Here you’ll find frequently asked questions and answers on particular topics about BAYANI Family Care plans.
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BAYANI Family Care is a multiple-use card that provides for emergency care and hospitalization for viral and bacterial illnesses, treatment of injuries resulting from accidents except for cerebrovascular accidents (stroke) in more than 500 PhilCare-accredited hospitals nationwide.*
Depending on the program’s service coverage, the following are the covered conditions:
Depending on the chosen variant, BFC provides coverage of hospital emergency room care plus expenses for the room and board, diagnostic and therapeutic procedures as medically necessary during confinement up to the plan aggregate limit. New modalities of treatment (e.g. Botox not cosmetics in nature, 4D ultrasound that’s not maternity related, PET Scan, etc.) is also subject to Php 5,000 inner limit.
BFC has no limit on the number of times you use the voucher within a year, for as long as the aggregate benefit is not yet consumed.
Yes. PhilHealth coverage is required. However, for those who do not have PhilHealth coverage, one may just pay the PhilHealth portion of the hospital bill before discharge.
Any member of the family may avail of the program. The only membership requirement is the age. Member must be at least 15 days to 65 years old from the voucher’s effectivity (based on 7 calendar days from registration date). Registration can be done through online only. Age requirement is based on actual age with continued coverage until product’s expiry.
No. You can only use your BAYANI Family Care voucher after seven (7) calendar days from successful registration date. That is why it is important to immediately register your voucher once you get it.
Yes, there’s a limit on the number of times that you can purchase and register the BFC. You can only enroll once per policy year, even if your aggregate benefit limit is already consumed. You may purchase another one after a year from your first purchase (validity period). Note that pre-existing conditions are not covered.
You cannot register BFC program if you are already enrolled in other PhilCare’s health programs with hospitalization benefits, even if your aggregate benefit limit was already consumed. This is in compliance to the existing policy on double coverage.
Yes, you may. It is not limited to your family members, you may register any person, for as long as you know their personal data that is required for the registration/application.
You may use the voucher within one year from the start of voucher’s effectivity.
No. Only the name of the member registered in the issued BFC voucher may avail of the services, subject to the BFC benefit arrangements and guidelines.
No, services can only be availed in the designated hospitals. We have already made arrangements with the hospitals regarding the procedures for accepting the vouchers and provision of services.
There are more than 500+ hospitals nationwide where you may avail the services for BFC.
Non-emergency, pre-existing, congenital, maternity related and those conditions under PhilCare’s general exclusion list will not be covered.
An illness or condition is considered pre-existing if prior to the effective date of health coverage the pathogenesis of such illness or condition has started, whether the member is aware or not. Similar to Congenital where condition or illness is in-born and have started prior to member’s effectivity in the healthcare coverage.
Emergency cases are the sudden, unexpected onset of illness or injury, which at the time of contract reasonably appeared as having the potential of causing immediate disability or death or requiring the immediate alleviation of severe pain and discomfort. Emergency cases include but are not limited to the following: (a) Massive Bleeding; (b) Acute Appendicitis; (c) Fractures/multiple injuries secondary to accidents; (d) Convulsions; (e) illnesses or conditions resulting in moderate or severe dehydration such as diarrhea or fever; and (f) Syncope.
The following are the diseases and conditions in which the BAYANI Family Care cannot be used. No health care benefits shall be paid for the following services, procedures or conditions. This is not a complete list of non-covered illnesses and diseases. PhilCare reserves the right to have the final interpretation of all definition, provisions and articles relating to the health cards.
A. List of diseases not covered but not limited to:
Anal fistulae / Asthma / Auto immune conditions / Cardiovascular diseases / Calculi of the urinary system / Cataracts / Sinus conditions requiring surgery / Cerebrovascular diseases / Cholecystitis/cholelithiasis / Chronic skin conditions / Cirrhosis of the liver / Collagen disease / Degenerative conditions / Diabetes mellitus / Diseased tonsils requiring surgery / Endometriosis / Epilepsy / Gastric or duodenal ulcer / Hallux valgus / Hemorrhoids / Hernia / HIV/AIDS / Hypertension / Neurologic conditions / Obesity, dyslipidemia and other metabolic conditions / Pathological abnormalities of nasal septum and turbinates / Thyroid conditions / Tuberculosis / Tumors, whether benign or malignant of all organs and organ systems, including malignancies of the blood or bone marrow / Non-emergency case during point of availment / Pre-existing and congenital conditions Pre-existing and congenital conditions – An illness or condition shall be considered pre-existing if, prior to the effective date of health coverage the pathogenesis of such illness or condition has started, whether or not the member is aware of such illness or condition.
