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BAYANI FAMILY CARE PREPAID HEALTH CARD | BAYANI FAMILY CARE PREPAID HEALTH CARD: UNLI-CONSULTATION CARDS


BAYANI FAMILY CARE PREPAID HEALTH CARD

What is BAYANI Family Care (BFC) Program?
↳ BAYANI Family Care is a multiple-use card that provides for emergency care and hospitalization for viral and bacterial illnesses, treatment of injuries resulting from accidents except for cerebrovascular accidents (stroke) in more than 500 PhilCare-accredited hospitals nationwide.*

There are two (2) Product packages and three (3) variants of BAYANI Family Care (BFC) card: No Pre-existing BFC 60, No Pre-existing BFC 80, No Pre-existing BFC 100, with 20k ABL Pre-existing BFC 60, with 20k ABL Pre-existing BFC 80, and with 20k ABL Pre-existing BFC 100. Cost of Bayani Family Care will be reliant to the age of the enrollee.

What are the coverable cases for BAYANI Family Care?
↳ 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
  • Dengue
  • Fracture, new
  • Acute Pneumonia
  • Sprain
  • Typhoid Fever
  • Upper Respiratory Tract Infection
  • Urinary Tract Infection
  • Viral Infection

Are all expenses incurred in the hospital covered?
↳ Depending on the chosen variant, BFC provides coverage of hospital emergency room care plus expenses for the room and board, diagnostic and therapeutic procedures as medically necessary during confinement up to the plan aggregate limit. New modalities of treatment (e.g. Botox not cosmetics in nature, 4D ultrasound that’s not maternity related, PET Scan, etc.)  is also subject to Php5,000 inner limit.

What if the total aggregate limit will not be consumed totally can I again use the voucher in the future?
↳ BFC has no limit on the number of times you use the voucher within a year, for as long as the aggregate benefit is not yet consumed.

Do I need to have PhilHealth for BAYANI Family Care Program?
↳ Yes. PhilHealth coverage is required. However, for those who do not have PhilHealth coverage, one may just pay the PhilHealth portion of the hospital bill before discharge.

Who are qualified to enroll for BAYANI Family Care?
↳ Any member of the family may avail of the program. The only membership requirement is the age. Member must be at least 15 days to 65 years old from the voucher’s effectivity (based on 7 calendar days from registration date). Registration can be done through online only. Age requirement is based on actual age with continued coverage until product’s expiry.

Once I register the program, can I already use it?
↳ No. You can only use your BAYANI Family Care voucher after seven (7) calendar days from successful registration date. That is why it is important to immediately register your voucher once you get it.

Is there a limit on the number of times I can purchase and register for BAYANI Family Care?
↳ Yes, there’s a limit on the number of times that you can purchase and register the BFC. You can only enroll once per policy year, even if your aggregate benefit limit is already consumed. You may purchase another one after a year from your first purchase (validity period). Note that contestability period does not apply for the Pre-existing condition. Pre-existing is either not covered (if purchased card is without Pre-existing) or up to 20,000 aggregate limit only.

If I have another PhilCare card with hospitalization benefits, can I register for BAYANI Family Care?
↳ You cannot register BFC program if you are already enrolled in other PhilCare’s health programs with hospitalization benefits, even if your aggregate benefit limit was already consumed. This is in compliance to the existing policy on double coverage.

Can I register/apply for BAYANI Family Care for other persons, aside from my family members or relatives?
↳ Yes, you may. It is not limited to your family members, you may register any person, for as long as you know their personal data that is required for the registration/application.

How long will the BAYANI Family Care be effective?
↳ You may use the voucher within one year from the start of voucher’s effectivity.

Is the BAYANI Family Care transferable?
↳ No. Only the name of the member registered in the issued BFC voucher may avail of the services, subject to the BFC benefit arrangements and guidelines.

Can I use the BAYANI Family Care in hospitals not included in the voucher’s provider list?
↳ No, services can only be availed in the designated hospitals. We have already made arrangements with the hospitals regarding the procedures for accepting the vouchers and provision of services.

There are more than 500+ hospitals nationwide where you may avail the services for BFC.

What are the non-coverable conditions for BAYANI Family Care?
↳ Non-emergency, pre-existing (subject to chosen plan type. If without Pre-existing, this is a limitation. If with 20K ABL, in excess of the limit), 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. Similar to Congenital where condition or illness is in-born and have started prior to member’s effectivity in the healthcare coverage.

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; (e) illnesses or conditions resulting in moderate or severe dehydration such as diarrhea or fever; and (f) Syncope.

What are the non-covered illnesses and diseases?
↳ The following are the diseases and conditions in which the BAYANI Family Care cannot be used. No health care benefits shall be paid for the following services, procedures or conditions. This is not a complete list of non-covered illnesses and diseases. PhilCare reserves the right to have the final interpretation of all definition, provisions and articles relating to the health cards.

