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Philippine Government Audit Service Employees Assn.

COA Compound, Commonwealth Avenue, Quezon City
Website: http://coaw2k3ws01/philgasea/
Email add - / Tel. No. - 9328184

SINCE 1990

October 12, 2016

NATIONAL EXECUTIVE Assistant Commissioner Manolo C. Sy

COUNCIL OFFICERS Systems and Technical Services Sector
Commission on Audit
ATTY. HAIDE T. ESPUELAS,CPA, CFE Commonwealth Avenue
President Quezon City
Subject: Enrollment to PhiIGASEA's Helath Card offered by
MediCard on a voluntary basis and other PhiIGASEA's
new projects or programs

Dear Asst. Commissioner Sy:

Good Day!
In line with PhiIGASEA's commitment for the wellness of its members, the
Association is now offering one of its new projects, a corporate account health
card to be provided by MediCard. It will cater to all our members' needs
nationwide at a very affordable price being under a Corporate Account.
The main/salient features of the said Health card are as follows:
Vice Chairperson 1. Hospitalization Confinement
2. Out-Patient Care
3. Preventive Health Care
4. Emergency Care
ENGR. LAURENCE T. TATO 5. Members' Financial Assistance
6. Dental Health Care
7. Emergency Assistance and Response Service (EARS) hotlines
JAZMIN C. MACABANGON which is available 24 hours a day, 365 days a year
8. Services are also available in FOREIGN COUNTRIES
9. Additional Benefits such as Open Heart Surgery within the
Am. FABIAN K. DELOS SANTOS, HI Dreaded Disease Limit (DDL except cost of pacemaker); Organ
Transplant within the DDL, except cost of organ and donor's
DR. KARLO A. CAYETANO 10.Executive Check-up
11.And other benefits
MediCard has offered the following initial plans/packages exclusively for
PhilGASEA members and COA employees:

With AHMC, MMC, SLMC (QC), TMC, and CSMC, but without SLMC-
Global City


PREMIUM (per PREMIUM (per Coverage
enrollee) enrollee)
Ward/ without P 7,690.00 P 4,076.00 P60,000.00
Semi-Private 9,961.00 5,276.00 80,000.00
without AHMC '
Regular Private 13,328.00 7,064.00 100,000.00
Large Private 15,809.00 8,379.00 150,000.00
Other features of the PhiIGASEA's health card are as follows:

1. The plans are affordable/reasonable since this is a

2. All pre-existing conditions or diseases of COA Employees
3. Employee's dependents are allowed to be enrolled subject to the
payment of another premium;
4. COA Retirees 66 to 70 years old may also enroll in the said heath
5. MediCard has accredited hospitals and clinics NATIONWIDE
which includes Asian Hospital and Medical Center (AHMC);
Makati Medical Center (MMC); Saint Lukes Medical Center
(SLMC); The Medical City (TMC); Cardinal Santos Medical Center
(CSMC) and Capitol Medical Center.
6. This is open to all COA employees including permanent, co-
terminous employees and job-order employees and is renewable
every year.

PhilGASEA's health card is being offered for the meantime on a voluntary

basis to be shouldered by the enrollees on a personal account while the same
is being negotiated with COA top management.

Enrollment and payments must be made directly with the PhiIGASEA

Office. Enrollees must fill-up the required MediCard form and payment of
the premiums must be made directly with PhiLGASEA on or before
November 20, 2016.

PhiIGASEA's entitlement to the corporate account privileges however,

requires that enrollees must not be less than 3,000 for principal members
referring to COA employees and 3,000 for eligible dependent members.
Reduction on the required number of enrollees is subject to a recomputation of
premiums. Tentatively, the said program will take effect on December 2016 or
January 2017, depending on the enrollees' compliance with the MediCard
requirements, especially on the required number of enrollees.
Thus, we are inviting you and all COA employees to enroll in the said
program. Further, may we also respectfully request for your assistance in the
dissemination of this information.

Lastly, the undersigned would also like to take this opportunity to

disseminate PhiIGASEA's new programs/projects as follows:

1 PhiILCAD or PhiIGASEA's Legal Consultation and Assistance Desk

which offers FREE legal consultation and FREE legal assistance to all
COA employees which is available from Monday to Friday at the
PhiIGASEA office;
2. PhiIGASEA's 1st FREE ID for the members nationwide;
3. PhiIGASEA's new life insurance with loan facility

For further inquiries, please visit or call the PhilGASEA office at 9328184.
Attached herewith are the enrollment forms and a copy of the complete
proposal from MediCard.

Thank you for your continued support to the Association.

Very truly yours,

Atty. T. E LAS, CPA, CFE


Copy Furnished:

All Cluster Directors and Assistant Cluster Directors





CIVIL STATUS: [ } Married [ } Single GENDER: [ I Vale [ I Female

Employees may enroll their dependents as follows:

Category Qualified Dependents

Single . Parent up to age 65, unemployed and dependent on the principal member
Siblings 30 days up to 21 years of age who are not gainfully employed, unmarried and are living under the
same roof as the principal member
, . .
Single Parent Child 30 days and up to 21 years of age whom are not gainfully emplOyed, unmarried and are living under the
same roof as the princijal member

Married Legal Spouse up to 65 years of age of the principal member .

