Dear Ma’am/Sir:

We a re pl ea s ed to s ubmi t our offer for the Comprehensive Health Care MediCard Select Package for your fa mi l y/______/__________.

The a ccompanying proposal includes i n depth information on:

 Hospitalization / In-patient  Emergency Care

 Out-patient Care  Dental Health Care
 Preventive Health Care

Medi Card has over 30 yea rs of experience in providing quality healthcare a cross a ra nge of i ndus tri es a nd ha ve hel ped ma ny of i ts cus tomers
ma nage their healthcare. As the only HMO founded and run by doctors, you a re assured that the plan we offer you is recommended a nd a pproved
by our i ndus try experts on boa rd.

Medi Card stands ta ll – i t has more than 43,000 a ccredited medical professionals i n more than 1,000 a ccredited hospitals and clini cs tha t s erve i ts
more tha n 700,000 members a cross the archipelago. Add to that the prestige of being the fi rst HMO i n the country tha t i s ISO -certi fi ed a nd ha s
ta ken s teps to a dva nce i ts Qua l i ty Ma na gement Sys tems s o you a re gu a ra nteed of qua l i ty hea l thca re.

Medi Card continues to play a role as a n innovator and a leader i n provi ding solutions to your needs so you ca n channel your a dministrative’ s ti me
a nd efforts to other more producti ve a rea s .

 Medi Card is the first to i ntroduce the E-corporate portal that lets you check your empl oyees ’ members hi p i nforma ti on, enrol l new
members , vi ew uti l i za ti on a nd more.
 Medi Card is also the fi rst to i ntroduce MyPocket Doctor, a telemedicine facility offered to i ts members that a ll ows cons ul ta ti on wi th a
doctor vi a vi deo or phone ca l l a nyti me, a nywhere
 Medi Ca rd i s the fi rs t to offer occupa ti ona l hea l th s ervi ces a nd corpora te s ta ffi ng for ons i te cl i ni cs
 Medi Ca rd ha s i ts own network of free -s ta ndi ng cl i ni cs a nd pha rma ci es for tota l ma na ged he a l thca re

On top of thes e, Medi Ca rd ha s a hi gh renewa l pers i s tency ra te a mong i ts s a ti s fi ed cl i ents .

We hope that you will fi nd our proposal convincing and that the package meets your requirements. Should you need further cla rifica ti on, pl ea s e
ca l l the unders i gned a t 8864-0907.

Tha nk you for a l l owi ng us the opportuni ty to pres ent our offer.

We l ook forwa rd to the pl ea s ure of s ervi ci ng the hea l th ca re needs of your fa mi l y.

Si ncerel y, Noted by:

JOSEPHER M. GILVERO RANDY V. VERDE

Members hi p Cons ul ta nt – Medi Ca rd Sel ect Seni or As s i s ta nt Sa l es Di rector- Sa l es a nd Bus i nes s Devel opment II
MediCard Philippines, Inc.

MediCard Select Program – Individual/Family/SME

A. Membership Eligibility
a. Principal Member

For Individual Account: Any person at least 18 years old up to 99 years of age
For Family Unit/SME Account: Any person at least 18 years old up to 60 years of age

b. Qualified Dependent Members for Family Unit/SME Account

Legal Spouse up to age 60

For Married Principal Members
Legitimate and/or legally adopted children, 30 days old up to 60 years of age
who are not gainfully employed and unmarried

Parents up to age 60, unemployed and dependent on the Principal Member

For Single Principal Members
Brothers and sisters, 30 days old up to 60 years of age, who are not gainfully
employed and unmarried
Children, 30 days old up to 60 years of age, who are not gainfully employed
For Single Parent Principal Members
and unmarried

Notes:
 All members must be below 60 years and 6 months old and younger upon enrollment
 No hierarchy to follow

B. Prev entiv e Healthc are S erv ic es

The Preventive Health Ca re Servi ces will be provided to MEMBERS by des i gna ted Medi Ca rd Medi ca l Servi ce Uni ts
Health Care Benefits Coverage/Limit

1. Annual Physical Examination (APE) to include* Covered

Covered
a. Complete Blood Count

b. Urinalysis (urine examination) Covered

c. Fecalysis (stool examination) Covered

d. Chest X-Ray Covered

e. Electrocardiogram (for _________________) Covered

f. Pap Smear (for _______________________) Covered

g. Eight Blood Chemistries:

Fasting Blood Sugar, Total Cholesterol, Uric Acid, Covered under APE; for members 30 years old and above
Creatinine, BUN, HDL, LDL and Triglycerides

h. Anti-flu vaccines Covered under APE; for members below 30 years old

2. Management of Health Problems Covered

3. Routine Immunization (___________cost of vaccines) Covered

4. Counseling on Health habits, diets and Family Planning Covered

5. Record keeping of medical history Covered

*APE may be conducted at any MediCard-free standing clini

MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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MediCard Philippines, Inc.

