Is a one year term plan that provides reimbursement of up to P30,000 worth of hospital confinement due to Dengue Hemorrhagic Fever (Dengue Fever with warning signs) and Severe Dengue (Dengue Shock Syndrome). The plan also covers up to P10,000 benefit in accidental death and disability.
|1 UNIT||2 UNIT|
|Child(0-20)||P 500.00||P 1,000.00|
|Adult(21-59)||P 150.00||P 300.00|
FREQUENTLY ASKED QUESTIONS (FAQs)
- What is Dengue Rx Plan?
- Who can avail the Dengue Rx Plan?
- How much is the Dengue Rx Plan and the corresponding coverage/limits?
- How many units can I buy?
- What type of Dengue do we cover under the Dengue Rx Plan?
- What are the covered expenses under Dengue Rx plan?
- Will the entire hospital confinement be covered by Dengue Rx benefits?
- If the availment of benefit has not reached P30,000.00 (1 unit)/ P60,000 (2 units), is an Insured still entitled to the balance?
- Are screen tests for Dengue Fever with warning signs, Severe Dengue, Dengue Hemorrhagic Fever confirmation if repeated will still be covered?
- Will the stay in the Emergency Room (ER) be counted in the minimum 18 hours requirement?
- When is an Insured obliged to pay for the Philhealth portion under Dengue Rx plan?
- How much is Philhealth’s benefit for Dengue Fever?
- Can an Insured file for reimbursement even if it is covered by HMO?
- Will I receive an insurance policy? When and how can I get it?
- When is the effective date of the Dengue Rx plan ?
- What is meant by 30 days waiting period?
- When does effectivity date of the Accidental Death and Disability (ADDB) rider coverage begin?
- What is the insurance cover for Accidental Death and Disability Benefit?
- What are the requirements/documents to be submitted to PhilLife to claim for Dengue Rx reimbursement?
- How long can I get my reimbursement?
- What is the validity of my coverage?
A one-year term plan that provides Reimbursement of hospital confinement (in-patient) due to Dengue Hemorrhagic Fever (Dengue Fever with Warning Signs) and Severe Dengue (Dengue Shock Syndrome). Dengue Rx also provides benefits for Accidental Death and Disability.
The Dengue Rx Plan coverage is available to any Individual from 0 – 59 years old.
|Child (0-20 years old)||P 500.00||1||P30,000/yr.|
|Adult (21 – 59 years old)||P 300.00||2||P60,000/yr.|
A maximum of two (2) units can be availed of an enrollee, at any given time.
Dengue Rx Plan covers hospital confinement of Dengue Fever with warning signs (Dengue Hemorrhagic Fever) and Severe Dengue (Dengue Shock Syndrome)
Generally, only medical expenses related to diagnostics, laboratory, drugs, medications and IV fluids among others, arising from confinement, that are medically necessary in Dengue Hemorrhagic Fever or Dengue with Warnings management are covered.
Yes, provided that the final diagnosis are Dengue Fever with warning signs (Dengue Hemorrhagic Fever) and Severe Dengue (Dengue Shock Syndrome) and has not exceeded the maximum benefit of Php30,000.00 per unit/per enrollee. Final computation of Dengue reimbursement will be after deducting Philhealth case rates whether Philhealth member or non- member. Moreover, confinements due to multiple diagnoses not related to Dengue Hemorrhagic Fever are not covered.
Yes. Insured can still file for reimbursement as long as the confinement is within the one-year period of coverage.
Laboratory diagnostics methods that may be used to confirm dengue virus infection may involve any of the two items namely (a) detection of antigen ( Dengue NS1) during the febrile phase and (b) antibody ( Dengue IgM) during the recovery phase, preferably on day 5 onwards from onset of the illness. These two tests however, maybe optionally requested by the Attending Physician, more than the CBC with hemoglobin/hematocrit and platelet count which are absolutely required. The two optional tests are also performed only once during the course of hospital confinement, thus, only one request per test is payable. CBC with hemoglobin/hematocrit and platelet count however, can be requested more than once in all three phases of the illness, hence, covered if repeated.
Yes, the number of hours stayed in the ER will be included in determining the 18 hours minimum requirement provided it will lead to hospital confinement upon the recommendation of the attending physician.
An insured is obliged to pay for the Philhealth portion under the following conditions:
a. If the Insured is not a Philhealth member.
b. If hospital confinement is 18 hours but less than 24 hours.
c. If the hospital confinement took place in a non-Philhealth accredited medical provider
d. If attended by a non-Philhealth accredited physician.
Philhealth benefits for Dengue Fever are as follows:
a. Dengue Fever with warning signs (Dengue Hemorrhagic Fever)- Php 10,000.00
b. Severe Dengue (Dengue Shock Syndrome) – Php 16,000.00
c. However, for cases with co-morbidity, 50% maybe applied on conditions referred to in
Annex 3 of Philhealth Circular No. 0035 s. 2013 ACR Policy No. 2 – Implementing Guidelines on Medical and Procedure Case Rates
Yes, provided that the Insured submit the required documents and a Certification from the HMO certifying the coverage of confinement signed by the HMO’s Authorized Signatory.
The Certificate of Cover (COC) is issued to the policyholder through the insured’s personal email and PhilLife web/link.
The effective date of the Dengue Rx plan begins upon full payment and as indicated in the Certificate of Cover.
A covered individual has to wait for 30 days from effective date as indicated in the Certificate of
Cover to avail of Dengue reimbursement benefits.
E.g. Effective Date: June 01, 2017
Waiting Period: June 01 to 30, 2017
Availment Date: July 01, 2017
The ADDB coverage begins on the effectivity date of the Dengue Rx plan as indicated in the Certificate of Cover. There is no 30-day waiting period to avail of the ADDB benefits.
Please refer to the following Table of Schedule of Indemnities subject to the exclusion and limitation of the Insurance cover:
|Schedule of Indemnities||Percentage of Amount of Insurance||1 unit (P30,000)||2 units (60,000)|
|Loss of life||100%||P 30,000||P 60,000|
|Loss of two limbs||100%||P 30,000||P 60,000|
|Loss of both hands||100%||P 30,000||P 60,000|
|Loss of both feet||100%||P 30,000||P 60,000|
|Total loss of sight of both eyes||100%||P22,500||P 60,000|
|Loss of hearing of both ears||75%||P 30,000||P 45,000|
|Loss of one hand||50%||P 15,000||P 30,000|
|Loss of one foot||50%||P 15,000||P 30,000|
|Loss of sight of one eye||50%||P 15,000||P 30,000|
The requirements/documents per each case are as follows:
a. Claimant Statement Form
b. Attending Physician Statement Form
c. Complete Medical Records (Medical/Clinical Abstract)
d. Laboratory and/or Diagnostic Results with Interpretation
e. Summary of Hospital Statement of Account
f. Itemized Statement of Account
g. Original Official Receipts both from the Hospital and Doctor’s Professional Fee’s
h. If confinement is covered by HMO – request from the HMO provider for the Certificate of
Cover signed by the Authorized Signatory indicating the total bill covered upon discharged.
PhilLife pays the benefit within 30 days from receipt of complete claim documents/requirements.
The coverage of this insurance plan is one (1) year from the date of effectivity.