. Child 30 days up to 21 years of age whom are not gainfully employed, unmarried and are living under the same
roof as the principal member

The choice of enrolling dependents must follow a hierarchy. This means that the spouskfirst must be enrolled followed by the eldest child,
second child and so on for married personnel. Under single employees, the parents must be enrolled first followed by eldest brother/sister
and s'o on.

There shall be no cancellation of dependent enrollment within the contract year while the Principal member is still actively enrolled.

Over aged enrollees from 66 to 70 years old shall be accommodated with an additional 100% load on premium.



Will apply PHILHEALTH?
Relation to
(applicable for Non-Philhealth
Date of Birth Employee
Room Plan members, ex. Parents below 60
Last Name First Name M.I. Gende (MM-DD- Civil Status (ex. Mother,
and Limit y.o.) If yes, with additional P 2700
YYYY) daughter, brother,
in premium rates
4 1;.
. .

E ......... L -

, on my behalf, and on behalf of my dependent/s, hereby consent to the
disclosure by MediCard and its representatives of any or all of my and my dependent/s' medical utilization/diagnosis to my
COMPANY, its officers, directors, employees, and/or other authorized agents/representatives, which may result in the course of
providing their medical services to me or my dependent/s, as PATIENT. 1 understand. that any information which they may
acquire and/or receive relating to the said utilization/diagnosis will no longer be covered by confidential/privileged
communication upon execution of this waiver:1-hus, I, on my behalf, and on behalf of my dependent/s, hereby waive any claim
of confidential/privileged communication against MediCard, its officers, directors, employees, and/or other authorized
agents/representatives, its Medical Service Units/Teams and its Accredited Hospitals/Clinics, and hereby release them from any
liability which may arise as an incident of the said disclosure to my COMPANY.

Name of Employee / Patient

(Signature ovet Printed Name)
Employee number:
4xAcimt &th14,
31 August 2016


Commission on Audit, Commonwealth Avenue,
Quezon City

Dear Atty. Espuelas:

We are pleased to submit our offer for the Comprehensive Health Care Package
of your valued officers, employees and
their dependents.

The main feature of the program includes services and benefits for:
Hospitalization Confinement or In-patient Members' Financial Assistance
Out-patient Care Dental Health Care
Preventive Health Care
Emergency Care

Aside from being known in the industry for flexibility and quality services, may we present the following advantages your
company will benefit if and when you wit give us the opportunity to administer your health care program:
1. MediCard is a pioneer in the HMO industry established in 1987.
It is also one of the six founding members of the
Association of Health Maintenance Organizations of the Philippines, Inc. (AHMOPI).
2. MediCard is the only HMO being rein and operated by doctors.
3. MediCard is the only HMO awarded with the ISO 9001: 2008 Certification
in the Philippines and in Asia.
4. MediCard is the largest HMO in the Philippines in terms of membership base totaling to more than 500,000, a very
significant factor to support claims.
5. Our hospital-based system or open-door policy, in contrast to clinic-based and designated hospital,
members to avail of hospitalization and out-patient services in any of our more than 1,000 accredited
hospitals/clinics backed-up by 40,000 doctors & specialists nationwide that is most convenient and accessible to
them. Leading the list are Asian Hospital and Medical Center, Makati Medical Center, St. Luke's Medical Center,
The Medical City and Cardinal Santos Medical Center.
6. MediCard has a team of well-trained liaison officers who assist members during confinement and before discharge.
7. MediCard has Emergency Assistance and Response Service (EARS) Hotlines-available 24 hrs. a day, 365 days a
8. Savings on administrative time and costs compared to the insurance/self-administered type of medical coverage.
You can now channel your administrative's time and efforts to other more productive areas. NO MORE TEDIOUS
DOCUMENTATION PROCEDURES. It is almost trouble-free.
9. Since our professional fees are based on HMO-industry standards, it will take longer for members to maximize the
limitations of their benefits. Unlike other HMOs, our maximum limit for the dreaded disease is on a per illness per year
basis and not on an aggregate, lifetime or entire membership limit,
10. MediCard is known for the quality services we have been extending to our clients for the past years as proven by our
renewal persistency rate of 88%. Some of our more than 2,300 corporate clientele are 24/7 Customer Philippines,
Inc., Citibank, N.A., CTBC Bank (Philippines) Corp., GMA Network Group of Companies, KGB Phils., Inc. (formerly
INFONXX), Toyota Motor Phils., Phil. Daily Inquirer, Philippine Star Daily, Kodak Phils. Ltd., Landbank of the Phils., etc.

We hope that you will find our proposal convincing and that the package meets your requirements. Should you need
further clarification, please call the undersigned. Thank you for allowing us the opportunity to present our offer. We look
forward to the pleasure of servicing the health care needs of the officers, employees and the dependents of PHILIPPINE

Very truly yours,


Sr. Corporate Accounts Manager Sales ctor

MediCard Philippines, Inc.

