Zendesk Incorporated - 2020 Conforme As of 4.23.2021

April 23, 2021
Ms. MARIA ISABEL PEREZ

Director, Finance Shared Services
ZENDESK INCORPORATED
Net Park Building, 30/F 5th Ave.
Bonifacio Global City
Taguig City
Thru: WILLIS TOWERS WATSON INSURANCE BROKERS PHILIPPINES, INC.
Brokers
Dear Ms. Perez:
This refers to your Company's Healthcare Program with Maxicare Healthcare Corporation which is
due for renewal on November 30, 2020.
Attached to this Conforme Letter are the Annexes with scope of the medical services that Maxicare
will provide to your Principal and Dependent Members covering the one (1) year period and
commencing November 30, 2020 (the "Effective Date") up to November 29, 2021.
Please find the following documents for your acceptance and conformity:
Annex A: Salient Features
Annex B: Benefits Summary
Annex C: General Provisions
Please also be informed of our Guidelines for your guidance and reference:
A. REQUIREMENTS FOR ENROLLMENT
1. Acceptance of enrollment of the Client shall be subject to evaluation and approval of

Maxicare based on the following:
1.1. Client's nature of business should not fall under ineligible groups.
1.2. Benefit program under Annex A should be on a uniform basis or superior according
to the rank classification.
1.3. Dependents can only have the same or lower benefits than their Principal. Also, a
uniform plan must be implemented for all Dependents of an employee.
1.4. Riders under Annex A should be on a uniform basis. It may only differ per
membership type.
1.5. There should be no modification of benefits within the coverage period.
1.6. If the Client is a previous client of Maxicare, approval will be based on Maxicare's
review of previous utilization.
2. Documentary requirements:
For the purpose of commencing the enrollment of the Client's employees and/ or
dependents, Client shall submit the following:
2.1. Signed Conforme Letter with attached Annex A, B and C

2.2. Know Your Customer (KYC) Requirements
SAP_CORP_FR_RB_CONFORME LETTER - 10070719 Page 1 of 72

a. For the Client and its Affiliates
3. For Contributory accounts, Certification from the Client's HR that the account is
contributory.
Notes:
a. The above documents must be submitted prior to activation. Lacking KYC
documents must be submitted within thirty (30) calendar days from the Effective
date. Non-submission of documents shall result to suspension of all services under
this Agreement.
b. No need to resubmit the KYC documents if Client has already provided all the
required documents.
B. RENEWAL MEMBERSHIP GUIDELINES
1. Submission of the Client's masterlist for renewal shall no longer be allowed. The Client's
existing masterlist in Maxicare database shall be rolled over and shall comprise the
Client's renewal billing.
2. Maxicare shall not render the services or activate the coverage unless this signed
Conforme Letter has been submitted to Maxicare prior to the Effective Date. However
subject to Maxicare's sole discretion, it may render the services or activate the coverage
even without the signed Conforme Letter as long as there is proof that the Client
accepted all the terms and conditions of this Conforme Letter as well as its annexes.
3. Membership Movement
3.1. The Enrollment period during renewal will run for a period of thirty (30) days from
Effective Date.
3.2. Member Movement (Addition, Cancellation, Change of Plan, Correction of Details)

shall be handled as normal subsequent endorsements.
a. Addition and Cancellation of Membership, Upgrading / Downgrading of Plan,
correction of details shall be subject to the provisions in Article VIII,(3) of the
attached Annex C.
b. Endorsement processed on or before the 8th day from the Effective date
("Renewal Billing Cut-off"), shall be part of the renewal billing. Endorsement
processed beyond the Renewal Billing Cut-off shall be part of the subsequent
billing.
3.3. Additional Enrollees

a. Additional enrollees endorsed within the enrollment period shall be activated
retro-actively based on Client's Effective Date.
b. Enrollees endorsed for activation shall be processed within three (3) business
days from the date of receipt of endorsement.
3.4. Cancellation of Members

a. Cancellation of membership shall be processed within one (1) business day
from receipt of endorsement.
b. Effective date of cancellation shall be based on the date endorsed or receipt,
whichever is later. Any cancellation that would take effect prior to the date

endorsed or receipt ("Retro Cancellation") shall not be allowed.
c. Standard refund provision shall be applied. See Article X (11) of the attached
Annex C.
3.5. Change of Plan

a. Change of plan resulting from revision of account plan and benefits effective
renewal shall be processed within five (5) days from the Client's Effective
Date.
b. Subsequent endorsements for Plan Upgrade / Downgrade shall follow
standard processing of three (3) business days from the date of receipt.
4. Statement of Account (SOA) shall be automatically generated on the 8th day from the
Effective date. SOA of Client with late renewal advice shall be processed on the 8th day
from the date the Client's Account plan details were processed.
5. For any dispute regarding the renewal billing issued, provisions in Annex C, General
Provisions, regarding dispute on payment of membership fees shall be strictly enforced.
5.1. Revisions for identified issues will be processed via Credit or Debit memo,
whichever is applicable.
C. MISCELLANEOUS
1. Maxicare shall provide the Conforme Letter and its Annexes (Salient Features, Summary
of Benefits and General Provisions) to the Client. The Client assumes responsibility to
ensure that they receive copies of the standard Service Agreement and all Addenda
thereto from Maxicare.
2. The Conforme Letter forms an integral part of the Service Agreement of Maxicare. The
provisions in Annex A Salient Features, Annex B Benefits Summary and Annex C
General Provisions are deemed incorporated in this Conforme Letter insofar as they are
applicable and not inconsistent with the provisions hereof. Should there be any
inconsistency between the provisions of this Conforme Letter, and its Annexes, the
Parties shall exert their best efforts to harmonize such inconsistent provisions having in
mind the intention of the Parties in executing this Conforme Letter and its Annexes and
giving effect thereto. In the event that the conflicting provisions cannot be harmonized,
the terms of Annex C General Provisions shall prevail.
3. All information given to Maxicare for use in connection with the transactions contemplated
in this Agreement (such as but not limited to members and/or their dependents' personal
details and medical records) are true and based on authentic documents. Should any of
the information/statement be found to be untrue, misleading or if a material fact be
omitted, Maxicare reserves the right to immediately terminate the Agreement, without
refund of fees paid, if any, and without prejudice to criminal liability of agent/broker and
officers/directors of Client for such untrue or misleading information.
Please feel free to communicate with us for any clarifications.
Should you be amenable to the proposed program, please affix your signature below to signify your
conformity to our offer.

We at Maxicare Healthcare Corporation look forward to a mutually beneficial business relationship
with you.
Thank you.
Respectfully yours,
______________________________________
Cedilyn Manarin
Account Officer
We agree to abide by the above mentioned terms and conditions and cause our respective
rd
authorized representatives to affix their respective signatures on this 23 day of April, 2021 in
Makati City.
MAXICARE HEALTHCARE CORPORATION ZENDESK INCORPORATED

By: By:
Jay-Ar Gutierrez Maria Isabel Perez

Business Development Manager Director, Finance Shared Services
Fiona Marie Victoria

Assistant Vice President - Sales

ZENDESK INCORPORATED_2020
ANNEX A
SALIENT FEATURES
This Annex A is attached to and made part of the Service Agreement ("the Agreement") between
MAXICARE HEALTHCARE CORPORATION ("Maxicare") and ZENDESK INCORPORATED
("Client").
It is hereby understood and agreed that Members covered under the above-mentioned Agreement
are entitled to the following:
A. GENERAL TERMS
A.1. AGREEMENT NUMBER : 10070719

A.2. COVERAGE PERIOD : November 30, 2020 to November 29, 2021
A.3. COVERAGE : Principals and Dependents ("Members")
A.4. NUMBER OF ENROLLEES : Principals: 261 Dependents: 448
A.5. TOTAL CONTRACT VALUE : Php 18,327,805.65
A.6. CONTRACT TYPE : Full HMO
B. MEMBERSHIP ELIGIBILITY
B.1. PRINCIPALS
Enrollee Minimum Age Maximum Age

EMPLOYEES (WITH ECU) Company Paid - 18 Years 65 Years
Gold
EMPLOYEES (WITHOUT ECU) Company 18 Years 65 Years
Paid - Gold
B.2. DEPENDENTS
B.2.1. Hierarchy of Dependents
ENROLLEE STATUS OF HIERARCHY DEPENDENTS MINIMUM MAXIMUM