List of MediCard Free Standing Clinics:

1. MediCard Lifestyle Center - Makati – 51 Paseo de Roxas Avenue corner Senator Gil Puyat Avenue, Makati City
2. MediCard Philippines, Inc. - Makati – 2129 G/F King's Court Bldg. II, Don Chino Roces Avenue, Makati City
3. MediCard Philippines, Inc. – Ortigas Clinic – Unit 105, Parc Royale Condominium, Julia Vargas Avenue, Ortigas Centre,
Pasig City
4. MediCard Philippines, Inc. – Sta. Rosa - 2nd Floor Humana Wellness Center, Tagaytay Highway, Brgy. Don Jose, Sta. Rosa,
Laguna
5. MediCard Philippines, Inc. – Centris - Unit E, F, G Two Cyberpod Centris, Eton Centris, EDSA corner Quezon Avenue, Quezon
City
6. MediCard Philippines, Inc. - Cavite Clinic - G/F MediCard, Anabu Kostal, Anabu II D, Aguinaldo Highway, Imus, Cavite
7. MediCard Philippines, Inc. – Alabang Filinvest Clinic – 3/L Festival Supermall, Corporate Avenue, Filinvest, Alabang,
Muntinlupa City
8. MediCard Philippines, Inc. – Calamba Clinic – Unit 1 G/F, Adenson Building, Brgy. Parian, National Hi -way Calamba,
Laguna
9. MediCard Philippines, Inc. – Fairview Clinic – Unit 31 E & F LF Building, Commonwealth Avenue corner Camaro Street,
Fairview, Quezon City
10. MediCard Philippines, Inc. – Clark - 2nd Floor, SM City Clark, Manuel A. Roxas Highway, Clark Freeport, Pampanga
11. MediCard Philippines, Inc. – Cebu Clinic – Unit 204 and 704, FLB Corporate Center, Cebu Business Park Mabolo, Archbishop Reyes
Avenue, Cebu City
12. MediCard Philippines, Inc. – McKinley – G/F Morgan Executive Suite, McKinley Hill, Bonifacio Global City, Taguig
13. MediCard Philippines, Inc. – Sta. Lucia – G/F Sta. Lucia East Grand Mall, Marcos Highway corner Felix Avenue, Cainta, Rizal
14. MediCard Philippines, Inc. – Lipa Clinic – G/F RDC Plaza, J.P. Laurel Highway (in front of Lipa Medix Medical Center), Lipa
City, Batangas
15. MediCard Philippines, Inc.- Uptown Bonifacio – LG05, Lower Ground Floor, One Uptown Residences, 9 th Avenue corner 36 th
Street, Bonifacio Global City, Taguig

C. Out-patient Care S erv ic es **

Out-pa ti ent Servi ces wi l l be provi ded to MEMBERS i n a ny Medi Ca rd a ccredi ted hos pi ta l /cl i ni cs
Health Care Benefits Coverage/Limit

1. Referral to specialists Covered

2. Regular consultations & treatment (___________

Covered
prescribed medicines)

3. Eye, Ear, Nose & Throat treatment Covered

4. Treatment of minor injuries and surgery not requiring
confinement Covered
5. X-ray and laboratory examinations prescribed by MediCard
physician Covered

6. Physical Therapy / Speech Therapy Covered

7. Laser treatment of Glaucoma & Retinal Detachment Up to ____________

8. Cataract Extraction including phacoemulsification);
Up to ____________
___________ cost of lens

9. Cauterization of warts (including facial warts) Up to ____________

10. ________ of anti-rabies, anti-venom, anti-tetanus Up to ____________

11. Tuberculin Test (_________ screening) Up to ____________

12. Pre & Post natal consults Covered; including labs

13. Sclerotherapy (_______________ sclerosing agent) Up to ____________

14. Chronic Dermatoses (__________________) Covered

15. Scabies (________________________) Covered

MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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MediCard Philippines, Inc.

Health Care Benefits Coverage/Limit

16. Allergy Testing Up to ____________

**Inclusive of operating room charges, professional fees and other incidental expenses relative to the procedure

D. Dental Care S erv ic es

MEMBERS ma y a va i l of the fol l owi ng denta l ca re s ervi ces from a ny of the a ccredi ted denta l cl i ni cs :
Health Care Benefits Coverage/Limit

1. Oral prophylaxis (_________________) Covered

2. Consultations and oral examinations Covered

3. Tooth extractions Covered; __________surgery for impacted or ankylosed tooth

4. Temporary fillings Covered

5. Gum treatments for cases like inflammation or bleeding

Covered
and adjustment of dentures
6. Recementation of loose jackets, crowns, in-lays and on-
Covered
lays

7. Treatment of mouth lesions, wounds and burns Covered

8. Emergency out-patient dental treatment Covered

9. Temporomandibular Joint (TMJ) consultations Covered

10. Restorative and Prosthodontic consultations Covered

11. Dental Nutrition & Dietary Counseling Covered

12. Dental Health Education Covered

13. Prenatal & Postnatal consultations Covered

14. Light cure fillings Covered

15. Deep scaling Covered

16. Root canal Covered

17. Dental X-ray Covered

E. I n-patient Care S erv ic es

The following hospitalization (In-Patient) s ervices shall apply when MediCard physicians prescribe the hospitalization of
MEMBERS i n a ny Medi Ca rd Accredi ted Hos pi ta l s :

Health Care Benefits Coverage/Limit

1. No deposit upon admission Covered

2. Room and board Regular Private Open

3. Use of operating theatre and Recovery Room Covered

4. Services of MediCard specialist like anesthesiologists,

Covered
internists, surgeons, etc.

MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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MediCard Philippines, Inc.

Health Care Benefits Coverage/Limit

5. Services and medications for general/spinal anesthesia or
other forms of anesthesia deemed necessary for a surgical Covered
procedure
6. Fresh whole blood (including screening/ processing), and
Covered
intravenous fluids

7. X-ray and laboratory examinations Covered

8. Administered medicines Covered

9. Dressings, sutures and plaster casts, etc. Covered

10. ICU confinements Covered

11. Chemotherapy
Up to ____________

12. Radiotherapy
a. Intensified Modulated Radiotherapy
b. Three-Dimensional Conformal Radiotherapy (3DCRT) Up to ____________
c. Tomotherapy
d. Brachytherapy
13. Dialysis
Up to ____________
a. Continuous Renal Replacement Therapy (CRRT)
14. Human Blood Products (including screening/ processing)
Covered
except gamma globulin

15. Admission kit including wee bag Covered

16. Laparoscopic Procedures (_________________)

Up to ____________
a. Single Incision Laparoscopy Surgery (SILS)

17. Lithotripsy/ESWL (_________________) Up to ____________

18. Hysteroscopic Procedures (_________________) Up to ____________

19. Stereotactic Brain Biopsy /

Up to ____________
Stereotactic Breast Biopsy (_________________)

20. Gamma Knife Surgery (_________________) Up to ____________

21. Percutaneous Ultrasonic Nephrolithotomy

Up to ____________
(_________________)
22. Transurethral Microwave Therapy (TUMT) of the prostate
Up to ____________
(_________________)

23. Arthroscopically-guided Procedures Up to ____________

24. CT Scan / MRI / Ultrasound guided excisions

a. Percutaneous Discectomy CT Guided Intradiscal Up to ____________
b. Electrothermal Ablation Technic (IDET)
25. Endoscopically-guided excisions / treatments / procedures Up to ____________

26. Laser / Coblation Tonsillectomy Up to ____________

27. Endovenous Laser Therapy/Endovenous Laser
Ablation/Radiofrequency Ablation (except for cosmetic Up to ____________
purposes)

28. Coblation Procedures Up to ____________

29. Ductoscopy (Breast) guided

Up to ____________
excisions/treatment/procedures
30. Endoscopic Ultrasound guided
Up to ____________
excisions/treatment/procedures

31. Infrared Coagulation Hemorrhoidectomy Up to ____________

MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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MediCard Philippines, Inc.