8th Floor, The World Centre Building, 330 Sen. Gil Puyat Avenue, Makati City 1200
Certification Trunkline: 884-9999 / Fax Nos. 810-3855: 848-6454
Email: / Website:
MediCard Healthcare Program
A. Hospitalization Confinement Benefit*
Members in need of hospitalization can always count on the convenience and expertise of MediCard. For
more than two decades, we have always been there to provide the peace of mind as well as the comfort
zone for both the patient and his family. And with our vast medical provider network, you can feel at ease
knowing that your health is ready to be taken cared of anytime, anywhere.

No deposit upon admission


Room and board

According to type of plan enrollment
Use of operating theatre and Recovery Room
Covered within DDL
X-ray and laboratory examinations
Covered within DDL
. _
Services of MediCard specialists
Covered within DDL

Surgery and anesthesia

Covered within DDL

Administered medicines
Covered within DDL

Dressings, sutures and plaster casts, etc.

Covered within DDL
Fresh whole blood (including screening/ processing), and
intravenous fluids Covered within DDL
Human Blood Products (including screening/ processing)
except gamma globulin Covered within DDL

ICU confinements
Covered within DDL
. . -^ '
Chemotherapy, Radiotherapy & Dialysis 12 sessions within DDL

12 sessions within DDL

Admission kit including wee bag


All other items directly related to the management of the

case Covered within DDL
Visitation of MediCard liaison officer Covered

B. Outpatient Care. Services*

Getting your needed out-patient medical services shouldn't be a hassle. That is why MediCard provides its
members with the complete range of out-patient healthcare services--a one-stop shop for quality out-patient
care. With one of the most expansive network of hospitals and clinics, doctors and dentists, members are
assured of trouble-free access to medical services, whenever and wherever you may need it.

Regular consultations & treatment Covered within DDL;

except prescribed medicines
Referral to specialists
Covered within DDL; except prescribed medicines


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Prepared by: EDalupang
MediCard ealthcare Program

Treatment of minor injuries and surgery not requiring

confinement Covered within DDL

X-ray and laboratory examinations Covered within DDL

Eye, Ear, Nose & Throat treatment

Covered within DDL

PT / Speech Therapy
. Up to 12 sessions within DDL

Laser treatment of Glaucoma & Retinal Detachment Covered within DDL

Cataract Extraction (excluding cost of lens), including
phacoemulsification Covered within DDL

Pre & Post natal consults

Except labs

Sclerotherapy (excluding sclerosing agent) up to P5,000

Cauterization of warts (including facial warts) up to P 2,000

Allergy Testing
up to P2,500

First dose of anti-rabies, anti-venom, anti-tetanus up to P 25,000

Tuberculin Test (except screening) up to Pt 000

Consultations for chronic dermatoses Covered

Consultations for scabies Covered

Modern Thera etutic Procedure* ,

q.....k' 1 : ... '
lfilPi .: i,,,,,
Laparoscopic Procedures Covered within DDL

Lithotripsy/ESVVL Covered within DDL

_ .. .
Hysteroscopic Procedures Covered within DDL
,.. . M... - .

Stereotactic Brain Biopsy Covered within DDL

Gamma Knife Surgery

Covered within DDL

Percutaneous Ultrasonic Nephrolithotomy

Covered within DDL

Transurethral Microwave Therapy (TWAT) of the prostate

Covered within DDL
.-----^-^ ^^.
Arthroscopically-guided Procedures
Covered within DDL

MRI / CT Scan / Ultrasound guided' excisions

Covered within DDL

Endoscopically-guided excisions / treatments /

procedures Covered within DDL


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Prepared by: EDaiupang
MediCard ealthcare Program

ex Dia nOstic -Procedure*

Covered within DDL

CT scan
Covered within DDL

Covered within DDL

Serum chemistry panels (eg. Chem 23, Spec M, etc.) Covered within DDL
Angiography (e.g. Coronary, cerebral, retinal, pulmonary,
GI, etc.) Covered within DDL

Pulmonary perfusion scan

Covered within DDL
Tests involving use of Nuclear Technologies (e.g.
Radionuclide Scan/Ventriculography, Thallium stress
testing, Pyrosphosphate Scintigraphy, Myocardial Covered within DDL
Perfusion Scanning, etc.)