PRINCIPAL (APPLICABLE / AGE AGE
ENROLLEE WAIVED)
DEPENDENTS Company Married Applicable Spouse - 1st 18 Years 65 Years
Paid - Gold Children - 2nd *15 Days 22 Years
DEPENDENTS Company Single Applicable Parents 18 Years 65 Years
Paid - Gold
DEPENDENTS Company Single Parent Applicable Children - 1st *15 Days 22 Years
Paid - Gold Parents - 2nd 18 Years 65 Years
DEPENDENTS OF Married Applicable Spouse - 1st 18 Years 65 Years
REGULARIZED FIXED Children - 2nd *15 Days 22 Years
TERM EMPLOYEES
Company Paid - Gold
DEPENDENTS OF Single Applicable Parents 18 Years 65 Years
REGULARIZED FIXED
TERM EMPLOYEES
Company Paid - Gold
DEPENDENTS OF Single Parent Applicable Children - 1st *15 Days 22 Years
REGULARIZED FIXED Parents - 2nd 18 Years 65 Years
SAP_CORP_FR_RB_ANNEX A - SALIENT FEATURES - 10070719 Page 5 of 72


ENROLLEE WAIVED)
TERM EMPLOYEES
Company Paid - Gold
DEPENDENTS (Extended Married Applicable Parents 18 Years 65 Years
Dependent of Married /
Dependents of Single
Employees w/ Partners -
Parent) Employee Paid - Gold
DEPENDENTS (Extended Married Applicable Siblings *15 Days 22 Years
Employees w/ Partner-
Siblings) Employee Paid -
Gold
DEPENDENTS OF Married Applicable Parents 18 Years 65 Years
REGULARIZED FIXED
TERM EMPLOYEES
(Extended Dependent of
Married / Dependents of
Single Employees w/ Partner
- Parent) Employee Paid -
Gold
DEPENDENTS OF Married Applicable Siblings *15 Days 22 Years
REGULARIZED FIXED
TERM EMPLOYEES
Married / Dependents of
Single Employees w/ Partner
- Siblings) Employee Paid -
Gold
DEPENDENTS ( 4th and Up - Married Applicable Children *15 Days 22 Years
Children ) Employee paid
(Effective April 12, 2021) -
Gold
DEPENDENTS ( 4th and Up - Single Parent Applicable Children *15 Days 22 Years
Children ) Employee paid
Gold
DEPENDENTS OF Married Applicable Children *15 Days 22 Years
REGULARIZED FIXED
TERM EMPLOYEES ( 4th
and Up - Children ) Employee
paid (Effective April 12, 2021)
- Gold
DEPENDENTS OF Single Parent Applicable Children *15 Days 22 Years
REGULARIZED FIXED
TERM EMPLOYEES ( 4th
and Up - Children ) Employee
- Gold
DEPENDENTS ( Immediate Single Applicable Siblings *15 Days 22 Years
Dependent of Single / Single
Parent - Siblings ) Employee


ENROLLEE WAIVED)
- Gold
DEPENDENTS ( Immediate Single Parent Applicable Children *15 Days 22 Years
Dependent of Single / Single
Parent - Siblings ) Employee
- Gold
DEPENDENTS OF Single Applicable Siblings *15 Days 22 Years
REGULARIZED FIXED
TERM EMPLOYEES (
Immediate Dependent of
Single / Single Parent -
Siblings ) Employee Paid
Gold
DEPENDENTS OF Single Parent Applicable Siblings *15 Days 22 Years
REGULARIZED FIXED
TERM EMPLOYEES (
Immediate Dependent of
Single / Single Parent -
Siblings ) Employee Paid
Gold
MEMBERSHIP ELIGIBILITY FOR NEWBORNS
*(ENFORCED)
1. Only newborns with full term birth or those born at least 37 weeks from
conception shall be given coverage.
2. However, pre-mature birth or those born prior to reaching 37th week from
conception must await such period for coverage eligibility.
(NOT ENFORCED)
1. Minimum eligibility shall be counted from date of birth of the baby, whether
pre-mature or with full term birth.
C. MEMBERSHIP FEES
Plan Type ANNUAL

Rank (Room & Benefit Type Benefit Limit No. of MEMBERSHIP FEES
Classification/ Board Enrollees Net of VAT VAT Total
Category Type/Limit) Payable
EMPLOYEES Gold Maximum Php 2 Php Php 0.00 Php
(WITH ECU) (Regular 260,000.00 21,748.65 21,748.65
Company Paid Private)
EMPLOYEES Gold Maximum Php 259 Php Php 0.00 Php
(WITHOUT ECU) (Regular 260,000.00 21,748.65 21,748.65
Company Paid Private)
DEPENDENTS Gold Maximum Php 436 Php Php 0.00 Php
Company Paid (Regular 260,000.00 28,239.75 28,239.75
Private)
DEPENDENTS OF Gold Maximum Php 0 Php Php 0.00 Php

REGULARIZED (Regular 260,000.00 28,239.75 28,239.75

FIXED TERM Private)
EMPLOYEES
Company Paid
(Extended (Regular 260,000.00 28,239.75 28,239.75
Dependent of Private)
Married /
Dependents of
Single Employees
w/ Partners -
Parent) Employee
Paid
(Extended (Regular 260,000.00 28,239.75 28,239.75
Married /
Dependents of
Single Employees
w/ Partner-
Siblings) Employee
Paid
FIXED TERM Private)
EMPLOYEES
(Extended
Dependent of
Married /
Dependents of
Single Employees
w/ Partner - Parent)
Employee Paid
FIXED TERM Private)
EMPLOYEES
(Extended
Dependent of
Married /
Dependents of
Single Employees
w/ Partner -
Siblings) Employee
Paid
DEPENDENTS ( Gold Maximum Php 0 Php Php 0.00 Php
4th and Up - (Regular 260,000.00 28,239.75 28,239.75
Children ) Private)
Employee paid
(Effective April 12,
2021)
FIXED TERM Private)
EMPLOYEES ( 4th
and Up - Children )
Employee paid

2021)
DEPENDENTS ( Gold Maximum Php 0 Php Php 0.00 Php
Immediate (Regular 260,000.00 28,239.75 28,239.75
Single / Single
Parent - Siblings )
Employee paid
2021)
FIXED TERM Private)
EMPLOYEES (
Immediate
Dependent of
Single / Single
Parent - Siblings )
Employee Paid
2021)
TOTAL MODAL CONTRACT VALUE Php 18,327,805.65
TOTAL CONTRACT VALUE Php 18,327,805.65
D. RIDER FEES
RIDER RIDER FEE

MATERNITY ASSISTANCE Principal - EMPLOYEES (WITH ECU) Company Paid - Gold : Covered
Principal - EMPLOYEES (WITHOUT ECU) Company Paid - Gold : Covered
Dependent - DEPENDENTS Company Paid - Gold : Covered
Dependent - DEPENDENTS OF REGULARIZED FIXED TERM EMPLOYEES Company
Paid - Gold : Covered
Dependent - DEPENDENTS (Extended Dependent of Married / Dependents of Single
Employees w/ Partners - Parent) Employee Paid - Gold : Covered
Employees w/ Partner- Siblings) Employee Paid - Gold : Covered
Dependent - DEPENDENTS OF REGULARIZED FIXED TERM EMPLOYEES (Extended
Dependent of Married / Dependents of Single Employees w/ Partner - Parent) Employee
Dependent of Married / Dependents of Single Employees w/ Partner - Siblings) Employee
Dependent - DEPENDENTS ( 4th and Up - Children ) Employee paid (Effective April 12,
2021) - Gold : Covered
Dependent - DEPENDENTS OF REGULARIZED FIXED TERM EMPLOYEES ( 4th and
Up - Children ) Employee paid (Effective April 12, 2021) - Gold : Covered
Dependent - DEPENDENTS ( Immediate Dependent of Single / Single Parent - Siblings )
Employee paid (Effective April 12, 2021) - Gold : Covered
Dependent - DEPENDENTS OF REGULARIZED FIXED TERM EMPLOYEES (
Immediate Dependent of Single / Single Parent - Siblings ) Employee Paid (Effective April
12, 2021) - Gold : Covered
ANNUAL CHECK-UP Principal - EMPLOYEES (WITHOUT ECU) Company Paid - Gold : Covered

RIDER RIDER FEE

DENTAL CARE Principal - EMPLOYEES (WITH ECU) Company Paid - Gold : Covered
EXECUTIVE CHECK-UP Principal - EMPLOYEES (WITH ECU) Company Paid - Gold : Covered
GROUP LIFE WITH ADD & D Principal - EMPLOYEES (WITH ECU) Company Paid - Gold : Covered
LIST OF DOCTORS Principal - EMPLOYEES (WITH ECU) Company Paid - Gold : Covered

RIDER RIDER FEE

OPTICAL ASSISTANCE Principal - EMPLOYEES (WITH ECU) Company Paid - Gold : Covered
OUT-PATIENT - MEDICINE Principal - EMPLOYEES (WITH ECU) Company Paid - Gold : Covered

