EMERGENCY

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AFFILIATED CLINICS / HOSPITALS

1. Go to the Emergency Room (ER) of the nearest affiliated clinic / hospital
2. Present your PhilCare ID card
3. Receive necessary emergency care
4. Inform PhilCare Call Center within 24 hours

     No confinement required:
          - Prior to discharge, sign Emergency Treatment Form and Hospital Statement of Account/Charge Slip

     Confinement required:
          - Go to Admitting Section
          - Make sure that an LOA is issued within 24 hours

     LOA may be secured from the following:
          - Visiting PhilCare Liaison Officer (if applicable)
          - PhilCare Hospital Coordinator's office
          - Hospital's Industrial/HMO section (may vary depending on the hospital regulations and set-up)
          - For PhilHealth members, file your PhilHealth with the hospital prior to discharge, to avoid paying the
            PhilHealth portion of the hospital bill.
          - Prior to discharge, sign Hospital Statement of Account and pay the ineligible charges and items not
            covered by PhilCare, if any

NON-AFFILIATED CLINICS / HOSPITALS

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1. Go to the Emergency Room (ER) of the nearest clinic / hospital
2. Receive necessary emergency care
3. Inform PhilCare Call Center within 24 hours

     No confinement required:
          - Settle all hospital bills incurred upon discharge
          - Secure the Attending Physician's Report or medical certificate from the ER doctor
          - Submit Reimbursement Claims to PhilCare office within 60 days from the date of discharge

     Confinement required:
          - Go to Admitting Section
          - Coordinate with the PhilCare Call Center if the patient can be transferred to an affiliated hospital.
          (If YES, please follow the access procedure for emergency care in an affiliated hospital.)
          - Settle all hospital bills incurred upon discharge
          - For PhilHealth members, file your PhilHealth with the hospital prior to discharge, to avoid paying the
            PhilHealth portion of the hospital bill.
          - Submit Reimbursement Claims to PhilCare office within 60 days from the date of discharge. Follow the
            reimbursement procedure.

Reminder:
Reimbursement of expenses in cases of emergency confinement in a non-affiliated hospital is subject to the emergency benefit provision of the contract.

OUT-PATIENT

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1. Go to the Preferred Clinic or PhilCare Clinic.
2. Present your PhilCare ID Card
3. Avail all medical services including consultation or procedure in the Preferred Clinic or PhilCare Clinic,
     unless the required medical services are not available in the said clinic.
4. Secure a Letter of Authorization (LOA) from the PhilCare Authorized LOA Issuer in the said clinic if the required
     medical services required are not available.
5. Present the LOA to the affiliated provider as indicated to avail of medical service/s.
     If there is no Preferred Clinic or PhilCare Clinic in the area,
          - Proceed to the designated Primary Care Clinic / Primary Care Physician / Affiliated Clinic. Avail all
            medical services including consultation or procedure in these facilities, unless the required medical
            services are not available here.
          - If there is no Primary Care Clinic / Primary Care Physician / Affiliated Clinic, proceed to the Office of the
            Hospital Coordinator or Industrial/HMO Section or PhilCare Authorized LOA Issuer in the Affiliated
            Hospital.

IN-PATIENT

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1. Go to the Preferred Clinic or PhilCare Clinic*
2. Present the admitting order from the PhilCare Affiliated Physician and also the PhilHealth - MDR Form to
     the authorized PhilCare LOA issuer
3. Secure LOA (In-patient LOA) or Approval Form
4. Go to the Hospital Admitting Section and present your PhilCare ID and LOA
5. Confinement.
6. Submit your PhilHealth documents to the Hospital Billing Section prior to discharge to avoid paying the
     PhilHealth portion of the hospital bill
7. Sign the Hospital Statement of Account prior to discharge and pay the ineligible charges and items not covered by PhilCare, if any.
     If there is no Preferred Clinic or PhilCare Clinic in the area,
          - Proceed to the designated Primary Care Clinic / Primary Care Physician / Affiliated Clinic. Avail all
            medical services including consultation or procedure in these facilities, unless the required medical
           services are not  available here.
          - If there is no Primary Care Clinic / Primary Care Physician / Affiliated Clinic, proceed to the Office of the
            Hospital Coordinator or Industrial/HMO Section or PhilCare Authorized LOA Issuer in the Affiliated
            Hospital.