Electromyography, Nerve Conduction Velocity Studies

Covered within DDL

24-Hour Hotter Monitoring, 2-D Echo and Doppler

Covered within DDL

Treadmill Stress Test

Covered within DDL

Covered within DDL

Diagnostic Endoscopy (including one of video)

Covered within DDL

Diagnostic Arthroscopy
Covered within DDL
Diagnostic Hysteroscopy
Covered within DDL
Plasma/Unnary Cortisol, Plasma Aldosterone,
Adrenocortical Function, etc. Covered within DDL

Mammography and Sonomammogram i Covered within DDL

Bone densitometry scan (Dexascan) Covered within DDL

Immunologic Studies: Anti-nuclear antibody (ANA), C-
Reactive protein, Lupus cell exam Covered within DDL

Genetic studies
Covered within DDL

New Dia nastic & Thera eutic Modalities*

Positron Emission Tomography (PET) Scan Covered within DDL

Mammotome Covered within DDL


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Prepared by: EDalupang
MediCard Healthcare Program
t to PE

3D & 4D Ultrasound (except for maternity cases)

Covered within DDL

Laser / Coblation Tonsillectomy

Covered within DDL

Robotic Surgery
Covered within DDL
- .
Endovenous Laser Therapy (except for cosmetic
purposes) Covered within DDL

Stapled Hemorrhoidectomy
Covered within DDL

Photodynamic Therapy
Covered within DDL

Intensified Modulated Radiotherapy (IMRT)

Covered within DDL
Covered within DDL
New diagnostic & treatment procedures for conditions
with established etiologies and its use is only as alternative
to the conventional methods. Covered within DDL

Laboratory/ancillary services for conditions whose

pathogenesis or subsequent clinical improvement is not
yet fully established in Medical Science Covered within DDL

C. Preventive Healthcare Services

An ounce of prevention is worth a pound of cure. That age-old adage of wisdom has been one of the
philosophies behind MediCard services. That is why we make sure that our cardholders enjoy the advantages
of the comprehensive gamut of preventive healthcare programs and services we've designed to keep them
at their health's best.

Annual Physical Examination (APE) to include Covered

Complete Blood Count Under APE

,. ......... . , . _
Urinalysis Under APE

Fecalysis (stool exam) Under APE

Chest X-Ray Under APE
^^ ^ - ,, ^^,

Eye Refraction Under APE

Electrocardiogram Under APE; For adults age 35 and above, or if prescribed

Pap Smear Under APE; For women age 35 and above, or if prescribed

Management of Health Problems Covered

Routine Immunization Except administered vaccine


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Prepared by: EDalupang
MediCard Healthcare Program

Counseling on Health habits, diets and Family Planning Covered

Record keeping of medical history


Wellness Lectures at 1 hour per session

Four (4) times a year

Once a year APE shall be conducted at any Medicard Stand Alone Clinics or at the COMPANY premises
through a Medicard Mobile Medical Team on a scheduled basis for a minimum of 50 principal members. For
provincial-based accounts, APE may be conducted at designated hospitals with prior coordination.

D. Emergency Care Services

In Accredited Hospitals
It may happen when you least expect it. That is why MediCard has taken steps in providing its members not
only a comprehensive emergency medical care program, but also access to swift emergency medical help for
the injured and the sick. So when an emergency does strike, you are assured that MediCard will be there to
provide you or your loved ones prompt medical assistance.


Doctor's services
Covered within DDL

Medicines used during treatment or for immediate relief Covered within DDL
Oxygen and intravenous fluids Covered within DDL

Dressings, plasterca a sutures

sts and reddtowitthheinDDL

Laboratory, x-ray and other diagnostic examinations Covered within DDL; directlyCreoivaete emergency management of the

In Non-Accredited Hospitals
For emergency medical services in non-participating hospitals and clinics, members must advance payment
and later file reimbursement from MediCard. Reimbursement shall be based on the table below:

Approved Hospital Bills

100% based on MediCard Relative Value up to Dreaded Disease Limit
Doctor's Professional Fees

In Areas Without Accredited Hospitals

Hospital Bills

100% based on MediCard Relative Value up to Dreaded Disease Limit

Doctor's Professional Fees


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Prepared by: EDalupang
MediCard ealthcare Program

In Foreign Countries
For emergency medical services in foreign territories, members must advance payment and later file
reimbursement from MediCard based on MediCard Relative Value and Philippine Currency. Reimbursement
shall be based on the table below:

Hospital Bills

100% based on MediCard Relative Value up to Dreaded Disease Limit

Doctor's Professional Fees

Ambulance Services and Erner enc Medical Assistance

Ambulance Services (Land,Transport)

Reimbursement up to P 5,000 per conduction per year

E. Member's Financial Assistance (For Employees only)

Aside from the medical benefits to which a Principal member is entitled to, MediCard shall also provide the
heirs of a principal member enrolled in the health care program in the event of death or injuries through natural
causes or accidental means, the following amount by way of financial assistance:

4:6 0**
Natural Death P 10,000
Accidental Death P 20,000

Loss of both hands/both feet; Loss of sight P 10,000


Loss of one hand, one foot or one eye P 5,000

Provided, that the death or injury results from causes that are covered and are not under the exclusions or
uncovered pre-existing condifions as stated in the MediCard Membership Contract.

Also, total annual premium for the contract year should have been paid at the time of availment. Otherwise,
all remaining unpaid premium will be deducted from the amount of assistance.

F. Dental Care Services

A smile goes a long, long w4. That is why MediCard makes sure that you continue to enjoy the services and
have trouble-free access to its dental healthcare program.