RIDER RIDER FEE

PRE-EMPLOYMENT MEDICAL Principal - EMPLOYEES (WITH ECU) Company Paid - Gold : Covered
EXAM Principal - EMPLOYEES (WITHOUT ECU) Company Paid - Gold : Covered
Notes:
1. The above Membership Fees and Rider Fees are inclusive of 0% VAT rate.
2. All Enrollees must be members of PhilHealth. In case a Member fails to file his PhilHealth
benefits, the PhilHealth portion must be paid by the Member directly to the hospital.
3. Rates are valid until the Client's renewal Effective Date. Rates may vary if there are
changes in the healthcare coverage and benefits. The revised renewal rates shall
automatically supersedes the prior renewal rates.
E. SPECIAL ENDORSEMENT
E.1. Effective Date and Application Form
ENROLLEE EFFECTIVE DATE OF APPLICATION EFFECTIVE MEMBER'S

ADDITIONAL FORM DATE PROVISO PARTICIPATION
ENROLLEE
Principal - EMPLOYEES (WITH Date of Hire Waived Not enforced Non-Contributory
ECU) Company Paid - Gold
Principal - EMPLOYEES Date of Hire Waived Not enforced Non-Contributory
(WITHOUT ECU) Company
Paid - Gold
Dependent - DEPENDENTS Date of Hire of Principal Waived Not enforced Non-Contributory
Company Paid - Gold
Dependent - DEPENDENTS Date of Regularization of Waived Not enforced Non-Contributory
OF REGULARIZED FIXED Principal
TERM EMPLOYEES Company
Paid - Gold
Married / Dependents of Single
Employees w/ Partners -
Parent) Employee Paid - Gold
Married / Dependents of Single
Employees w/ Partner-
Siblings) Employee Paid - Gold
TERM EMPLOYEES (Extended

Employees w/ Partner - Parent)
Employee Paid - Gold
TERM EMPLOYEES (Extended
Employees w/ Partner -
Dependent - DEPENDENTS ( Date of Hire of Principal Waived Not enforced Non-Contributory
4th and Up - Children )
Employee paid (Effective April
12, 2021) - Gold
TERM EMPLOYEES ( 4th and
Up - Children ) Employee paid
(Effective April 12, 2021) - Gold
Dependent - DEPENDENTS ( Date of Hire of Principal Waived Not enforced Non-Contributory
Immediate Dependent of Single
/ Single Parent - Siblings )
Employee paid (Effective April
12, 2021) - Gold
TERM EMPLOYEES (
Immediate Dependent of Single
/ Single Parent - Siblings )
Employee Paid (Effective April
12, 2021) - Gold
Legend:
1. Effective Date Proviso
Not Enforced: Coverage of members shall start upon effective date, including
confinement.
2. Member's Participation
Non-Contributory Funding - The Account shall pay the entire Membership Fee; One
hundred percent (100%) of all eligible individuals are required to enroll.
E.2. Grace Period for enrollment of additional enrollees is 30 Days for EMPLOYEES
(WITH ECU) Company Paid.
Grace Period for enrollment of additional enrollees is 30 Days for EMPLOYEES

(WITHOUT ECU) Company Paid.
Grace Period for enrollment of additional enrollees is 30 Days for DEPENDENTS

Company Paid.

Grace Period for enrollment of additional enrollees is 30 Days for DEPENDENTS OF

REGULARIZED FIXED TERM EMPLOYEES Company Paid.

(Extended Dependent of Married / Dependents of Single Employees w/ Partners -
Parent) Employee Paid.

(Extended Dependent of Married / Dependents of Single Employees w/ Partner-
Siblings) Employee Paid.

REGULARIZED FIXED TERM EMPLOYEES (Extended Dependent of Married /
Dependents of Single Employees w/ Partner - Parent) Employee Paid.

REGULARIZED FIXED TERM EMPLOYEES (Extended Dependent of Married /
Dependents of Single Employees w/ Partner - Siblings) Employee Paid.
Grace Period for enrollment of additional enrollees is 30 Days for DEPENDENTS ( 4th
and Up - Children ) Employee paid (Effective April 12, 2021).

REGULARIZED FIXED TERM EMPLOYEES ( 4th and Up - Children ) Employee paid
(Effective April 12, 2021).
Grace Period for enrollment of additional enrollees is 30 Days for DEPENDENTS (

Immediate Dependent of Single / Single Parent - Siblings ) Employee paid (Effective
April 12, 2021).

REGULARIZED FIXED TERM EMPLOYEES ( Immediate Dependent of Single /
Single Parent - Siblings ) Employee Paid (Effective April 12, 2021).
E.3. Maximum Number of Dependents
Maximum number of Dependents is 4 for DEPENDENTS Company Paid.
Maximum number of Dependents is 4 for DEPENDENTS OF REGULARIZED FIXED

TERM EMPLOYEES Company Paid.

ANNEX B
BENEFITS SUMMARY
A. BENEFITS AND COVERAGE
Maxicare undertakes to arrange the following healthcare benefits and coverage for the
Members on date of coverage (the "Effective Date"). All procedures, examinations and others
are covered up to MBL whenever Medically Necessary in the medical management of the
Member subject to the exclusions, limitations, and conditions specified in this Agreement.
PLAN TYPE NETWORK WITHOUT ACCESS TO:

ACCESS MMC SLMC SLMC AHMC CSMC CDH CHH TMC DDH H OTHERS
GC QC
Principal - Nationwide ER
EMPLOYEES IP
(WITH ECU)
Company Paid -
Gold
Principal - Nationwide ER
EMPLOYEES IP
(WITHOUT ECU)
Company Paid -
Gold
Dependent - Nationwide ER
DEPENDENTS IP
Company Paid -
Gold
DEPENDENTS IP
OF
REGULARIZED
FIXED TERM
EMPLOYEES
Company Paid -
Gold
DEPENDENTS IP
(Extended
Dependent of
Married /
Dependents of
Single
Employees w/
Partners -
Parent)
Employee Paid -
Gold
DEPENDENTS IP
(Extended
Dependent of
Married /
Dependents of
Single
SAP_CORP_FR_RB_ANNEX B - BENEFITS SUMMARY - 10070719 Page 15 of 72

Employees w/
Partner- Siblings)
Employee Paid -
Gold
DEPENDENTS IP
OF
REGULARIZED
FIXED TERM
EMPLOYEES
(Extended
Dependent of
Married /
Dependents of
Single
Employees w/
Partner - Parent)
Employee Paid -
Gold
DEPENDENTS IP
OF
REGULARIZED
FIXED TERM
EMPLOYEES
(Extended
Dependent of
Married /
Dependents of
Single
Employees w/
Partner -
Siblings)
Employee Paid -
Gold
DEPENDENTS ( IP
4th and Up -
Children )
Employee paid
(Effective April
12, 2021) - Gold
DEPENDENTS IP
OF
REGULARIZED
FIXED TERM
EMPLOYEES (
4th and Up -
Children )
Employee paid
(Effective April
12, 2021) - Gold
DEPENDENTS ( IP
Immediate

Dependent of
Single / Single
Parent - Siblings
) Employee paid
(Effective April
12, 2021) - Gold
DEPENDENTS IP
OF
REGULARIZED
FIXED TERM
EMPLOYEES (
Immediate
Dependent of
Single / Single
Parent - Siblings
) Employee Paid
(Effective April
12, 2021) - Gold
Legend:
MMC: Makati Medical Center; SLMC GC: St. Luke's Medical Center Global City; SLMC QC: St.
Luke's Medical Center Quezon City; AHMC: Asian Hospital and Medical Center; CSMC:
Cardinal Santos Medical Center; CDH: Cebu Doctors Hospital; CHH: Chong Hua Hospital;
TMC: The Medical City; DDH: Davao Doctors Hospital; H: Healthway Medical Clinic
HEALTHCARE BENEFITS COVERAGE / LIMIT
1. OUT-PATIENT (OP) CARE

1.1 All outpatient consultations (as long as it is medically necessary)
Applicable to all Plans Subject to MBL
1.2 All outpatient procedures (as long as it is medically necessary)
1.3 Eye laser therapy only for retinal tear, retinal hole, retinal detachment and glaucoma prescribed by an
Affiliated Physician/Specialist. Eye correction such as Lasik, PRK and the like are not covered.
1.4 Electrocauterization of skin lesions such as plantar warts, flat warts, periungual warts, filiform warts and
molluscum contagiosum, in any part of the body prescribed by an Affiliated Physician/Specialist
Applicable to all Plans Up to Php 1,000 / member / year
1.5 Sclerotherapy for varicose veins (except medicines and for cosmetic purposes) as prescribed by an
Affiliated Physician, to be availed through affiliated vascular surgeons.
1.6 Allergy Testing/ allergy screening and other related examinations prescribed by an Affiliated Physician.
Applicable to all Plans Up to Php 2,500 / member / year
1.7 Speech therapy for stroke patients only.
Applicable to all Plans Covered as charged subject to MBL
1.8 Tuberculin test
Applicable to all Plans Up to Php 600 / member / year
2. IN-PATIENT CARE
2.1 Room and Board Accommodation
Applicable to all Plans Subject to the Member's Room and Board limit
2.2 All other items directly related in the medical management of the patient, as deemed medically
necessary by the Attending Affiliated Physician and/or Maxicare Coordinator

2.3 Room upgrade in case of room unavailability (Emergency case leading to confinement)
Applicable to all Plans Covered for the first 24 Hours
3. PRE-EXISTING CONDITIONS
Principal - EMPLOYEES (WITH ECU) Company Paid - Gold
3.1 Dreaded Conditions Covered up to 100.00% of MBL
3.2 Non-dreaded Conditions Covered up to 100.00% of MBL
Principal - EMPLOYEES (WITHOUT ECU) Company Paid - Gold
Dependent - DEPENDENTS Company Paid - Gold
Dependent - DEPENDENTS OF REGULARIZED FIXED TERM EMPLOYEES Company Paid - Gold
Dependent - DEPENDENTS (Extended Dependent of Married / Dependents of Single Employees w/
Partners - Parent) Employee Paid - Gold
Dependent - DEPENDENTS (Extended Dependent of Married / Dependents of Single Employees w/
Partner- Siblings) Employee Paid - Gold
Dependent - DEPENDENTS OF REGULARIZED FIXED TERM EMPLOYEES (Extended Dependent of
Married / Dependents of Single Employees w/ Partner - Parent) Employee Paid - Gold
Married / Dependents of Single Employees w/ Partner - Siblings) Employee Paid - Gold
Dependent - DEPENDENTS ( 4th and Up - Children ) Employee paid (Effective April 12, 2021) - Gold
Dependent - DEPENDENTS OF REGULARIZED FIXED TERM EMPLOYEES ( 4th and Up - Children )
Employee paid (Effective April 12, 2021) - Gold
Dependent - DEPENDENTS ( Immediate Dependent of Single / Single Parent - Siblings ) Employee
paid (Effective April 12, 2021) - Gold
Dependent - DEPENDENTS OF REGULARIZED FIXED TERM EMPLOYEES ( Immediate Dependent
of Single / Single Parent - Siblings ) Employee Paid (Effective April 12, 2021) - Gold
Notes:
a. If a Member is enrolled under an Agreement that does not cover pre-existing conditions, then the
Member shall not be covered at all for any pre-existing condition at any time during the Member's
coverage under that same Agreement.

b. If a Member is enrolled under an Agreement that does not cover pre-existing conditions for the first
twelve (12) months from the Effective Date of the Member's coverage, then the Member shall not be
covered for any pre-existing condition during the first twelve (12) months from the Effective Date of the
Member's coverage under that same Agreement; The Member's pre-existing condition shall be covered
after the first twelve (12) months from the Effective Date of the Member's coverage under that same
Agreement provided that the Member's coverage under that same Agreement is continued after the
first 12 months of coverage. There must be no gap on the Member's coverage between the first 12
months of coverage and the Member's coverage after the first 12 months.
c. If a Member is enrolled under an Agreement that covers pre-existing conditions from the Effective Date
of the Member's coverage, then the Member shall be covered for any pre-existing condition from the
Effective Date of the Member's coverage under that same Agreement.
4. DIAGNOSTIC / THERAPEUTIC PROCEDURES
IN-PATIENT OUT-PATIENT
4.1 All diagnostic / therapeutic procedures medically necessary for treatment
Applicable to all Plans Subject to MBL Subject to MBL
4.2 Arthrocentesis
Applicable to all Plans Subject to MBL Up to six (6) sessions
subject to MBL
4.3 Continuous Positive Airway Pressure (CPAP) titration for sleep study
(shared limit for OP and IP) (shared limit for OP and IP)
4.4 Dialysis
4.5 Non-oral chemotherapy (for cancer treatment only)
4.6 Oral chemotherapy (for cancer treatment only)
4.7 Physical therapy / Occupational therapy excluding subspecialties such as cardiac rehabilitation,
pulmonary rehabilitation and the like
Note: Therapy of one (1)
body area shall be part of
the limit.
4.8 Therapeutic Radiology:
4.9 a. Brachytherapy
Applicable to all Plans Subject to MBL Up to twelve (12) sessions
subject to MBL
4.10 b. Cobalt
subject to MBL
4.11 c. Linear Accelarator Therapy
subject to MBL
4.12 d. Radioactive Cesium
subject to MBL
4.13 e. Radioactive Iodine
subject to MBL
4.14 Transurethral Microwave Therapy of Prostate
Applicable to all Plans Up to Php 25,000 / member Up to Php 25,000 / member
/ year / year

4.15 Stapled Hemorrhoidectomy
Applicable to all Plans Up to Php 5,000 / member / Up to Php 5,000 / member /
year year
4.16 Mammotome
year year
4.17 4D Ultrasound except for maternity-related cases
year year
4.18 Esophageal Manometry
year year
4.19 Intensified Modulated Radiotherapy
year year
4.20 Botox which is not cosmetic in nature nor for beautification purpose
year year
4.21 Positron Emission Tomography (PET) Scan
4.22 CT Pulmonary Angiography
year year
4.23 Photodynamic Therapy
year year
4.24 Acoustic Radiation Force
4.25 Alpha Globin/ Globulin Genotyping
4.26 Anchored Periplasmic Expression (APEx)-2 Hyrbid
4.27 Antivascular Endothelial Growth Factor (VEGF) drugs (Avastin, Lucentis, Macugen) for Retinopathy,
Macular Degeneration and other Optha indications
4.28 BCR-ABL by Quantitative Real-time Polymerase Chain Reaction (QRT-PCR, RT-PCR)
4.29 Beta Globin/ Globulin Genotyping


4.30 Capsule Endoscopy
4.31 Coblation Procedures
4.32 Continuous Renal Replacement Therapy (CRRT)
4.33 Contrast Enhanced Ultrasound
4.34 Contrast Enhanced Fluorodeoxyglucose FDG PET Scan
4.35 Ductoscopy (Breast)
4.36 Duolink In-Situ Fluoresence Hybridization (DISH)
4.37 Endoscopic Ultrasound
4.38 Endovenous Laser Treatment
4.39 Endovenous Laser Ablation
4.40 Enhanced Fluorescent Protein Voltage Sensor (VPSP2.1)
4.41 Enhanced Luciferase Complementation
4.42 Enzymed-linked Immunosorbent Spot (ELLISPOT) Assay
4.43 Epidermal Growth Factor Receptor (EGFR) Mutation Assay / Test
4.44 ESAT-6 and CFP-10 Antigens
4.45 Fluorescence In-Situ Hybridization (FISH)
4.46 Gastric Electrical Stimulation Technology

4.47 Image-guided Surgery / Radiotherapy
4.48 Infrared Coagulation Hemorrhoidectomy
4.49 Infrared Thermography
4.50 Intravenous Ultrasound
4.51 JAK-2 Mutation
4.52 Karyotyping
4.53 KRAS Testing
4.54 Magnetic Resonance Spectroscopy
4.55 Mammotome or Vacuum Assisted Breast Biopsy
4.56 Monoclonal Antibody Therapy for Autoimmune conditions and Rheumatological Diseases (Note:
Certain Monoclonal Antbodies have immunosuppressive properties and this led to their therapeutic
application (monoclonal antibody therapy) in autoimmune conditions and rheumatologic diseases, such
as SLE, ankylosing spondylosis, rheumatoid arthritis, etc)
4.57 Multiphoton imaging
4.58 Multislice / Multidetector/ Spiral / Multirow CT
4.59 Neutral Commet Assay
4.60 Optical Glutamate Sensor
4.61 Parkinson's Profile
4.62 Percutaneous Discectomy CT Guided Intradiscal Electrothermal Ablation Technic (IDET)

4.63 Peritonial Dialysis Adequacy Test

4.64 Peritoneal Equilibrium Test
4.65 phaA and phaB genes test
4.66 Pharmacoscintigraphy
4.67 Philadelphia chromosome
4.68 Photodynamic Glutamate Sensor
4.69 Platelet Aggregation Test
4.70 Polymerase Chain Reaction (PCR) for katG and rpoB
4.71 Polymerase Chain Reaction Single Strand Confirmation Polymorphism (PCR-SCCP)
4.72 QuantiFERON Tuberculosis (QFTB)
4.73 Radiofrequency Ablation (RFA) and other RF procedures
4.74 Renal Denervation
4.75 Reverse Transcription Polymerase Chain Reaction (RT-PCR)
4.76 Robotic Surgery / Robotically assisted Surgery
4.77 Single Incision Laparoscopy Surgery (SILS)
4.78 Spinal Angiogram
4.79 Stereotactic Breast Biopsy
4.80 Stereotactic Radiation Therapy/ Stereotactic Radiosurgery


4.81 Supramagnetic ion oxide (SPIO)- enhanced MRI
4.82 Transarterial Hemorrhoidal Dearterialization (THD)
4.83 Terahertz Imaging
4.84 Three-Dimensional Conformal Radiotherapy (3DCRT)
4.85 Thyroplasty
4.86 Tomotherapy
4.87 Tractography
4.88 Ultrafast Electron Beam Computed Tomography
4.89 Ultroid Hemorrhoid Management
4.90 Vulcan EAS (Electro Thermal Arthroscopy System)
5. EMERGENCY CARE
5.1 Doctor services, X-Rays, laboratory and diagnostic examinations, and other medical services related to
the emergency treatment of the patient
5.2 In Non-Affiliated Hospitals
Applicable to all Plans Reimbursable up to 100% of hospital bills and professional
fees based on Maxicare rates incurred during the first 24
hours of treatment up to MBL / availment / member / year
5.3 Outside the Philippines
Applicable to all Plans Reimbursable up to 100% of actual cost up to MBL /
availment / member / year
5.4 Areas without Affiliated Hospital
5.5 Ambulance Service (Affiliated Hospital/Clinic to Affiliated Hospital/Clinic)
5.6 Ambulance Service (Non-Affiliated Hospital/Clinic to Affiliated Hospital/Clinic: Reimbursement)
Applicable to all Plans Reimbursable up to Php 5,000 per conduction
Note: The ambulance service provided herein shall be available regardless of the location within the
Philippines.
6. CONDITIONS WITH SPECIFIC LIMITATIONS

IN-PATIENT OUT-PATIENT
6.1 Initial Treatment within 24 hours from time of bite of Animal bites
Applicable to all Plans Not Covered Subject to MBL
(except cost of vaccines)
6.2 Succeeding treatment after 24 hours from time of bite of Animal bites
(except cost of vaccines)
6.3 Vaccines for treatment of tetanus and animal bites (including administration fee but excluding ER Fees)
6.4 Scoliosis including necessary procedures, except physical therapy sessions, whether congenital,
pre-existing, developmental or acquired
/ year / year
Note: Physical Therapy Note: Physical Therapy
sessions shall form part of sessions shall form part of
the Physical therapy/ the Physical therapy/
Occupational therapy limits Occupational therapy limits
6.5 Congenital Conditions except physical therapy sessions and developmental disorders.
/ year / year
Note: Physical Therapy Note: Physical Therapy
sessions shall form part of sessions shall form part of
the Physical therapy/ the Physical therapy/
Occupational therapy limits Occupational therapy limits
6.6 Consultations of Chronic Dermatoses
6.7 Hepatitis B except vaccines and screening
if acquired if acquired
7. ANNUAL CHECK-UP (ACU)
The following ACU program shall be conducted at a designated Maxicare Affiliated Clinic or Mobile Clinic
(except Healthway Medical Clinic) once a year.
Procedures:
7.1 BASIC 5 - FECALYSIS Covered.
7.2 BASIC 5 - URINALYSIS Covered.
7.3 BASIC 5 - CBC Covered.
7.4 BASIC 5 - CHEST X-RAY Covered.
7.5 BASIC 5 - PHYSICAL EXAMINATION Covered.
7.6 ECG (Optional) For members 35 years old and above
7.7 PAP SMEAR (Optional) For Female members 35 years old and above
Procedures:


Procedures:
Dependent - DEPENDENTS (Extended Dependent of Married / Dependents of Single Employees w/ Partners
- Parent) Employee Paid - Gold
Procedures:
Dependent - DEPENDENTS (Extended Dependent of Married / Dependents of Single Employees w/ Partner-
Procedures:
Procedures:


Procedures:
Procedures:
Procedures:
Dependent - DEPENDENTS ( Immediate Dependent of Single / Single Parent - Siblings ) Employee paid
Procedures:
Dependent - DEPENDENTS OF REGULARIZED FIXED TERM EMPLOYEES ( Immediate Dependent of
Single / Single Parent - Siblings ) Employee Paid (Effective April 12, 2021) - Gold

Procedures:
8. EXECUTIVE CHECK-UP (ECU)
The following ECU program shall be conducted at St. Luke's Medical Center - Global City once a year.
Procedures:
8.1 ALT/SGPT Covered.
8.2 CBC Covered.
8.3 CHEST X-RAY Covered.
8.4 CREATININE Covered.
8.5 FBS Covered.
8.6 LIPID PROFILE Covered.
8.7 OPHTHALMOLOGIC EXAMINATION Covered.
(VISUAL ACUITY, FUNDOSCOPY)
+FUNDUS PHOTO
8.8 POTASSIUM Covered.
8.9 PURE TONE AUDIOMETRY Covered.
(HEARING TEST)
8.10 SODIUM Covered.
8.11 TREADMILL EXERCISE TEST (WITH Covered.
12-L ECG)
8.12 TSH Covered.
8.13 ULTRASOUND OF LIVER AND Covered.
GALLBLADDER, KIDNEYS, AND
BLADDER
8.14 URIC ACID Covered.
8.15 URINALYSIS AND RANDOM URINE Covered.
MICROALBUMIN-CREATININE TEST
8.16 WEIGHT MANAGEMENT Covered.
CONSULTATION AND BODY FAT
ANALYSIS
9. PRE-EMPLOYMENT MEDICAL EXAMINATION (PEME)
Procedures: Fee for Service
Procedures: Fee for Service


10. GROUP LIFE INSURANCE WITH ACCIDENTAL DEATH, DISMEMBERMENT & DISABLEMENT
(ADD&D) BENEFITS
10.1 Insurance Provider The Manufacturers Life Insurance Co. (phils.), Inc.
(manulife)
10.2 Death (Amount of Insurance) Php 50,000
10.3 Age Eligibility Principal
* Group Life: 18 to 65 years old
* ADD&D: 18 to 65 years old
10.1 Insurance Provider The Manufacturers Life Insurance Co. (phils.), Inc.
(manulife)
10.2 Death (Amount of Insurance) Php 50,000
10.3 Age Eligibility Principal
* Group Life: 18 to 65 years old
* ADD&D: 18 to 65 years old
11. DENTAL CARE
11.1 Dental Provider Maxicare Dental Hub
11.2 Out of Network Availment Not Covered
11.3 Mode of Availment Outright
11.4 Package Standard Alternative
Procedures
1. Oral Consultation / Examination Covered.
2. Gum Treatment For Cases Like Covered.
Inflammation Or Bleeding
3. Emergency Dental Treatment Covered.
4. Oral Incision and drainage Covered.
5. Oral Prophylaxis Up to two (2) Session per year
6. Simple Tooth Extraction Covered.
7. Temporary Filling Covered.
8. Simple Repair And Adjustment Of Covered.
Dentures
9. Recementation Of Jacket Crowns, Covered.
Bridges, Inlay And Onlay
10. Palliative Treatment Of Simple Covered.
Mouth Sores And Blisters
11. Desensitization Of Hypersensitive Up to two (2) Teeth per year
Teeth
12. Permanent Filling Up to two (2) Teeth per year
11.3 Other Procedures
Procedures


Dentures
Teeth
Procedures
Dentures
Teeth
Procedures


Dentures
Teeth
Procedures
Dentures
Teeth
Procedures
Dentures
Teeth
Procedures
Dentures
Teeth
Procedures
Dentures

Teeth
Procedures
Dentures
Teeth
Procedures
Dentures

Teeth
Procedures
Dentures
Teeth
Procedures
Dentures
Teeth


12. OPTICAL ASSISTANCE PROGRAM
Coverage Limit Php 5,000.00 Per Family
Mode of Availment Reimbursement
13. MATERNITY BENEFIT
13.1 Covered Members Female Employees (Single/Married)
13.2 Maxicare shall cover the hospital bills and professional fees incurred by covered Member for maternity
services/procedures, up to the following limit:

a. Normal Spontaneous Vaginal Php 20,000.00

Delivery
b. Caesarian Php 30,000.00
c. Dilation and Curettage Not Covered
d. Others Not Covered
e. Maternity Complications other than Php 10,000.00
the above mentioned
13.3 Type of Availment LOA-facilitated if availed within the network; and shall be on
reimbursement basis based on actual amount and subject to
above mentioned limits if availed outside the network
13.4 PhilHealth benefits Required to file
and On top of Maternity Limit
13.5 280 days Waiting Period (from Waived
Member's original effective date with
the Client)
13.6 Laboratory procedures/work-ups
13.7 For availments in Affiliated Hospitals but with Non-Affiliated Physicians, Maxicare shall provide outright
coverage for the hospitals bills and the professional fees of Non-Affiliated Physicians shall be on a
reimbursement.
13.1 Covered Members Female Employees (Single/Married)
Delivery
the above mentioned
the Client)
reimbursement.
13.1 Covered Members and Spouse of Male Employees
Delivery


the above mentioned
the Client)
reimbursement.
Delivery
the above mentioned
the Client)
reimbursement.
Delivery
the above mentioned


the Client)
reimbursement.
Delivery
the above mentioned
the Client)
reimbursement.
Delivery
the above mentioned

the Client)
reimbursement.
Delivery
the above mentioned
the Client)
reimbursement.
Delivery
the above mentioned
the Client)

reimbursement.
Delivery
the above mentioned
the Client)
reimbursement.
Delivery
the above mentioned
the Client)
reimbursement.