Health Care Benefits Coverage/Limit

32. Mammotome/Vacuum Assisted Breast Biopsy Up to ____________

33. Stereotactic Radiation Therapy / Stereotactic Radiosurgery Up to ____________

34. Thyroplasty (implant not covered) Up to ____________

35. Transarterial Hemorrhoidal Dearterialization (THD) Up to ____________

36. Ultroid Hemorrhoid Management Up to ____________

37. Any other modern therapeutic procedure not mentioned

Up to ____________
above
38. Magnetic Resonance Imaging (MRI) / Magnetic Resonance
Angiography (MRA)
Up to ____________
a. Tractography / Diffusion Tensor Imaging
b. Superparamagnetic Iron Oxide (SPIO) enhanced MRI
39. CT scan
a. Multislice / multidetector / spiral / multirow CT Up to ____________
b. Ultrafast Electron Beam Computed Tomography
40. Ultrasound
a. Intravenous Ultrasound / Intravascular Ultrasound Up to ____________
b. Contrast Enhanced Ultrasound

41. Robotic Surgery / Robotically-assisted Surgery Up to ____________

42. Photodynamic Therapy Up to ____________

43. Acoustic Radiation Force Up to ____________

44. Capsule Endoscopy Up to ____________

45. New diagnostic and treatment procedures for conditions

with established etiologies and its use is only as alternative Up to ____________
to the conventional methods.
46. Laboratory/ancillary services for conditions whose
pathogenesis or subsequent clinical improvement is not Up to ____________
yet fully established in Medical Science
47. Other medically necessary modalities not mentioned
above and those for which there are no comparable, Up to ____________
conventional or traditional counterparts
48. Positron Emission Tomography (PET) Scan Up to ____________

49. Stapled Hemorrhoidectomy Up to ____________

50. Cryosurgery Up to ____________

51. Work-related illness/accidents (_________________) Up to ____________

52. Unprovoked/Provoked Assault Up to ____________

53. Hyperventilation syndrome Up to ____________

54. Congenital Illnesses (regardless of PEC limit) Up to ____________

55. Slipped Disc, Scoliosis, Spondylosis, Spinal Stenosis Up to ____________

56. Open heart surgery (_____________cost of stent and

Up to ____________
pacemaker)
57. Organ transplant (_____________ cost of organ and
Up to ____________
donor’s expense)
58. The following complex diagnostic examinations a nd
thera peutic procedures:

MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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MediCard Philippines, Inc.

Health Care Benefits Coverage/Limit

a. Angiography (e.g. Coronary, cerebra l,
retinal/fluorescein, pulmonary, GI, etc.)
b. Serum chemistry panels (e.g. Chem 23, Spec M, etc.)
c. Pulmonary perfusion scan
d. Tests involving use of Nuclear Technologies (e.g.
Radionuclide Ventriculography / Thallium stress
testing / Radionuclide (Isotope) Sca nning,
Pyrophosphate Scintigraphy, etc.)
e. Electromyography, Nerve Conduction Velocity Studies
f. 24-Hour Holter Monitoring, 2-D Echo and Doppler
g. Treadmill Stress Test
h. Myelogram
i. Diagnostic Endoscopy (including one of video)
i.1 Multiphoton endoscopy
j. Diagnostic Arthroscopy
k. Diagnostic Hysteroscopy
l. Plasma/Urinary Cortisol, Plasma Aldosterone,
Adrenocortical Function, etc.
m. Mammogram and Sonomammogram
n. Bone densitometry scan (Dexascan)
o. Immunologic Studies:
o.1 Anti-nuclear antibody (ANA)
o.2 C-Reactive protein
o.3 Lupus cell exam
o.4 Enhanced Luciferase Complementation /
Luciferase Immunoprecipitation Assay
o.5 Enzyme-linked Immunosorbent Spot (ELISPOT) Up to ____________
Assay
o.6 ESAT-6 and CFP-10 Antigens
o.7 QuantiFERON Tuberculosis (QFTB)
p. Genetic studies:
p. 1 Alpha Globin / Globulin Genotyping
p. 2 Beta Globin / Globulin Genotyping
p. 3 BCR-ABL by Quantitative Real-time Polymerase
Chain Reaction (QRT-PCR, RT-PCR)
p. 4 Duolink In-Situ Fluoresence Hybridization (DISH) /
Array Comparative Genomic Hybridization (aCGH)
p. 5 Epidermal Growth Factor Receptor (EGFR)
Mutation Assay / Test
p. 6 Fluorescence In-Situ Hybridization (FISH)
p. 7 JAK-2 Mutation
p. 8 Karyotyping
p. 9 KRAS Testing
p. 10 Philadelphia chromosome
p. 11 Polymerase Chain Reaction (PCR) for katG and
rpoB
p. 12 Polymerase Chain Reaction Single Strand
Conformation Polymorphism (PCR-SSCP)
p. 13 Reverse Transcription Polymerase Chain
Reaction (RT-PCR)

q. Magnetic Resonance Spectroscopy Up to ____________

r. Platelet Aggregation Test Up to ____________

s. 3D & 4D Ultrasound (except for maternity cases) Up to ____________

t. Ductoscopy (Breast) Up to ____________

u. Endoscopic Ultrasound Up to ____________

v. Peritoneal Dialysis Adequacy Test Up to ____________

MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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MediCard Philippines, Inc.

Health Care Benefits Coverage/Limit

w. Peritoneal Equilibration Test Up to ____________

x. Spinal Angiogram Up to ____________

y. Any other complex diagnostic procedure not

Up to ____________
mentioned above
59. Professional fee of the assisting physician in surgical
Covered
procedures
60. All other items directly related to the management of the
Covered
case

61. Visitation of MediCard liaison officer Covered

F. Emergenc y Care S erv ic es

1. In Accredited Hospitals

In ca s es of emergency where the MEMBER avails of the s ervi ces of Medi Ca rd Accredi ted Hos pi ta l s / Cl i ni cs , the
fol l owi ng wi l l be provi ded:
Health Care Benefits Coverage/Limit

a. Doctor’s services Covered

b. Medicines used during treatment or for immediate relief Covered

c. Oxygen and intravenous fluids Covered

d. Dressings, plaster casts and sutures Covered

e. Laboratory, x-ray and other diagnostic examinations Covered

2. In Non-Accredited Hospitals

For emergency medical servi ces i n non-participating hospitals a nd clinics, members must advance pa yment a nd l a ter
fi l e rei mburs ement from Medi Ca rd. Rei mburs ement s ha l l be ba s ed on the ta bl e bel ow:

Health Care Benefits Coverage/Limit

a. When a MEMBER is in immediate danger of losing a
limb, eye or other parts of the body or is in severe pain
that requires immediate relief and enters a
non-MediCard accredited hospital for treatment.
b. MediCard shall pay the said amount when it is verified
that MediCard facilities were not used because to have
Covered; Reimburse 100% of Approved Hospital Bills and
done so would entail a delay resulting in death, s erious
Professional Fees based on MediCard Relative Value (MRV)*
disability or significant jeopardy to the MEMBER's
condition or the choice of hospital was beyond the
control of the MEMBER or the MEMBER's family. Other
expenses not covered in using non-MediCard
Accredited Hospitals for emergency care is follow up
care
*MRV – what it would have cost had the service been rendered in an accredited hospital through the services of an accredited doctor

MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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MediCard Philippines, Inc.

3. In Foreign Countries
In ca s es of emergency where a MEMBER a vails of services i n a foreign territory, members must a dvance pa yment a nd
l a ter fi l e rei mburs ement from Medi Ca rd. Rei mburs ement s ha l l be ba s ed on the ta bl e bel ow:
Health Care Benefits Coverage/Limit

Approved Hospital Bills

Covered; 100% based on MediCard Relative Value (MRV)*
and Philippine Currency
Doctor’s Professional Fees
*MRV – what it would have cost had the service been rendered in an accredited hospital through the services of an accredited doctor

4. In Areas without Accredited Hospitals

In ca s es of emergency where the MEMBER avails of s ervices in a reas wi thout a ccredi ted hos pi ta l s , members mus t
a dva nce payment and later file reimbursement from MediCard. Reimbursement s hall be ba s ed on the ta bl e bel ow:
Health Care Benefits Coverage/Limit

Approved Hospital Bills

Covered; 100% based on MediCard Relative Value (MRV)*
Doctor’s Professional Fees
*MRV – what it would have cost had the service been rendered in an accredited hospital through the services of an accredited doctor

5. Ambulance Services and Emergency Medical Assistance

Health Care Benefits Coverage/Limit

Ambulance services (Land transport) Covered; on a reimbursement basis

Health Care Benefits Coverage/Limit

6. In cases of non-availability of room according to plan
during confinements
Member may avail of the next higher room available except
suite within the first 24 hours of confinement upon admission.
All incremental costs incurred after the first 24 hours shall be
for the personal account of the member, except when the
Accredited Hospital issues a certification of non-availability of
the member’s room and board accommodation.

G. Other B enef its & Considerations

Health Care Benefits Coverage/Limit

1 . Medical evaluation for enrollees age 41 and above is waived for Principal and Dependent members. Application Forms are
waived for SME Account.
Maternity assistance for all female members subject to the limits on the table
below:
Type of Delivery Coverage
Caesarean
Normal Delivery
D&C (For Miscarriage and Abortion) Up to __________
Abnormal Pregnancies*
2. Maternity Benefit (Outright Coverage) Maternity complications**
H.Mole/ Gestational Trophoblastic
Disease (including D&C)
*Abnormal Pregnancy refers to all pregnancy related conditions whose onset
occurred from conception to puerperium (six weeks after delivery), including
pre-delivery availments / confinements. This is an additional limit on top of
Manner of Delivery/Termination.
** Maternity Complications refers to all maternity related conditions whose
onset occurred beyond puerperium, including but not limited to incisional

MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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MediCard Philippines, Inc.

Health Care Benefits Coverage/Limit

hernia, pelvic relaxation, rectocoele, uterine prolapse, etc.

NOTE: All maternity benefits except “Maternity Complications” may be availed

ONLY for one (1) pregnancy per contract year.
It is hereby declared and agreed that hospitalization benefits due under the
PHILHEALTH and/or Employee Compensation Commission (ECC) program are
assigned to and integrated with the MediCard program such that any of the
PhilHealth/ECC Provision MediCard benefits due under this Agreement shall be net of the MEMBER's
PHILHEALTH and/or Employee Compensation Commission (ECC) benefits.
MediCard will not pay or advance the costs of such benefits, nor be responsible
for filing any claims under PHILHEALTH and/or ECC.

H. Pre-Ex isting Conditions Cov erage

Principal Members
Pre-existing conditions are covered up to ___________

Dependent Members
Pre-existing conditions are covered up to ___________

NOTES:
 All other limits mentioned in this proposal are subject to the Pre-Existing Condition limit, if applicable, based on the
given diagnosis

2. Any illness, injury or any adverse medical condition shall be considered pre-existing if prior to the effectivity date of
membership, the pathogenesis or onset of such illness, injury or adverse medical condition has started as determined by
MediCard's Medical Director or accredited physicians. The determination of the pre-existing condition shall not be limited to
one (1) year from the effectivity date of membership.

3. 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. Annual Benefits listed below except for letters k & l

b. Hypertension
c. Goiter (Hypo/Hyperthyroidism)
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
l. Benign Tumors
m. Uterine Myoma, Ovarian cysts, Endometriosis
n. Buergher's Disease
o. Varicose Veins
p. Arthritis
q. Migraine headache
r. Gastritis/duodenal or gastric ulcers

MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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MediCard Philippines, Inc.

Dreaded Disease
Dreaded Diseases are potentially or actually life-threatening conditions or illnesses which ma y require prolonged or repeated
hospitalization or intensive care management. MediCard shall pay for hospitalization services up to the maximum limit subjec t 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 Disease (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 (Rheumatoid Arthritis, Systemic Lupus Erythematosus)
i. Diabetes Mellitus and its complications
j. Malignancies and Blood Dyscrasias (Cancer, Leukemia, Idiopathic Thrombocytopenic Purpura)
k. Injuries from accidents or assaults, frustrated homicide or frustrated murder
l. Complications of an apparent ordinary illness including MODS and SIRS (e.g. sepsis due to pneumonia, typhoid ileitis, cerebral
malaria, etc.)
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

