and burns, except alveolectomy and gingivectomy 
§ Relief and/or prescription for acute dental pain 
§ Diagnosis of oral disease, restorative and prosthodontic treatment planning 
§ Dental nutrition and dietary counseling 
§ Dental health education through Chairside Instruction 
§ First aid treatment/emergency treatment 
§ Unlimited temporary fillings 
§ Re-cementation of loose crowns, inlays, onlays, and fixed bridges 
§ Simple repair and adjustment of denture 
§ Simple tooth extraction/unlimited simple extraction of an unsavable tooth 
§ Desensitization of hypersensitivity teeth 
§ Annual prophylaxis (light cases only)

Exclusions:
The only exceptions are maternity-related cases and cases related to all forms of behavioural disorders ,
developmental or psychiatric disorder and psychosomatic illness whether acquired or congenital.

Other Benefits
Consultations for pre-existing conditions not requiring emergency attention
 AVAILMENT PROCEDURE

Consultation Availment

1. For medical consultations, create a self-issued Letter of Authorization (LOA) and personalized
membership card at Consultation Page. Present LOA, personalized membership, card and 1 valid ID
with picture to chosen medical specialist.
2. For dental consultations, ensure to call the dentist first for available schedule. download and print the
personalized membership card at  Consultation Page and present this with one (1) valid ID of the
cardholder on the day of availment. 

Digital Consultation Procedure

1. Download the HeyPhil DigiMed application through Play Store (for android phones) or App Store (for
IPhones)
2. Log in using the credentials sent to your registered email.
3. Go to DigiConsult.
4. Enter your Chief Complaint or the reason why would you like to seek for medical consultation.
5. Attach a photo of your most recent doctor’s prescription or laboratory test results if available, otherwise,
proceed to read and agree with the terms and conditions in availing a digital consultation.
6. Click the Request Consultation to queue your digiconsult request with one of our DigiMed doctors.
7. Stand by for your DigiMed Doctor’s call until the submitted chief complaint and copies of prescription
and laboratory test results have been assessed. Please be reminded that your DigiMed Doctor calls
from an unregistered number in your contact list.
8. Engage with a medical tele-conferencing with your DigiMed Doctor.
9. Check on the medical assessment and prescription sent to your registered email.
10. Rate and send your feedback about your HeyPhil DigiMed consultation experience.

IMPORTANT REMINDERS

* Terms and conditions apply

** See FAQs for more details
The Certificate of Coverage (COC) is issued together with the soft copy policy (provided within 24 hours from
COC receipt). To request for a full hard copy policy contract, please send an email to [email protected].

I. Emergency Cases That Cannot Be Accommodated in an Out-patient Consultation

These are medical conditions requiring urgent care within the hospital facility:

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: (a) Massive Bleeding; (b) Acute Appendicitis; (c) Fractures/multiple injuries secondary to
accidents; (d) Convulsions; (f) Illnesses or conditions resulting in moderate or severe dehydration such as
diarrhea or fever; and (e) Syncope.

II. General Exclusions

No Healthcare Benefits shall be paid for the following services, procedures or conditions unless otherwise
specified in the Agreement.

