Emergency Care

In the event of any life threatening condition caused by any illness or injury, MediCard shall provide its members the following emergency care services:

MEMBERSHIP BENEFITS AND PRIVILEGES

When the member is under Emergency Case and ends up at the emergency room of MediCard Accredited Hospitals or MediCard centers, the following are provided free of charge:

Doctor’s services
Medicines used during treatment or for immediate relief
Oxygen and intravenous fluids
Dressings, casts, and sutures
Laboratory, X-ray and other diagnostic examinations directly related to the emergency management of the patient.

EMERGENCY CARE IN NON-MEDICARD Accredited Hospitals

For emergency medical services in non-MediCard accredited medical facilities, members must first settle all payments and later file reimbursement from MediCard. MediCard shall reimburse eighty percent (80%) of the total bills, inclusive of professional fees, based on what would have cost had the service been rendered in an accredited hospital through the services of an accredited doctor, but not to exceed the amount of ₱5,000. MediCard shall reimburse members for the medical services in non-accredited hospitals when it is verified that MediCard facilities were not used because to have done so would entail a delay resulting in death, serious disability or significant jeopardy to the member’s condition or the choice of hospital was beyond the control of the member or the member’s family.

In filing reimbursement for emergency medical services availed in non-participating hospitals, members must submit to MediCard Claims and Reimbursement Section the following documents within (30) calendar days from discharge:

a. Duly filled-out claim form
b. Official receipt (original)
c. Itemized statement of account
d. Charge slips/itemized breakdown of charges
e. Professional fee receipts (original)
f. Medical certificate/clinical abstract
g. Hospital report/surgical report (for any procedure done)
h. Incident report
i. Police reports, if due to accident or medico-legal case
j. Photocopy of MediCard ID
k. Prescription of attending physician for medicines purchased

  1. When a member is in immediate danger of losing a limb, eye or other parts of the body or is in severe pain that requires immediate relief and enters a non-MediCard accredited hospital for treatment, MediCard agrees to reimburse only (80%) of the total hospital bills inclusive of professional fees and base on relative values for MediCard accredited hospitals, but not to exceed the amount of P5,000.00.
  2. MediCard shall pay the said amount when it is verified that MediCard facilities were not used because to have done so would entail a delay resulting in death, serious disability or significant jeopardy to the member s condition or the choice of hospital was beyond the control of the member or the member s family. Other expenses not covered in using non-MediCard Accredited Hospitals for emergency care are:
  • Follow-up care
  • Transportation to MediCard facility