Delivery
the above mentioned
the Client)
reimbursement.
14. OUT-PATIENT MEDICINES / TAKE HOME MEDICINES
14.1 Out-Patient Medicines Covered up to Php 5,000 Per Family. Reimbursement
14.2 Take Home Medicines Not Covered

Note:
The coverage for the Special Diagnostic Procedures is subject to the recommendation of the
Affiliated Physician if medically necessary and the provisions of the dreaded and non-dreaded
pre-existing conditions.
B. EXCLUSIONS AND LIMITATIONS
Notwithstanding any provisions to the contrary, the following shall not be covered:
1. Services obtained for non-emergency conditions from Physicians and Hospitals in any of the following
circumstances:
a. Non-Affiliated Physicians in non-Affiliated Hospitals
b. Non-Affiliated Physicians in Affiliated Hospitals
c. Affiliated Physicians in non-Affiliated Hospitals or other non-Affiliated healthcare facility.
Applicable to all Plans Not Covered
2. Additional hospital charges and physician's professional fees resulting from:
a. Room-upgrading beyond Member's allowable time during emergency care
b. Extension of hospital stay despite release of discharge order from Member's attending physician
c. Fees of the assistant surgeons / resident doctors who assisted the Attending Physician in the
process of rendering the medical services shall not be chargeable to the Member and/or Maxicare
except for hospitals that do not have resident physicians to assist during surgeries subject to the
prior approval of Maxicare
d. Use of extra bed, TV, electric fan, DVD/ VCD, and other similar items unless such appliances and
items are necessarily and ordinarily included in the Member's Room & Board Accommodation
e. Extra food
f. Toilet articles like face towel, soap, toothbrush and the like
g. Difference in room and board, the incremental rate differences for professional fees, diagnostic
and laboratory examinations, and other ancillary medical services brought about by obtaining a
room accommodation higher than the Member's Room and Board Accommodation limit
h. Services of a private or a special nurse
i. All other items not medically necessary in the medical management of the patient.
3. Custodial, domiciliary, convalescent and intermediate care.
4. Long-term rehabilitation and psychiatric and/or psychological illnessesand conditions including neurotic
and psychotic behavior disorders;anxiety disorders.
5. Treatment for injury and its complications resulting from self-inflictedinjuries including infections as a
result of tattoos, piercing of theear or in any body part, whether self-inflicted or done by a third partyor

attempted suicide or self-destruction, whether sane or insane.

6. Developmental disorders including functional disorders of the mind, suchas but not limited to
Attention-Deficit Disorder (ADD)/Attention-DeficitHyperactivity Disorder (ADHD), Autism Spectrum
Disorders, BipolarDisorders, Central Auditory Processing Disorder (CAPD), Cerebral Palsy,Down
Syndrome, Neural Tube Defects, and Mental Retardation.
7. Treatment of any injury received when there is:
a. Negligence
b. Unauthorized use of prohibited drugs or regulated drugs
c. Alcoholic liquor intake
d. Direct or indirect participation in the commission of a crime whether consummated or not
e. Violation of a law or ordinance
f. Unnecessary exposure to imminent danger, knowingly or unknowingly or hazard to health, by the
member
Note: Maxicare shall be given a copy of the police or doctor's report (the "Report"), if any. To determine
whether or not such treatment is an exclusion under this paragraph, Maxicare may rely on the Report, as well
as on the evaluation of its own medical resource group provided, however, that if Maxicare has yet to receive
the Report or the evaluation of its medical resource group, the Member shall shoulder the expenses for
medical treatment subject to Maxicare's reimbursement should it be found, after submission of pertinent
documentary evidence, that the treatment is not an exclusion under this paragraph. Reimbursement will be
based on Maxicare standard rates and will be based on the terms and conditions of Service Agreement.
8. Aesthetic, cosmetic and reconstructive surgery or any consultation ortreatment for any beautification
purposes except if necessary to treat afunctional defect due to accidental injury within the
initialconfinement.
9. Oral surgery following accidental injury to teeth for purposes ofbeautification.Dental examinations,
extractions, fillings, other dental treatment andtheir complications except to the extent that are
medically necessaryfor repair or alleviation of damage to the Member caused solely by
anaccident.Medical care resulting from any dental related conditions.
10. Maternity care and all other conditions (except pre and post natalconsultations) related to and/or
resulting from pregnancy and/ordelivery which affect the conditions of the Member and the unborn
child.
Applicable to all Plans Modified: Refer to Benefits and Coverage if Maternity Care
is covered
11A. Circumcision (except for treatment of urological conditions)
11B. Sex Transformation
11C. Diagnosis, treatment and procedures related to fertility or infertility,artificial insemination, sterilization or
reversal of such and theircomplications
12. Experimental medical procedures and its complications.
13. Acupuncture, chirotherapy and other forms of therapies and itscomplications.
14. All expenses incurred in the process of organ donation andtransplantation if the Member is the donor of
such donation ortransplantation, and its complications.
15. Routine physical examinations required for obtaining or continuingemployment, requirement in school,
insurance/travel or governmentlicensing, health permit and other similar purposes

16. Purchase or lease of durable medical equipment, oxygen dispensingequipment, and oxygen except
during covered in-patient care
17. Corrective appliances, prosthetics and orthotics such as but not limited to eye glasses and contact
lenses, hearing aids, pacemaker, artificial limbs, valves, knee-tibial insert for total knee arthroplasty,
vascular grafts, titanium thread, myringotomy tube, intravascular catheters, vascular stents, bone
screws/plates, pins, wires, balloons, orthopedic internal fixator/fixation systems, orthopedic external
fixator or fixation systems, intraocular lens, braces, crutches
Applicable to all Plans Up to MBL
18. Take-home medicine and out-patient medicine except
a. Chemotherapy medicine (except for cancer treatment)
b. Medicine administered during an emergency treatment.
Applicable to all Plans Modified: Refer to Benefits and Coverage if Take-Home or
Out-patient Medicine are covered
19. Congenital, genetic and hereditary diseases and their complications(except for hernias) affecting
functions of individuals.
20. All physical deformities prior to enrollment.
21. Treatment of injuries/illnesses caused directly or indirectly byengaging in any professional sport or
hazardous activity such as but notlimited to scuba diving, surfing, water skiing, mountain climbing,
rockclimbing, mountaineering, parachuting, airsoft, drag racing,paintballing, wakeboarding and bungee
jumping, except for activitiesunder company-sponsored sports activities.
22. Injuries resulting from direct participation in riots, strikes, andother civil disturbances.
23. Treatment of injuries or illnesses resulting from war or anycombat-related activities while in military
service.
24. Sexually transmitted diseases, genital warts, AIDS and AIDS relateddiseases, HIV and HIV related
diseases
25. Pre-existing ConditionsDreadedNon-Dreaded
Applicable to all Plans Modified: Refer to Benefits and Coverage if Pre-existing
Conditions are covered.
26. Treatment for chronic dermatoses (except consultations)
27. Infectious diseases (i.e. Avian Flu, Meningococcemia, etc.) that aredeclared epidemic or pandemic by
the Department of Health, World HealthOrganization or any recognized health authority.
28. Pre-existing Hepatitis BScreening and vaccines for all types of Hepatitis
29. Benefits covered by PhilHealth and all other government fundedhealthcare entitlements as provided for
by law.
30. Speech therapy for developmental and congenital diseases.
31. Weight reduction programs, surgical operation or procedure for treatmentof obesity, including gastric
stapling or balloon procedures andliposuction.
32A. Administration of vaccines for immunization

32B. Cost of vaccines for immunization

33. Cost of medico-legal cases.
34. Routine medical examination or check up or medical examination for employment or medical
examination for travel.
35. Intravenous Immunoglobulin (IVIG).
36. Treatment of work-related injuries of high-risk occupations such as butnot limited to construction
workers, miners, loggers and drillers.
37. Cost of the medical services and professional fees in excess of the MBL.
C. OTHER ARRANGEMENT
1. Treatment of unused Membership Fees shall be refunded automatically subject to Refund /

Credit of Membership Fee provision.
2. Experience Refund (ER)
Three (3) months after renewal of coverage, ER shall be computed based on the following
formula:
ER = 50.00% x [(Total Membership Fees Paid x 70.00%) - (Total Utilization)]
where:
a. Membership fees must be net of commission and VAT

b. Total utilization is inclusive of Riders and IBNR
c. Experience refund is contingent to the Client's renewal. Should the Client decide to
discontinue with Maxicare, ER shall not be applicable.
3. Wellness Program - For the Whole Account

b. Fitness: 1 session(s) per year
a. Lectures: 1 session(s) per year

ANNEX C
GENERAL PROVISIONS
This Annex C is attached to and made part of the Service Agreement ("the Agreement") between
MAXICARE HEALTHCARE CORPORATION ("Maxicare") and ZENDESK INCORPORATED
("Client").
Notwithstanding provisions of the Agreement to the contrary, it is hereby understood and agreed that
the following provisions shall be part of the Agreement:
ARTICLE I - ACCEPTANCE
1. Maxicare shall extend, during the effectivity of this Agreement, healthcare and health
maintenance services and programs to Client's employees who would qualify as bona fide
Members of Maxicare upon enrollment and payment of the appropriate Membership Fees by
Client.
2. Within fifteen (15) days from receipt of this Agreement, the Client may cause the cancellation or
revocation of this Agreement by returning the Membership ID Card and this Agreement to
Maxicare. Maxicare shall thereafter cancel or revoke the membership and the Membership Fee
paid shall be returned in full. Failure to cancel or revoke this Agreement within the period set
shall be understood as an acceptance of all the terms and conditions provided hereunder. Any
availment within the 15-day period shall also mean acceptance of this Agreement. The Member
shall have the right to examine this Agreement, a copy of which is held by the Client during
regular office hours upon presentation of due proof of coverage.
3. Maxicare shall extend and provide healthcare benefits and coverage for the Members on the
date of coverage (the "Effective Date"), whenever Medically Necessary in the medical
management of the Member and subject to the exclusions, limitations and conditions specified
in this Agreement.
ARTICLE II - DEFINITION
1. ACCIDENT: A visible, external, sudden and violent event occasioned by a physical or natural
cause and occurring entirely beyond the Member's control causing damaged to the health of the
Member.
2. ACQUIRED CONDITION: Any condition that is not qualified as pre-existing.
3. ANESTHESIOLOGIST: A specialist duly licenses and registered to administer anesthetic agents

and conduct other anesthesia procedures under this Agreement.
4. ANNUAL CHECK UP (ACU): The annual medical examination which includes comprehensive
medical history, physical examination, and pre-arranged diagnostic and laboratory procedures
geared toward health promotion, early detection of illness, and health monitoring based on
previous medical examination.
5. ADMITTING PHYSICIAN: The physician responsible for admitting a patient to a hospital or

other in-patient health facility.
6. AFFILIATED HOSPITAL: A duly licensed hospital included in the list of affiliated hospitals of
SAP_CORP_FR_RB_ANNEX C - SERVICE AGREEMENT - 10070719 Page 46 of 72

Maxicare with which Maxicare has an existing and valid service agreement where a Member
can avail of Medical Services pursuant to this Agreement.
7. AFFILIATED MEDICAL CLINIC: A duly licensed medical health care facility included in the list
of affiliated medical clinics of Maxicare which has an existing and valid affiliation agreement with
Maxicare where a Member can avail of Medical Services pursuant to this Agreement.
8. AFFILIATED MEDICAL STAFF: A group of medical practitioners and other allied health
professionals who are affiliated and authorized by Maxicare to deliver the required Medical
Services to Members.
9. AFFILIATED PHYSICIAN OR SPECIALIST: A duly licensed physician or specialist affiliated by

Maxicare and named in the list of Maxicare's affiliated physician with whom Maxicare has made
arrangements to provide the required services under this Agreement.
10. AGREEMENT: This Service Agreement, including all schedules, attachments, endorsements,
addenda, Conforme Letter, Membership Application Form, and any other contracts or
documents relevant to the relationship between the Member, Client and Maxicare.
11. ANNUAL BENEFIT LIMIT (ABL): The maximum liability that Maxicare shall assume for all
covered services rendered to a Member within the term of this Agreement. The covered
services include in-patient benefits, out-patient benefits, preventive healthcare benefits and
emergency benefits but excluding Annual Check-up (ACU). ABL is replenished upon renewal of
this Agreement but not during extension.
12. APPLICANT: A person, group of persons, or corporate account applying for Membership with
Maxicare.
13. ATTENDING PHYSICIAN: An Affiliated Physician who is part of the medical staff of an Affiliated
Hospital or Affiliated Medical Clinic, and legally responsible for the care given to a Member while
in the hospital or on out-patient basis.
14. BALANCE BILLING: It is the act of an Affiliated Physician and other health practitioners to
charge Members for the difference between their desired higher professional fees and the
agreed Maxicare standard professional fees for services rendered.
15. CONFINEMENT/HOSPITALIZATION: The state of being admitted in an Affiliated Hospital or

Affiliated Medical Clinic.
16. CONFORME LETTER: A contract between Maxicare and the Client which contains the effective
date, description or reference to benefits, coverage, mode of payment and Membership Fees
and other matters relevant to the relationship between Client and Maxicare. This document
must be signed prior to Effective Date.
17. CONGENITAL DISEASE: A disease or disorder that may or may not be present or manifest at
birth, which may be a result of genetic abnormalities and intrauterine conditions such as but not
limited to errors of morphogenesis or chromosomal abnormalities. Congenital Disease includes
but not limited to the following:
a. Congenital physical anomaly: an abnormality of the structure of a body part that may or
may not be present or manifest at birth.
b. Congenital Malformation: a congenital physical anomaly.
c. Genetic Disorder/Chromosomal Aberration: An illness or condition caused by one or more
abnormalities in the genome, which may be present at birth or recognized until later in life,

such as but not limited to Thalassemia and Hemophilia.
18. CONSENT: Any freely given, specific, informed indication of will, whereby the Member agrees
to the collection, processing, sharing of personal information about and/or relating to him or her,
including personal, sensitive and privileged information. Consent shall be evidenced by written,
electronic or recorded means. It may also be given on behalf of a Member by a lawful
representative or an agent specifically authorized by the Member to do so.
19. CONTRIBUTORY MEMBER: A Member whose Membership Fee is fully or partially paid for by
the Member.
20. CONVALESCENT CARE: The recovery of health and strength after an illness or injury.
21. CUSTODIAL OR MAINTENANCE CARE: The degree of care furnished primarily to provide
room and board, which may or may not include nursing care, training, personal hygiene, and
other forms of self or supervisory care, to those persons who are physically or mentally disabled
or both AND
a. Who are not under any specific medical, surgical or psychiatric treatment to reduce the
existing disability to the extent medically necessary to enable the patient to live outside an
institution providing such care; or
b. When despite such treatment, there is no reasonable possibility that the disability will be
reduced or diminished.
22. DATA PRIVACY LAWS: shall refer to Republic Act No. 10173, otherwise known as the Data
Privacy Act of 2012 as well as its Implementing Rules and Regulations ("IRR").
23. DEPENDENT: Any person included in the Hierarchy of Dependents who can apply for
Membership, through the Membership of the Principal.
24. DEVELOPMENTAL DISORDER: Disorders that interrupt normal development of a child which
may affect a single area or several areas of development. These developmental disorders may
respond to interventions such as, but not limited to, speech therapy, physical therapy and
occupational therapy. Examples: Autism, cerebral palsy, attention deficit hyperactivity disorder
(ADHD), mental retardation.
25. DOMICILIARY CARE: Degree of care provided in the patient's home when in-patient care is not
medically necessary.
26. DREADED DISEASE/CONDITION: A condition (i) that is considered to be chronic, progressive,

and life-threatening or which may have complications or may entail lifelong therapy; or (ii)
wherein complete cure cannot be ensured. This includes, but shall not be limited to, the
following:
a. Neurological conditions: seizure disorder (secondary to space occupying lesions), stroke;

b. Poliomyelitis;
c. Neurosurgical conditions: brain tumors, arteriovenous fistula, aneurysm and others;
d. Cardiovascular Diseases: coronary/hypertensive heart diseases, valvular heart disease
except Mitral Valve Prolapse;
e. Chronic pulmonary diseases: Chronic and Organic Pulmonary Disease
(emphysema/chronic bronchitis), sleep apnea;
f. Liver parenchymal diseases: Cirrhosis, Hepatitis, Newgrowth;
g. Chronic Kidney/ Urological diseases and its complications;

h. Collagen immunologic diseases: Systemic Lupus Erythematosus, scleroderma, rheumatoid

arthritis;
i. Diabetes and its complications;
j. Blood dyscrasias: includes leukemia, lymphoma; and
k. Malignant tumor.
27. EFFECTIVE DATE: The effective date of this Agreement and as indicated in Conforme Letter
and Annex A, wherein all the benefits and coverage pursuant to this Agreement shall be made
available to the Members, subject to the terms and conditions hereof.
28. ELECTIVE CASE: Non-emergency condition that needs no urgent treatment and may be
deferred to a later time without endangering the patient's life or limb.
29. EMERGENCY CONDITION: A life threatening or accidental injury or a sudden and unexpected
onset of a condition or illness which at the time of the occurrence reasonably appears to have
the potential of causing immediate disability or death, or which requires the immediate action or
alleviation of pain or discomfort. These illnesses or injuries require urgent medical or surgical
care and attention which the Member secures immediately after the onset or as soon as the
care may be made available but in any case not later than twenty four (24) hours after the
onset. Heart attacks, cardiovascular accidents, poisonings, loss of consciousness or respiration
and convulsions are some examples of emergency conditions.
30. EXCESS CHARGES: Availments which are not covered within the benefits and coverage under
this Agreement, as well as those which are availed in violation thereof, including but not limited
to the benefit availment of Members with cancelled Membership even if approved by Maxicare,
hospital bills and professional fees that are in excess of Maxicare rates, amount in excess of the
ABL/MBL and other limitations provided in the Agreement, and availments which are specifically
excluded in this Agreement. Excess Charges shall be for the account of the Member.
31. EXPERIMENTAL MEDICAL PROCEDURE: Experimental or investigational medical service,