B. General exclusions applicable to health care coverage:
Yes. You have an option to include unlimited outpatient consultation to the plan you selected.
BAYANI Family Care Unli-Consults (Basic and Specialists; Nationwide)
Usage: Unlimited outpatient consultation for one year to PhilCare accredited pediatricians (for children 15 days to 17 years old), family medicine specialists, internal medicine specialist, cardiologists, endocrinologists, nephrologists, pulmonologists, gastroenterologists (for adult) nationwide
Restrictions: Does not include consultation services related to maternity and conditions related to all forms of behavioral disorders, developmental, psychiatric disorder and psychosomatic illness, whether congenital or acquired
Registration can be done via online (http://bit.ly/PhilCarePrepaidRegistration) Coverage is effective seven (7) calendar days from registration date. By registering, you agree to the terms and conditions governing the use of the Philcare Consultation voucher.
Once the PhilCare system receives your registration, you will receive an email confirmation informing you if your registration is successful or not and will advise you is there is a concern in the data you entered.
The count of one (1) year starts once card is activated. Card is activated seven (7) days from registration date.
The consultation voucher is not transferable once successfully registered. The name that has been entered during registration will be the recognized PhilCare member.
After seven (7) calendar days from date of successful registration, you can already avail of consultation services.
Set an appointment with the doctor via phone call prior your day of visit to make sure that he will be holding his clinic on the day you desire to have your consultation and also that you will be accommodated. You have to present a Letter of Authorization (LOA) as downloaded in the PhilCare website, personalized member card and one (1) valid ID to the doctor on the day of availment.
Note that consultation must be availed within the LOA validity period which is with three (3) calendar days start from day of issuance and must be provided by the doctor indicated in the LOA.
The beauty of the consultation card, it is very convenient for you to get a LOA. You just self-generate it from the PhilCare website. You can do it in your most convenient time and day.
Here are the steps to get a LOA:
No, you cannot avail of the consultation service without a LOA. You need to secure an appointment by calling the accredited designated provider prior to availment. The LOA is the document that would inform the doctor that you have been authorized by PhilCare to have a consultation service.
You have to submit the 2 copies of the LOA to the doctor. He will forward one copy to PhilCare for his professional fee to processed and paid. And the other copy of the LOA for his reference.
Yes, a new LOA should be downloaded for every consultation service. An approval code will be indicated by the system per LOA extracted. The approval code indicates that PhilCare allows you to have the consultation service.
There is no limit on how many consultations you can avail in a day. You just need to generate separate LOAs for the consultation services you would need.
We design that LOA should be self-generated for it to be very convenient for you.
Please call our Customer Service Hotline at +63 (02) 462-1800; for outside Metro Manila (toll-free for PLDT): 1-800-1888-3230 for assistance if there is a concern on downloading an LOA.
PhilCare offices and clinics will only issue an LOA if the PhilCare website system is down, otherwise LOA must be self-generated.
Enjoy the perks of all-around health and wellness by using it for regular check-ups or monitoring of existing conditions except for consultations relating to maternity-related cases and cases related to all forms of behavioral disorders, developmental, psychiatric disorder and psychosomatic illness, whether congenital or acquired. Please refer to the list of specialists that you are entitled to, based on your age requirement.
The consultation voucher covers only the consultation fee. Other services will not be paid by PhilCare
No, PhilCare will already take care of the consultation fee. You should not pay any excess charges relating to the consultation service. If the doctor asks you to pay for anything, please inform PhilCare, so that we may investigate and assist you further.
No, the consultation voucher is only for an out-patient consultation. You can seek out-patient consultation from PhilCare-accredited physicians and generate your LOA from this link: