Emergency Medical Insurance

1. The Emergency Medical Insurance is for one-time use only. Once claim is paid, the maximum benefit limit is considered fully exhausted and the policy is automatically terminated.
    
2. For Emergency Outpatient Treatment:

   • You must be accommodated for treatment in the Emergency Room (ER) Department of a hospital in the Philippines.

   • Cash assistance is based on the actual medical expense incurred in the ER of a hospital for a one-time occurrence per period of coverage not exceeding the plan limit.
    

3. For Emergency Inpatient Treatment

   • Confinement is defined as a continuous stay for a period of not less than 18 hours as a registered bed patient in a hospital in the Philippines required by a doctor.

   • Cash assistance is 100% lump sum payment via reimbursement of the maximum benefit limit.

    

4. Effectivity of the policy is after the waiting period of 7 calendar days from the date of purchase. Pre-existing conditions are covered starting on the effective date of the policy.
    
5. You may only purchase one policy for yourself at a time. Once your existing policy already expired or utilized due to a valid claim, whichever comes first, you may only purchase a new policy 60 days after the expiry or termination date of your existing policy.
    
6. If you will purchase for a minor or someone who has a condition, you must be the legal guardian of the insured.
    
7. Only the insured person can claim the benefits. In the event that he or she is a minor, or has a condition, only the buyer/legal guardian may claim the benefits for them. To know more about this, please contact us at +63 (2) 8838-2364 or email us at bdo-insure@bdo.com.ph
    
8. Illnesses or injuries arising out of epidemics, such as COVID-19, are exclusions to the coverage of this plan.  However, emergency outpatient and inpatient treatments due to COVID-19 diagnosis is currently covered due to business consideration.  The insurance company may discontinue this consideration anytime without prior notice.
    
9. There are other exclusions to the coverage of this plan, such as pregnancy and confinements required for routine medical exams. For complete details on this, please read the Terms and Conditions of Emergency Medical Insurance.
    
10. You may request for the cancellation of your policy to BDO Insure subject to the approval of the insurance company. The insurance company has the right to retain a portion of the premium (including the taxes) as indicated on the Terms and Conditions. 

For Out-patient, you may avail of the treatment with no cash out through Pacific Cross’ accredited network. Please see www.pacificcross.com.ph for complete list of Pacific Cross’ accredited hospitals. Please inform the hospital that you have a plan from Pacific Cross. You may also file for the reimbursement of the actual medical expenses exclusively incurred in the Emergency Room Department. 

For In-Patient, you may claim your benefit through reimbursement only. Please settle the bill with the hospital and file for the claim of 100% lump sum payment of the maximum benefit limit. 

Illnesses or injuries due to epidemics, such as COVID-19, are not covered. However, emergency outpatient and inpatient treatments due to COVID-19 diagnosis is currently covered due to business consideration. The insurance company may discontinue this consideration anytime without prior notice.

No. There is a waiting period of 7 days from policy issuance date before your plan becomes effective or activated.

For example:

No. Your plan is for one-time use only. Your coverage is terminated once claim is paid. For example, if you purchased Plan B:

 - your actual medical cost is P5,000, you may avail the cashless settlement or you may file for reimbursement of P5,000

 - your actual medical cost is P15,000, you will receive your maximum benefit limit of P10,000

However, for Inpatient availment, you will be paid based on your maximum benefit limit regardless of the actual medical cost you have incurred.

For the filing of reimbursement of actual medical expenses for Emergency Out-patient, the claims checklist includes: 

- Duly accomplished Notification of Claim (NOC) 

- Medical Prepaid Card Form 

- Emergency Medical Certificate 

- Original Official Receipt 

- Statement of Account 

- Copy of laboratory and diagnostic test result/s, if any 

For the filing of lump sum benefit for Emergency In-patient, the claims checklist includes: 

- Duly-accomplished Notification of Claim (NOC) form

- Medical Prepaid Card Form 

- Admitting Medical History 

- Discharge Summary Report or Clinical Abstract stating the final diagnosis and confinement date 

- Statement of Account reflecting room and board charges 

If the cause of emergency treatment is an injury as a result of an accident: 

- Basic requirements for Emergency Out-Patient or Emergency In-Patient Claims 

- Copy of police report 

- Incident report 

Kindly submit the necessary claims requirements to bdo-insure@bdo.com.ph. The insurance company may ask for additional documents. 

Important Note: Your plan’s coverage is terminated once your claim is paid. 

No. Your insurance cannot be transferred to others.