1. All forms of behavioral disorders whether congenital or acquired; developmental or psychiatric disorder ;
psychosomatic illness.
2. All Sexually Transmitted Diseases such as but not limited to herpes, gonorrhea, syphilis and conditions
such as vulvar warts
3. Injuries resulting from direct participation in riots, strikes, and other civil disturbances.
4. All diseases declared as epidemic or pandemic by the Department of Health or any recognized health
agencies.
5. Cosmetic procedure and surgery and oral surgery solely for purpose of beautification, including but not
limited to wart removal through excision or electrodessication/ cauterization, mesotherapy, liposuction,
except reconstructive surgery to treat functional defects due to disease or accidental injury.
6. Weight reducing programs, surgical operation or procedure for treatment of obesity, including but not
limited to gastric stapling.
7. Dental examination, extraction, fillings and general dental attention and conditions and all complications
arising there from, including oral surgery and prosthodontics procedures following accidental injury to
teeth for purposes of beautification. Exceptions are treatment to the extent necessary for repair and or
restoration of function of the Member caused solely by accidental injuries.
8. All pregnancy-related conditions and their complications, requiring medical and surgical care, regardless
of time/date of occurrence (during the actual time of pregnancy or thereafter). MATERNITY-RELATED
or PREGNANCY-RELATED. Any cause or condition arising out of or during any one pregnancy ,
childbirth, miscarriage or abortion or any complications arising from the same.
9. Circumcision, sterilization of either sex or reversal of such, artificial insemination, sex transformation or
diagnosis and treatment of infertility.
10. 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.
11. Routine physical examinations required for obtaining or continuing employment, requirement in school ,
insurance, government licensing, health permit and other similar purposes.

12. Procedure and/or services considered screening.

13. Treatment for injury and its complications resulting from self -inflicted injuries including infections as a
result of tattoos, piercing of the ear or in any body part, whether self -inflicted or done by a third party or
attempted suicide or self-destruction, whether sane or insane.
14. Treatment of any injury received wherein there is negligence, unauthorized use of prohibited or
regulated drugs, alcoholic liquor intake, direct or indirect participation in the commission of a crime
whether consummated or not, violation of a law or ordinance or unnecessary exposure to imminent
danger, knowingly or unknowingly, or hazard to health, by the Member.
15. Any injury, illness or condition which the Member may suffer after he/she has taken intoxicating drugs or
alcoholic beverage as evidenced by clinical history or alcoholic breath as duly determined by the
examining physician/medical personnel and/or as indicated in the police report and other official medical
documents conditions or illnesses resulting from alcoholism and drug addiction.
16. Treatment of injuries or illnesses caused directly or indirectly by engaging in any professional sport or
hazardous activity such as but not limited to scuba diving, surfing, water skiing, mountain climbing, rock
climbing, mountaineering, parachuting, airsoft, drag racing, paintballing, wakeboarding and bungee
jumping.

17. Treatment of injuries or illnesses due to military service or suffered under conditions of War .
18. Treatment for Chronic Dermatoses
19. Services obtained for non-emergency conditions from physicians and hospitals in any of the following
circumstances:
a. non-affiliated physicians in non-affiliated hospitals or non- affiliated clinics
b. non-affiliated physicians in affiliated hospitals or affiliated clinics
c. affiliated physicians in non-affiliated hospitals or non-affiliated clinics or other healthcare facility.
20. Additional hospital charges and physician’s professional fees resulting from :
a. room-upgrading beyond twenty-four (24) hours during Emergency Conditions;
b. extension of hospital stay despite release of discharge order from Member’s Attending Physician ;
c. fees of the assistant surgeons for surgeries with less than 250 RUV units/resident doctors who
assisted the Attending Physician in the process of rendering the medical services shall not be
chargeable to PhilCare except for hospitals that do not have resident physicians to assist during
surgeries subject to the prior approval of PhilCare;
d. use of extra bed, TV, electric fan, DVD/VCD and other similar items unless such appliances and
items are necessarily and ordinarily included in the Member’s Room and Board Accommodation ;
e. extra food, toilet articles like face towel, soap, toothbrush and the like;
f. difference in Room and Board Accommodation, the incremental rate differences for professional
fees, diagnostic and laboratory examination, and other ancillary medical services brought about
by obtaining a room and board accommodation higher than the Member’s Room and Board
Accommodation limit;
g. services of a private or special nurse;
h. all other items not medically necessary in the medical management of the Member.
21. Custodial, Domiciliary, Convalescent and Intermediate care. These pertain to care in a skilled affiliated
facility or an institution that meets certain standards for medical car and includes nursing care and
therapeutic services following hospital confinement.
22. Medical Certificates.
23. Professional fees of medico-legal officer/s.
24. All expenses incurred in the process of organ donation and transplantation if the Member is the donor
and its complications.
25. Benefits covered by PhilHealth and all other government funded healthcare entitlements as provided for
by law.
26. Cost of the medical services and professional fees in excess of the MBL and applicable inner limits of
the Plan.
27. Purchase of lease of any Durable Medical Equipment, oxygen dispensing equipment, and oxygen
except during covered in-patient care.
28. Procurement or use of corrective appliances, prosthesis, artificial aids and durable equipment such as
but not limited to the following: (a) stents; (b) prolene mesh; (c) pins, screws, plates, wires; (d) VP
shunt, clips; (e) hearing aids; (f) intraocular lens, eyeglasses, contact lenses; (g) balloons, valves; (h)
braces, crutches; (i) pace maker.
29. Hepatitis B, C and D.
30. Allergens used for hypersensitivity testing regardless if administered as an out -patient or in-patient
procedures.
 31. Blood screening, blood typing, cross-matching for potential donors.
32. Executive check-ups and confinement which are for purely diagnostic purposes except as specified in
the Agreement.
33. All cases of assault perpetrated by the Member including domestic violence which result in harm or
injury to the Member perpetrator.
34. Charges by Physicians and health professionals, whether or not affiliated by PhilCare, on the difference
between their charged rate and PhilCare standard professional fees for specific medical services.
35. Take-home medicines, preventive and/or non-therapeutic drugs, such as but not limited to vitamins,
supplements, hormonal preparations, medicines or drugs during confinement which are not available in
the Philippines, immunizing agents and all other medicines /drugs not approved by the Bureau of Food
and Drugs (BFAD).