Oral prophylaxis Twice a year

Consultations and oral examinations Covered


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Prepared by: EDalupang
MediCard ealthcare Program

Tooth extractions Limited to simple tooth extraction; excluding surgery for impacted or ankylosed
_ tooth, etc.
Temporary fillings

Permanent amalgam and/or Light cure filling Up to two (2) teeth per member per year

Gum treatments for cases like inflammation or bleeding Covered

Recementation of loose jackets, crowns, in-lays and on-

lays Covered

Treatment of mouth lesions, wounds and bums Covered

Adjustment of dentures

Emergency out-patient dental treatment

In accredited dental clinics only

Temporomandibular Joint (TMJ) consultations Covered

Restorative and Prosthodontic consultations Covered

Dental Nutrition & Dietary Counselling through chairside

instruction Covered

Dental Health Education Covered

Prenatal & Postnatal consultations Covered

G. Additional Benefits

Work-related illness/accidents (except those in exclusion) Up to DDL for Employees only

^- r--

Unprovoked Assault i Up to DDL

Congenital Illnesses j Up to DDL

-^----^^---... '

Slipped Disc, Scoliosis, Spondylosis, Spinal Stenosis Up to DDL

..-------,.--- M.. 1.-

Open heart surgery within DDL except cost of pacemaker

Organ transplant i within DDL excluding cost of organ and donor's expense
,--.^..--^,-Try ^

Hyperventilation syndrome First ER availment up to P5,000 for Employees only

P 400.00 per head for pre-employment physical examinations (paid up front) at

designated MediCard owned clinics.
Pre-employment services If the applicant is hired and enrolled under MediCard, this will serve as his
annual physical examination and MediCard shall refund the said amount back
to the company.


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Prepared by: EDalupong
MediCard Healthcare Program
"IP T7,

To be arranged by MediCard at any accredited hospital on a "fee for service

basis." MediCard shall accommodate first then later bill the company of
Executive check up
actual expenses with an 18% service charge, payable within 10 days from
date of receipt.

Member may avail of the next higher room a;&lable

available except large suite room
Room upgrade in cases of room non-availability within the first 2 days, upon admission provided a certification from the
hospital admitting section must be secured before the date of discharge to
that effect.
At e end of each year of coverage for which premiums have been paid in
full, the total utilization experience of the company shall be reviewed. In case
of a favorable claims experience wherein the budget for utilization is not used
up, the unused portion shall constitute the basis for amount to be discounted
for the following year's premium payments. This discount may only be availed
of if the service contract with MediCard is renewed.

Experience refund benefit Computation of the EXPERIENCE DISCOUNT shall be according to the
following formula:

EXPERIENCE DISCOUNT = (Total Annualized premiums paid x 0.30 - Total

Amount Utilized for Benefits) x 50%

The refund will be computed three (3) months after the contract is
The COMPANY shall be entitled to a refund on membership fees except when
the reason for pre-termination is the fault of the COMPANY. The followingshall
be the schedule of refund:

if the Agreement/Membership has . Percent of refund from

been in force for the paid
, . < Annual membership fees'

Not more than one (1) month 80%

Refund of unused premium
More than one (I ) month but less than three
(3) months 70%
At least three (3) months but less than six (6)
months 40%

Six (6) months or more No refund

lote: where n member hnc csIrtimeari fnr KAamhcaric Fir,,,,,,, A re ir 4.-.... ,-. .... li . - .

shall not be entitled to a refund during the concerned contract period.

Free consultations at MediCard owned clinics from the following primary
physicians and specialists:

1.General Surgeon
2. Obstetrician Gynecologist
3. Pediatrician
4. Family Medicine
5. General Practitioner
Free consultations at MediCard owned clinics 6. General Internist

Above consult will not be charged to the member's Maximum Benefit Limit.

Members can also avail of the free consultations even for conditions which are
classified under general exclusions or pre-existing conditions which are not

On top of this, members can avail of discounts on laboratory examinations up

to 20% for cases which are not covered.


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Prepared by: EDalupang
MediCard Healthcare Program
You may also want to extend the benefits of having a MediCard plan to your
employees dependents. Through RxER, MediCard's latest emergency product,
they get a specialized healthcare maintenance service that covers
emergency, preventive and outpatient care for one year for P1,998.00. Best of
all, there's no age-limit, no medical exam required, and no hierarchy to be

Applying is simple too. Just fill out the application form, pay for the
corresponding amount and get your card in an instant.

Salient benefits which you may avail in any of our MediCard-owned clinics
Unlimited check-ups with primary care physicians, Pediatricians,
Medical Internists and OB Gynecologists
Flat rate of P350.00 for specialists
One FREE Oral Prophylaxis
Dental consults with dentists
30% discount on dental procedures
30% discount on diagnostics and tests
One-time basic 5: CBC, Urinalysis, Stool Exam, Chest X-ray and
Physical Exam
Emergency Care* for trauma cases in all MediCard accredited
hospitals nationwide

L *Rules apply,For more details, please call account officer.