I . Members Satisfaction Service

Benefit Remarks

24/7 Call Center Service/Access Trunkline: 8841-8080; Toll Free: 1-800-1888-9001

Hospitals 456 nationwide

Clinics 512 nationwide

Doctor 19,567 nationwide

Direct Access to the MediCard

Dentists 776 nationwide
healthcare network

Hospital Satellite Clinics 8 satellite clinics

Referral desks 13 referral desks

Stand-alone Full Service

Text MediCard
e-MediCard
A secured web-based application
which maximizes the backbone of the
internet to deliver value.
Added services to MediCard’s
clientele. It ensures privacy and
integrity as provided
MySecureSign, the Philippine affiliate
of Verisign the worlds largest
Certification Authority.
To experience MediCard’s newest
innovation, log on now @
www.MediCardphils.com.
15 Full Service Clinics
Clinics (MediCard)
Access to TEXT MediCard Service providing members real time access to the database of
accredited hospital, doctors and clinic schedules; Key in MediCard and send to Smart -
0908-884-1814 Globe and Sun Subscribers - 0917-851-2648 for more information
 Membership Information
 Latest payment Made
e-Member Services  Medical and Dental Availments
-is the virtual place for all MediCard (Principal and Dependents)
members  Request for ID Replacement (For
Individual and Family Accounts)
 Reimbursement Status/Details
 On site APE scheduling
 Benefits and Exclusions
by
 Utilization reporting
e-Corporate Data Administration -is  Reimbursement Status/Details
intended for authorized and registered  Membership endorsement
representatives from MediCard Corporate  ECU scheduling
/ Group accounts  Request for ID Replacement
 List of Active Members
 List of Resigned Members
 List of Enrollees with Action Memo

MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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MediCard Philippines, Inc.

Benefit Remarks
e-Account Management
-is specially designed for MediCard sales It is a replica of their active accounts’ e-
agents and intermediaries to help them Corporate Data Administration screens.
manage clients more efficiently.

K. Membership F ees
We shall require the setting up of a REVOLVING FUND (See below for the options) to start the program.
This fund will be exclusively used to pay all approved hospital bills, professional fees and our
corresponding administrative fee of 15%; and it shall be replenished on a regular basis to maintain the
required fund balance stated. In addition, an Annual Network Access Fee of P3,000.00 per member
shall be charged to cover the processing of application and identification card (QR Code IDs), access fee
to our accredited providers, Annual Physical Exam including eight (8) blood chemistries for members 30
years old and above and anti -flu vaccines for members below 30 years old and other incidental expenses.
Annual Network Access Fee and fund are inclusive of 12% VAT. The administrative fees are subject to
12% VAT.

ROOM AND BOARD: REGULAR PRIVATE OPEN

FOR INDIVIDUAL ACCOUNT

WITH ACCESS TO ALL MALL-BASED CLINICS

WITHOUT AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY
AGE REVOLVING FUND* Projected Coverage

60 yea rs old and below ------------------ ------------------

61 yea rs old and up ------------------ ------------------
*Possible fund adjustments after review of duly filled-out application forms

WITH ACCESS TO ALL MALL-BASED CLINICS

WITH AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY
AGE REVOLVING FUND* Projected Coverage

60 yea rs old and below ------------------ ------------------

61 yea rs old and up ------------------ ------------------
*Possible fund adjustments after review of duly filled-out application forms

FOR FAMILY ACCOUNT

(All members must be below 60 years and 6 months old and younger upon enrollment*)

WITH ACCESS TO ALL MALL-BASED CLINICS

WITHOUT AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY
REVOLVING FUND** Projected Coverage
Number of Family Members
(per family) (per family)
Fa mily of 2-4 ------------------ ------------------
Fa mily of 5 a nd up ------------------ ------------------
**Possible fund adjustments after review of duly filled-out application form
WITH AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY
WITH ACCESS TO ALL MALL-BASED CLINICS
MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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MediCard Philippines, Inc.

REVOLVING FUND** Projected Coverage

Number of Family Members
(per family) (per family)
Fa mily of 2-4 ------------------ ------------------
Fa mily of 5 a nd up ------------------ ------------------
*For a member age 61 and up, the member must apply for an individual account
**Possible fund adjustments after review of duly filled-out application forms

FOR SME ACCOUNT

WITH ACCESS TO ALL MALL-BASED CLINICS

WITHOUT AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY
ROOM & BOARD REVOLVING FUND* Projected Coverage

REGULAR PRIVATE OPEN ------------------ ------------------

WITH ACCESS TO ALL MALL-BASED CLINICS

WITH AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY
ROOM & BOARD REVOLVING FUND* Projected Coverage

