Hospital Emergency Care Availment



The EME program secures a one-time availment of emergency care requirements subject to the member’s corresponding Maximum Emergency Benefit Limit, of qualified emergency situations or conditions in any certified hospital emergency rooms or facilities of accredited hospitals. It covers also for the emergency medical expense availment in non-accredited hospitals on reimbursement basis.


INCLUSIONS

1. Emergency Care Benefits

BENEFIT FEATURES WITHIN EASTWEST ACCREDITED NETWORK OUT OF NETWORK BY REIMBURSEMENT
Professional Fee(s) of Attending Physician(s) Up to Plan Limits Up to Plan Limits
Emergency Room or Facility Fees Up to Plan Limits Up to Plan Limits
Medicine used for immediate relief & during
treatment in the confines of the Emergency Room
Up to Plan Limits Up to Plan Limits
Whole blood human and Blood Products Up to Plan Limits Up to Plan Limits
Oxygen and Intravenous Fluids Up to Plan Limits Up to Plan Limits
Sutures, Dressings and Plaster Casts Up to Plan Limits Up to Plan Limits
Laboratory, Xray and other Diagnostic Procedures
directly related to the emergency management
of the patient
Up to Plan Limits Up to Plan Limits
Anti-Rabies Vaccine / Anti-Venom Sera
1st Passive Dose (Up to Maximum Emergency Benefit Limit)
1st Passive Dose (Up to Maximum Emergency Benefit Limit)
Anti-Tetanus Vaccine
Covered Up to Maximum Emergency Benefit Limit
Ambulance Service
(From point of incident to an emergency treatment facility)
Covered Up to Maximum Emergency Benefit Limit
Maximum Limit for Emergency Cases Up to Plan Limits Up to Plan Limits



2. Accidental Death & Dismemberment / Disability



PLAN PROGRAM


BENEFIT FEATURES OPTION 1 OPTION 2 OPTION 3 OPTION 4 OPTION 5
Emergency Medical Expense Limit
Per Member Per Year
Php 5,000 Php 10,000 Php 15,000 Php 20,000 Php 25,000
Accidental Death &
Disemberment / Disability Benefit
Php 5,000 Php 10,000 Php 15,000 Php 20,000 Php 25,000


QUALIFIED EMERGENCY CONDITIONS or SITUATIONS


Emergency Conditions or Situations shall refer to the sudden and unexpected onset of illness or injury which at the time of occurrence reasonably appears to have potential of causing immediate, permanent disability or death; or which requires the immediate alleviation of severe pain and discomfort in an Emergency Room of a hospital facility; and/or shall include any of the following warning signs:




ELIGIBILITY
30 days old up to 65 years of age


VALIDITY
Valid for one (1) year from the time of member’s card activation