H. Other Benefits

24/7 Call Center Service/Access Trunkline: 841-8080; Toll Free: 1-800-1888-9001

A unique addition to complement MediCard services is an SMS service for members to

Text MediCard access the database of MediCard's accredited network of hospitals and doctors. Text
MediCard is accessed by simply sending the keyword MediCard to access numbers
0908-8841814 for Smart subscribers and 0917-8512648 for Globe and Sun subscribers.
Access to the special discounted prices on vaccines through the MediCard-
Vaccines GlaxoSmithKline (GSK) adult vaccination campaign (Influenza, Hepa A & B, Typhoid,

I. Pre-existing Contditions Coverage

For the initial 3,000 Principal members,

3,000 Dependent members and Up to Dreaded Disease Limit per illness per member per year.
_succeeding enrollees
NOTE: All other limits mentioned in this proposal are subject to the Pre-Existing Condition limit, if applicable, based on the given diagnosis

Any illness, injury or any adversemedical condition shall be considered pre-existing if during the entire period prior'and within the first
twelve (12) months from the effectivity date of this Agreement:

a. Any professional advice orconsultation and/or treatment was made given as a result of such illness, injury or adverse medical
condition; or
b. The MEMBER was aware orshould reasonably have been aware of the signs or symptoms of such illness, injury or adverse medical
condition; or
c. The pathogenesis or onset of such illness, injury or adverse medical condition has been started during the contestability period for
membership in this Corporate Health Program as determined by MEDICARD's Medical Director or accredited physicians.

2. Without necessarily limiting the following enumeration, the following are automatically considered as pre-existing conditions if
consultation or treatment is sought within the first twelve (12) months of coverage:

a. Dreaded Diseases listed below except for letters k & I

b. Hypertension
c. Goiterfrlypo/Hyperthyroidismt


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Prepared by: EDalupang
MediCard Healthcare Program
d. Cataracts/Glaucoma
e. ENT conditions requiring surgery
f. Bronchial Asthma /Allergy / Urticaria
g. Tuberculosis
h. Chronic Cholecystitis/Cholelithiasis (gall bladder stones)
I, Acquired Hernias
j. Prostate disorders
k. Hemorrhoids and Anal Fistulae
I. Benign Tumors
m. Uterine Myoma, Ovarian cysts, Endometriosis
n. Buergher's Disease
o. Varicose Veins
p. Arthritis
q. Migraine headache
r. Gastritis/duodenal orgastric ulcers
" -

J. Dreaded Disease
Dreaded diseases are potentiallyor actually life-threatening conditions or illnesses which may require prolonged or repeated hospitalization
or intensive care management. MediCard shall pay for hospitalization services up to the maximum limit subject to the pre-existing
conditions coverage.

The following are considered dreaded disease:

a. Cerebrovascular Accident (stroke)
b. Central nervous system lesions (Poliomyelitis/Meningitis/Encephalitis/Neurosurgical conditions)
c. Cardiovascular Disease(Coronary/Valvular/Hypertensive Heart Disease/Cardiomyopathy)
d. Chronic Obstructive Pulmonary niSease (Chronic Bronchitis/Emphysema), Restrictive lung disease
e. Liver Parenchymal Disease [Cirrhosis, Hepatitis (except type A), New growth]
f. Chronic Kidney/Urological disease (Urolithiasis, Obstructive Uropathies, etc.)
g. Chronic Gastrointestinal Tract Disease requiring bowel resection and/or anastomosis
h. Collagen diseases (RheumatoidArthritis, Systemic Lupus Erythematosus)
i. Diabetes Mellitus and its complications
I, Malignancies and Blood Dyscrasias (Cancer, Leukemia, Idiopathic Thrombocytopenic Purpura)
k. Injuries from accidents or assaults, frustrated homicide or frustrated murder
Complications of an apparent Ordinary illness including MODS and SIRS (e.g. sepsis due to pneumonia, typhoid ileitis, cerebral malaria,
m. Single or multiple organ dysfunction and failure (MODS and MOF)
n. Conditions that may require dialysis
o. Chronic pain syndrome (greater than six weeks)
p. Any illness other than the above which would require Intensive Care Unit confinement
q. Et cetera

K. Membersh

Principal Member At least 18 years old up to age 65 and employed by the company.

For Single Principal 2 Parents up to age 65

Siblings, 30 days old up to 21 years of age
Qualified Dependent Member
Legal Spouse up to age 65
For Married PrincipaI L
Children, 30 days old up to 21 years of age

For Single Parent

Principal Members Children, 30 days old up to 21 years of age


The choice of enrolling dependents must follow a hierarchy. This means that the spouse first must be enrolled followed by the eldest
child, second child and so on for married personnel. Under single employees, the parents must be enrolled first followed by eldest
brother/sister and so on.
There shall be no cancellation of dependent enrollment while the Principal member is still
actively enrolled.
Application forms and Medical evaluation are waived.
Over aged enrollees from 64to 70 shall be accommodated with an additional 100% load on premium.