REGULAR PRIVATE OPEN ------------------ ------------------

Al l enrolled members shall be provided with a MediCard ID. Ava i l ment of medical benefits s ha l l be s i mi l a r to our
us ual procedures as outlined in our Medical a nd Health Care Handbook. All hospital bills a nd professional fees s ha l l
be cha rged to MediCard and shall be subsequently paid through wi thdrawals from the FUND. MediCa rd shall bill a l l
hos pital charges a nd professional fees as they a re i ncurred, including therein corresponding a dministrati ve cha rges
a nd Value Added Ta x (VAT). MediCa rd shall indicate i n the bi l l i ng s ta tement the fund ba l a nce, whi ch mus t be
repl eni s hed wi thi n s even (7) ca l enda r da ys from the ti me i t rea ches 50% of i ts requi red l evel .

Legend:
AHMC As i an Hospital a nd Medical Center
MMC Ma ka ti Medical Center
SLMC-QC St. Luke’s Medical Center - Quezon Ci ty
SLMC-Global St. Luke’s Medical Center - Global City
TMC The Medical Ci ty
CSMC Ca rdi nal Santos Medical Center

Limitations and Guidelines

HOSPI TALI ZATI ON

1. All confinement shall be upon recommendat ion of t he corporat e healt h pro gram holder's MediCard
accredit ed Phy sician, or t he MediCard Medical Direct or or t he Emergency Room Resident Phy sician of t he
MediCard Accredit ed Hospit al w ho decides t o admit MediCard pat ient -member in cases of life t hreat ening
emergencies.

2. Hospit al bills for t he follow ing hospit al serv ices shall be charged t o t he account of t he MediCard
pat ient -member: serv ices of a priv at e nurse or doct or, use of ex t ra food and/or bed, T.V., elect ric fan, VCD, I D
bracelet , t hermomet er, admission kit and all ot her it ems not direct ly relat ed t o t he medical management of t he
pat ient .

3. Hospit alizat ion and t reat ment out side t he Philippines is not cov ered.

4. MediCard is not responsible and w ill not recognize any hospit al bills incurred by a corporat e healt h program
holder in hospit als not accredit ed by MediCard, ex cept for emergency care serv ices under t he t erms prov ided
in t his Agreement .

5. Cost of hospit alizat ion, medical serv ices, medicine and ot her ex penses incurred as a result of a member's
decision t o av ail of such hospit alizat ion, medical serv ices, t reat ment or procedure, not prescribed or cont rary t o

MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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MediCard Philippines, Inc.

w hat has been prescribed by t he at t ending MediCard prov ider, or w it hout MediCard’s ex press w rit t en report
shall not be shouldered by MediCard.

B. OU T-PATI ENT SERVI CES

1. Prescribed medicines on an out -pat ient basis are not prov ided by MediCard Medical Cent er or Medical Serv ice
U nit s.

2. The absolut ely no charge out -pat ient medical and healt h care serv ices are prov ided only during clinic hours of
Medical Serv ice U nit s.

3. Second opinions and cost of t reat ment incurred in non-accredit ed hospit al or clinic should t he member
unilat erally decide t o seek such recourse.

C. ELI GI BI LI TY
1. Deadline for enrollment of dependent s:

a. For new & renew ing account s - 30 day s from t he effect iv it y dat e of t he agreement .

b. For dependent s w ho meet t he eligibilit y requirement s w it hin t he agreement period - 30 day s from t he
dat e dependent become eligible for membership. (copy of birt h cert ificat e or marriage agreement
must be submit t ed)

c. For addit ional principal members of t he company , dependent /s must be enrolled t oget her w it h t he
principal.

d. Any addit ional dependent s ot her t han t he abov e can be enrolled upon t he renew al of agreement ,
w it hin t he one (1) mont h enrollment period.

Aft er t he lapse of t he periods specified abov e, MediCard w ill no longer receiv e, ev aluat e and accept
any designat ion or applicat ion t o be a qualified dependent from any PRI NCI PAL MEMBER.

2. U nderw rit ing cut -off dat es in assigning effect iv it y dat e:

Dat e of Receipt of Applicat ion/Endorsement Effect iv it y Dat e

11th t o 25th of t he mont h 1st of t he follow ing mont h
26th t o 10th of t he mont h 16th of t he same mont h

CONFIRMATION:

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. under the MediCard Select Program
effective _________________.

_____________________________
CONFORME
SIGNATURE OVER PRINTED NAME

MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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