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

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 , pace maker
  • 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 in patient 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, motor sports (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 or 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
  • In-patient 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

BAYANI FAMILY CARE PREPAID HEALTH CARD: UNLI-CONSULTATION CARDS

Do you Offer Top-up plans?
↳ Yes. Customer has an option to also include Unli-Consult card.

What is the extent of coverage for Unli-Consultation?
↳ BAYANI Family Care Unli-Consults (Basic and Specialists; Nationwide)
Usage: Unlimited outpatient consultation for one year to PhilCare accredited pediatricians (for children 15 days to 17 years old), family medicine specialists, internal medicine specialist, cardiologists, endocrinologists, nephrologists, pulmonologists, gastroenterologists (for adult) nationwide

Restrictions: Does not include consultation services related to maternity and conditions related to all forms of behavioral disorders, developmental, psychiatric disorder and psychosomatic illness, whether congenital or acquired

How do I register my voucher?
↳ Registration can be done via online (http://bit.ly/PhilCarePrepaidRegistration) Coverage is effective seven (7) calendar days from registration date. By registering, you agree to the terms and conditions governing the use of the Philcare Consultation voucher.

How would I know if I was able to successfully register?
↳ Once the PhilCare system receives your registration, you will receive an email confirmation informing you if your registration is successful or not and will advise you is there is a concern in the data you entered.

When will the one year coverage start?
↳ The count of one (1) year starts once card is activated. Card is activated seven (7) days from registration date.

Is it transferable?
↳ The consultation voucher is not transferable once successfully registered. The name that has been entered during registration will be the recognized PhilCare member.

When can I avail the consultation service?
↳ After seven (7) calendar days from date of successful registration, you can already avail of consultation services.

What is the procedure for availment of the consultation services?
↳ Set an appointment with the doctor via phone call prior your day of visit to make sure that he will be holding his clinic on the day you desire to have your consultation and also that you will be accommodated. You have to present a Letter of Authorization (LOA) as downloaded in the PhilCare website, personalized member card and one (1) valid ID to the doctor on the day of availment.

Note that consultation must be availed within the LOA validity period which is with three (3) calendar days start from day of issuance and must be provided by the doctor indicated in the LOA.

How do I get a LOA?
↳ The beauty of the consultation card, it is very convenient for you to get a LOA. You just self-generate it from the PhilCare website. You can do it in your most convenient time and day.
Here are the steps to get a LOA:

  1. Step 1 : Go to www.philcare.com.ph/consultationcards and click request for LOA. Input your certificate number provided to you upon online registration. Include also your birthdate and birthplace.
  2. Step 2: Select your choices of area, hospital/clinic, specialization and doctor
  3. Step 3: Download and print the LOA and your personalized membership card

Can I avail of medical services without an LOA?
↳ No, you cannot avail of the consultation service without a LOA. You need to secure an appointment by calling the accredited designated provider prior to availment. The LOA is the document that would inform the doctor that you have been authorized by PhilCare to have a consultation service.

You have to submit the 2 copies of the LOA to the doctor. He will forward one copy to PhilCare for his professional fee to processed and paid. And the other copy of the LOA for his reference.

Do I need to generate a LOA every time I will avail of a consultation service?
↳ Yes, a new LOA should be downloaded for every consultation service. An approval code will be indicated by the system per LOA extracted. The approval code indicates that PhilCare allows you to have the consultation service.

Is there a limit on how many consultations I can avail within a day?
↳ There is no limit on how many consultations you can avail in a day. You just need to generate separate
LOAs for the consultation services you would need.

Can I get LOA from PhilCare offices and PhilCare clinics?
↳ We design that LOA should be self-generated for it to be very convenient for you.
Please call our Customer Service Hotline at +63 (02) 462-1800; for outside Metro Manila (toll-free for PLDT): 1-800-1888-3230 for assistance if there is a concern on downloading an LOA.
PhilCare offices and clinics will only issue an LOA if the PhilCare website system is down, otherwise LOA must be self-generated.

Can I avail of any consultation service?
↳ Enjoy the perks of all-around health and wellness by using it for regular check-ups or monitoring of existing conditions except for consultations relating to maternity-related cases and cases related to all forms of behavioral disorders, developmental, psychiatric disorder and psychosomatic illness, whether congenital or acquired. Please refer to the list of specialists that you are entitled to, based on your age requirement.

Can I also request for other services example laboratory examinations etc.?
↳ The consultation voucher covers only the consultation fee. Other services will not be paid by PhilCare

Do I need to pay any additional amount to the doctor if I just requested for consultation services?
↳ No, PhilCare will already take care of the consultation fee. You should not pay any excess charges relating to the consultation service. If the doctor asks you to pay for anything, please inform PhilCare, so that we may investigate and assist you further.

Can I use it when I am hospitalized?
↳ No, the consultation voucher is only for an out-patient consultation. You can seek out-patient consultation from PhilCare-accredited physicians and generate your LOA from this link:
www.philcare.com.ph/consultationcards