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Prepared by: EDalupang
MediCard Healthcare Program
L.. Membership Fees

With AHMC, MMC, SLMC Q.C. , TMC and CSMC but without SLMC-Global C'

Without AHMC P 7,690 P 60,000

Without AHMC 9,961 80,000

Regular Private 13,328 100,000

Large Private 15,809 150,000

Rates presented are inclusive of 12% VAT.
The foregoing premium is applicable for an initial enrollment of 3,000 employees and 3,000 dependents,
reduction by more than 10%
Shall be subjected to a recomputation.
Non-PhilHealth/Medicare members (he, unemployed parents below 60 years old, etc.) must pay an additional P2,700.00 per head
upon inception of membership or shall pay the corresponding portion during confinements and out-patient surgical procedures
out-patient cataract extraction). (i.e.
Above rates are valid within 6Odays from date of proposal.
Services availed by a MEMBEN in excess of the coverage or allowable limit shall be settled by the MEMBER directly with the hospital.
Failure of the MEMBER to settlei the excess charges shall necessitate MediCard to bill the MEMBER, through the COMPANY, all excess
charges with corresponding twenty percent (20%) service fee, payable within fifteen (15) calendar days from receipt of billing.
Otherwise, a corresponding *ally of 3% per month will be incurred. If the bills remain unpaid after thirty (30) days, the concerned
MEMBER shall cease to be eqdlited for coverage until after bills have been settled in full
For in-patient services at The Medical City (TMC) where there is no Semi-Private Room category, members enrolled under Semi-Private
Room Plan may avail of theltandarcl A & B considered as Small Private Room. Excess in RIB shall be shouldered by the member. If the
member opts to stay in DelUx* or Superior Room considered as Large Private, the room difference and incremental charges shall be
shouldered by the member.

AHMC Asian Hospital:and Medical Center
MMC Makati Medical Center
SLMC Saint Luke's Medical Center
TMC The Medical City
CSMC Cardinal Santos Medical Center
DDL Dreaded Disease Limit
ore Canditions

MRV MediCard relaitive value (what it would have cost had the service been rendered in an accredited hospital through
the services clan accredited doctor).
Inclusive of operating room charges, professional fees and other incidental expenses relative to the procedure


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Prepared by: EDalupang
MediCard Healthcare Program
Exclusions, Limitations and Guidelines
Except as otherwise provided in this Proposal, the following are the limitations / exclusions in the coverage given by MediCard:


1. All confinement shall be upon recommendation of the corporate health program holder's MediCard accredited Physician, or the
MediCard Medical Director or the Emergency Room Resident Physician of the MediCard Accredited Hospital who decides to admit
MediCard patient-member in cases of life threatening emergencies.

2. Hospital bills for the following hospital services shall be charged to the account of the MediCard patient-member: services of a
private nurse or doctor, use of extra food and/or bed, T.V., electric fan, VCD. ID bracelet, thermometer, admission kit and all other
items not directly related to the medical management of the patient.

3. Hospitalization and treatment outside the Philippines is not covered.

4. MediCard is not responsible and will not recognize any hospital bills incurred by a corporate health program holder in hospitals not
accredited by MediCard, except for emergency care services under the terms provided in this Agreement.

5. Cost of hospitalization, medical services, medicine and other expenses incurred as a result of a member's decision to avail of such
hospitalization, medical services, treatment or procedure, not prescribed or contrary to what has been prescribed by the attending
MediCard provider, or without MediCard's express written report shall not be shouldered by MediCard.


1. Prescribed medicines on an out-patient basis are not provided by MediCard Medical Center or Medical Service Units.

2. The absolutely no charge out-patient medical and health care services are provided only during clinic hours of Medical Service

3. Second opinions and cost of treatment incurred in non-accredited hospital or clinic should the member,unilaterally decide to seek
such recourse.

1. Deadline for enrollment of dependents:

a. For new & renewing, accounts - 30 days from the effectivity date of the agreement.

b. For dependents who meet the eligibility requirements within the agreement period - 30 days from the date dependent
become eligible formembership. (copy of birth certificate or marriage agreement must be submitted)

c. For additional principal members of the company, dependent/s must be enrolled together with the principal.

d. Any additional dependents other than the above can be enrolled upon the renewal of agreement, within the one (1)
month enrollment period.

After the lapse of the periods specified above. MediCard will no longer receive, evaluate and accept any designation or
application to be a qualified dependent from any PRINCIPAL MEMBER.

2. Underwriting cut-off dates in assigning effectivity date:

Date of Receipt of Application/Endorsement Effectivity Date

llth to 2511' of the month 1st of the following month
26th to 10th of the month 16th of the same month

If the company opts to specify an effectivity date, the advice for inclusion/addition should be received two (2) weeks before the
desired effectivity date. Otherwise, the Underwriting cut-off dates will apply.

3. New enrollees who are approaching age of ineligibility must be enrolled at least six (6) months counting from the date of effectivity
up to the date that the enrollees become ineligible for them to be accepted as members. All pre-existing condition/ dreaded
disease limits will be computed on a prorated basis (i.e. If age of eligibility is up to 60 years old, only applicants who are 60 years and
6 months old and younger Will be accepted for membership).

