Emergency Healthcare Services, may be availed of in emergency conditions as defined in Article 2 after his enrollment to the health care program. In which case, Emergency health care services listed previously under hospitalization and in-patient health care services, may be availed of in any Forticare accredited or non-accredited hospitals or medical centers such that:
Included Services:
- if the Emergency Care Services is secured at an accredited hospital or medical center. Forticare shall pay for the actual cost of health care services needed by the Member;
- if the emergency treatment has been administered in an Accredited Hospital and the Member still requires confinement. Forticare shall provide the in- patient benefits subject the provisions of this Agreement.
- and Board If the Emergency Care Services is secured at a non- accredited hospital or medical center, Forticare shall reimburse 80% of the cost of health care services based on Forticare Standard Rates being used by Forticare in paying the same health services to other health partners and providers;
- If emergency treatment has been administered in non- accredited hospital and the Member still requires confinement, he, or his representative, as a pre-requisite for in-patient coverage, must notify within a period of twenty-four (24) hours from admission. However, in case the Member, due to his medical condition, is unable to communicate directly or through a representative, the 24- hour notification period shall be extended for twenty-four (24) hours from the time he is clinically able to do so;
- Ambulance Service not to exceed Two Thousand Five Hundred Pesos (P2,500) per availment from a non- accredited to an accredited hospital or medical center if approved by the attending physician, Forticare shall be reimbursed and charged to the ABL or the Member; & medically necessary laboratory and diagnostic procedures.
NOTE: Whether the Emergency Health Care Services are secured in any Forticare accredited or non-accredited hospital or medical center, the Member, directly or through his representative should inform Forticare within twenty- four (24) hours from the start of the emergency. However, in case the Member, due to his medical condition, is unable to communicate directly or through a representative the 24-hour notification period shall be extended for twenty- four (24) hours from the time he is clinically able to do so.