36. Out-patient medicines, with the exception of intravenous chemotherapy medicine and those
administered during an emergency treatment.
37. Vaccines, whether elective or administered during an emergency treatment.
38. Diagnosis and treatment of Error of Refraction conditions such as myopia, astigmatism, and the like,
including laser treatment for the purpose of corrective eye refraction.
39. Out-Patient Pain Management is not covered except in cases of emergency. In-patient Pain
management necessitating specialized pain management team and /or the use of specialized
equipment.
40. Complications arising from non-covered procedures and surgery.
41. 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.

III. General Limitation

The rights of a Member and obligations of PhilCare are subject to the following limitations:

If a major disaster or epidemic causes unavailability of facilities or personnel, or if circumstances not within
the control of PhilCare such as temporary lack of hospital facilities, complete or partial destruction of
facilities, war, riot, civil insurrection, labor disputes, or similar causes occur, then PhilCare shall not be liable
for any delay or failure to provide services to the Member. PhilCare shall, however, exert its best effort to
provide services to the Member, as the circumstances permit.

Client may examine and cancel this health plan within a period of 15 days from receipt of the Certificate of
Coverage/health plan voucher, provided that the product hasn’t been utilized or availed for its purpose. The
membership coverage shall be terminated thereafter.
Refund provisions apply in accordance to PhilCare’s Termination Policy.
Please email your request at [email protected]

***The Certificate of Coverage (COC) is issued together with the soft copy policy (provided within 24 hours from the
COC receipt). To request for a full hard copy policy contract, please send an email to [email protected].

PhilhealthCare, Inc.
5F STI Holdings Center, 6764 Ayala Avenue, Makati City
Website: www.philcare.com.ph | Email: [email protected]
Contact Center Hotline: +63 (2) 8462-1800 | Toll Free Hotline Outside Metro Manila: 1-800-1888-3230

Important Notice: The Insurance Commission, with offices in Manila, Cebu and Davao, is the government office
in-charge of the enforcement of all laws related to Insurance and has supervision over insurance providers and
intermediaries. For any inquiries or complaints, please contact the Public Assistance and Mediation Division
(PAMD) of the Insurance Commission at 1071 United Nations Avenue Manila. Insurance Commission can be
reached at [email protected] or at www.insurance.gov.ph