4. Renewing members who will become age ineligible within the next renewal agreement year will be allowed to renew regardless of
the remaining months that the member will remain eligible. However, pre-existing condition/dreaded disease limits will be computed
on a prorated basis (i.e. If age of eligibility is up to 60 years old, a renewing member who is 60 years and 9 months old will still be
renewed but pre-existing condition/dreaded disease limits will be computed based on the following formula:
Total months thatpember remains eligible X PEC/DD limit = Pro-rated Limit


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Prepared by: EDalupang
MediCard Healthcare Program


1. Services which a member receives from a non- MediCard Physician, non- MediCard Accredited Hospital or other provider of care,
except as described in the emergency care in non- MediCard hospitals, as provided for in this Agreement;

2. Hereditary, and/or congenital defects of whatever form;

3. Sensorineural hearing impairments except those acquired during time of membership;

4. Plastic and reconstructive surgery for cosmetic purposes and for physical congenital deformities and abnormalities;

5. Dermatological care for aesthetic purposes such as electrocautery or chemical treatment for skin tags, xanthelasma, milia, keloids,
scars, etc. on any exposed areas of the body;

6. Guillain-Barre syndrome, multiple sclerosis, demyelinating disease, Parkinson's disease, Alzheimer's disease, Myasthenia Gravis,
epilepsy, seizure disorder and other autoimmune neurological disease:

7. Slipped disc, scoliosis, spinal stenosis and spondylosis;

8. AV malformation and aneurysms which are considered congenital except only those unequivocably proven to be acquired

9. Corrective eye surgery for error of refraction including laser surgery for correction of myopia and hypermyopia;

10. Psoriasis, vitiligo;

11. Experimental medical procedures, acupuncture, acupressure. reflexology and chiropractics;

12. Services to diagnose and/or reverse infertility or fertility and virility/potency (erectile dysfunction);

13, Open heart surgeries, angioplasties, valvulaplasties, permanent pacemaker insertion, intro coronary thrombolysis, balloon
valvuloplasties, transvenous endocardial biopsy, percutaneous intraaortic balloon pump insertion, balloon atrial septostomy,
previous craniotomy sequelde, organ transplantation and complication and other surgeries related to the heart;

14. Diagnostics for hypersensitivity and desensitization treatment;

15. Purchase or lease of durable medical equipment, oxygen dispensing equipment and oxygen except during hospital confinement
under the Hospital Confinement Benefit;

16. Corrective appliances and artificial aids and prosthetic devices;

17. Human blood products like platelets, packed RBC, plasma, gamma globulin, etc. and its processing;

18. Psychiatric and psychological illnesses including neurotic and psychotic behavior disorders;

19. Treatment for alcoholic intoxication and drug addiction or overdose reaction to use of prohibited drugs including illnesses directly
related to it and other injuries attributed as a result of it;

20. Rehabilitation treatment, physical, speech, occupational and hormonal therapies;

21. Developmental disorders, metabolic diseases, sleep and eating disorders;

22. Sexually transmitted diseases such as AIDS, Hepatitis B, condyloma, gonorrhea, syphilis, herpes etc. and their attendant

23. Pelvic Inflammatory disease, tubo-ovarian abscess, pyosalpingitis, etc.;


25. Hazardous job-related illnesses and/or injuries:

26. Physical examinations required for obtaining or continuing employment, insurance or government licensing;

27. Injuries or illnesses resulting from participation in war-like or combat operations, riots, insurrection, rebellion, strikes and other civil

28. Treatment of self-inflicted injuries or injuries attributable to the MEMBER'S own misconduct, gross negligence, use of alcohol and/or
drugs, vicious or immoral habits, participation in act of crime, violation of a law or ordinance, unnecessary exposure to imminent
danger or hazard to health and hazardous sports related injuries;


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Prepared by: EDalupang
MediCard ealthcare Program

29. Matemity care and other conditions as a result of pregnancy unless specifically provided;

30. Custodial, domiciliary care, convalescent and intermediate care;

31. Oral surgery for purposes of beautification. temporomandibular joint disease (TMJ) surgery done by dental practitioner;

32. Circumcision, except for correction of Phimosis;

33. Treatment of injuries sustained in a motor vehicle accident if the member or his guardian fails or refuses to execute the deed of
Subrogation specified in Article VII hereof;

34. Professional fees of medico-legal officers;

35. Diagnosis of unknown etiology or the absence of any organic dysfunction;

36. Cost of vaccines for active and passive immunization except as otherwise provided for in this Agreement;

37, Laboratory examinations for screening sexually related illnesses and injuries;

38, Any condition or illness waived upon membership except as otherwise provided for in this Agreement;


This is to signify that all benefits, exclusions and premium incorporated to this proposal are amenable to us. By this, we
have decided to avail the services of MediCard Philippines, Inc. for the health maintenance program of PHILIPPINE



, 4444


Note Please fill up information above - for contract agreement purposes.


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Prepared by: EDalupang