Limitations of Health Plan


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The rights of the Member and obligations of PhilamCare are subject to the following limitations.

If a major disaster or epidemic causes unavailability of facilities or personnel or if circumstances not within the control of PhilamCare such as temporary lack of hospital facilities, complete or partial destruction of facilities, war, riot, civil insurrection, labor dispute, or similar causes occur, then PhilamCare shall not be liable for any delay or failure to provide services to the enrollee. PhilamCare shall, however, exert its best efforts to provide services to the enrollee, as the circumstances permit.

If a Member avails of the latest modalities of treatment and or diagnostic tests, the liability of PhilamCare shall be limited to the prevailing cost of hospital bills, professional fees and related expenses ordinarily charged for the traditionally accepted treatment modality and/or diagnostic tests. Notwithstanding this provision, PhilamCare's liability shall be limited to the amounts specified in your Health Care Agreement.

If the member refuses to follow the recommended treatment of procedure and the PhilamCare physician or the affiliated physician believes that no professional acceptable alternative exists, then PhilamCare shall no longer be responsible to provide care for the condition under treatment.

Hospital services are subject to all the rules and regulations of the hospital selected, including the rules and regulations governing admissions.

The total liability of PhilamCare on any dreaded disease and its complications during the entire lifetime of a member shall be limited to the Maximum Sum Per Disability.