procedure or supply:
A service, procedure or supply including, but not limited to the diagnostic service, treatment,
facility, equipment, drug or device is considered experimental or investigational if any of the
following criteria are met:
A medical society or regulatory agency deems it experimental; or
The services, procedures or supplies requiring Governmental body approval, such as drugs and
devices, do not have unrestricted market approval from the Food and Drug Administration
(FDA) of the Philippines or US FDA or final approval from any other governmental regulatory
body for use in treatment of a specified condition. Any approval that is granted as an interim
step in the regulatory process is not a substitute for final or unrestricted market approval; or
There is insufficient or inconclusive medical and scientific evidence to evaluate the therapeutic
value of the service, procedure or supply for the given diagnosis or indication.
32. HIERARCHY OF DEPENDENTS: The list of dependents, enumerated based on member's

eligibility as stated in this Agreement.
33. ID CARD: The identification card issued by Maxicare to a Member containing the latter's name
and signature, ID reference number, and other matters pertaining to his Membership.
34. IN-PATIENT MEDICAL SERVICES: The hospitalization services which include

accommodations, medicines and supplies, procedures and/or surgery whenever medically

necessary, furnished to a patient admitted in an Affiliated Hospital.
35. INTERMEDIATE CARE: A level of nursing care service that provides long-term care for the
chronically ill, disabled or elderly people.
36. ILLNESS: A poor health or poor physical condition marked by a pathological deviation from
normal healthy state caused by disease or sickness.
37. LETTER OF AUTHORIZATION (LOA): Letter of authorization duly issued by Maxicare to, and
signed by, the Member which shall serve as the authority of the latter to avail of the Medical
Services.
38. MAXICARE COORDINATOR: A duly licensed medical practitioner designated by Maxicare in an

Affiliated Hospital or Affiliated Medical Clinic to direct and supervise the extension of Medical
Services to Members, and who may render medical advice, prescribe medication or treatment,
issue referrals to Affiliated Specialists, and request for laboratory examination and
hospitalization, upon consultation by Members.
39. MAXIMUM BENEFIT LIMIT (MBL): The maximum liability that Maxicare shall cover and assume
per covered illness or injury of a Member within the one-year term of this Agreement, including
all Out-patient, In-patient and Emergency Care Benefits for any one-year period with respect to
any particular disease/condition and their complications, but excluding ACU. MBL is replenished
upon renewal of the Agreement by Client but not during any extension thereof.
39. MEDICALLY NECESSARY: A Medical Service, as determined by Maxicare, which is (a)

consistent with the diagnosis and customary medical treatment of the condition, (b) in
accordance with the standards of managed care and good medical practice, (c) not for the
convenience of the Member or the Affiliated Physician or Specialist, (d) performed in the most
cost effective manner required by the medical condition and (e) consistent with the terms and
conditions of this Agreement.
41. MEDICAL SERVICES: Out-Patient, Emergency and In-Patient Services.
42. MEDICINES AND DRUGS: Those for which a licensed medical practitioner has prescribed for
dispensing, which are specifically required for the treatment of a covered illness or injury under
this Agreement.
43. MEMBER: A Principal and/or Dependent who is eligible, has been accepted for Membership by
Maxicare after complying with the Membership Eligibility, and is currently enrolled under this
Agreement.
44. MEMBERSHIP: refers to membership in Maxicare, pursuant to this Agreement.
45. MEMBERSHIP FEES: refer to the fees for the enrollment of the Members, as specified in Annex
A.
46. NON-CONTRIBUTORY MEMBER: A Member whose Membership Fee is fully paid for by the
Client.
47. OUT-PATIENT MEDICAL SERVICES: The Medical Services which include consultations,
treatment, laboratory, diagnostic examinations and/or ancillary procedures provided to a
Member by an Affiliated Physician or Specialist, excluding the In-Patient Medical Services
rendered to such Member.

48. PARTY/PARTIES: Collectively refer to Maxicare and Client.
49. PERSONAL INFORMATION: Any information, whether recorded in a material form or not, from
which the identity of the Member is apparent or can be reasonably and directly ascertained by
the entity holding the information, or when put together with other information would directly and
certainly identify the Member.
50. PHILHEALTH: Philippine Health Corporation, an entity administering the National Health
Insurance Program of the Philippines.
51. PRE-EXISTING CONDITION: An illness, injury or condition shall be considered pre-existing if:
(1) any professional advice or treatment has been obtained for such illness, injury, or condition
prior to the Effective Date of Member's coverage, (2) such illness, injury or condition was
evident upon medical examination in connection with the Member's application, and (3) the
pathogenesis of such illness, injury or condition can be clinically determined to have started
prior to the Effective Date of the Member's coverage or at the time of processing of the
Member's application, whether or not the Member is aware of such illness or injury.
52. PRINCIPAL: An employee of Client.
53. REASONABLE CHARGES: Professional fees of non-Affiliated Physicians for services rendered
to Members which do not exceed the standardized professional fees/terms of the Affiliated
Physicians/Specialists. In cases where Maxicare does not have a standard professional fee for
the professional service rendered, Maxicare reserves the right to determine the amount of
reasonable charges for the said service.
54. REHABILITATION CARE: The restoration of a person's ability to function as normally as

possible after an illness or injury.
55. RELATED CONDITION: An illness, condition, or disease which is associated with the particular
diagnosis in question either as a direct symptom or sign, a risk factor, an underlying cause, a
part of a syndrome, or a complication including complications of diagnostics and treatment.
56. ROOM AND BOARD ACCOMMODATION: The pre-assigned type of hospital room and board
by Maxicare to the Member based on the benefit and coverage of the health care plan under
this Agreement.
57. SCREENING TEST: A test to be done on a Member (i) if he is asymptomatic or has no clinical
signs and symptoms, or (ii) that does not pertain to the presenting signs/symptoms and
diagnosis at point of consult nor related to the previous condition/ disease of the Member, or (iii)
upon personal request of the Member which may fall under the above reasons, or (iv) to rule out
diagnosis.
58. STATEMENT OF ACCOUNT or "SOA": The statement of account duly issued by Maxicare on
or before the due date of payment reflecting Membership Fees and other monetary obligations,
if any, payable by Client.
ARTICLE III - INTERPRETATION
1. In this Agreement, unless the context otherwise requires, words importing the singular number
shall include the plural and vice versa, and words importing the masculine shall include the
feminine and neuter gender and vice versa.

2. Any reference to Articles is a reference to Articles in this Agreement, and its Annexes shall be
deemed integral parts hereto. Any reference to any document, instrument or agreement (i) shall
include all exhibits, schedules and other attachments thereto; (ii) shall include all documents,
instruments or agreements issued or executed in replacement thereof; and (iii) shall mean such
document, instrument or agreement, or replacement or predecessor thereto, as amended,
modified and supplemented from time to time in accordance with the terms thereof and in effect
at any given time.
3. The headings of the Articles and paragraphs herein are inserted for ease of reference only and
shall not affect the interpretation thereof or of this Agreement. Unless otherwise provided, any
reference to "writing" or cognate expressions includes a reference to telex, cable, facsimile
transmission, email or comparable means of communications. All consents and approvals to be
obtained hereunder shall be in writing.
4. Any reference to a person includes its permitted successors and assigns.
5. The words "include", "includes" and "including" are not limiting and shall be deemed to be
followed by the words "without limitation," whether or not so followed. The words "hereof",
"herein" and "hereunder" and words of similar import when used in any document shall refer to
such document as a whole and not to any particular provision of such document.
6. Any reference to "days" shall mean calendar days, unless the term "Business Days" is used,
and any reference to "month" shall mean a calendar month.
7. Words denoting persons shall include individuals, corporations, partnerships, joint ventures,
trusts, unincorporated organizations, political subdivisions, agencies or instrumentalities.
ARTICLE IV - BENEFITS AND COVERAGE
1. Maxicare shall extend and provide during the effectivity of this Agreement all the benefits
pertaining to Membership, subject to the terms and conditions stipulated herein.
2. This Agreement and the benefits appurtenant thereto shall apply only within the territorial
jurisdiction of the Philippines, except for conditions stated in Annex B.
3. Maxicare undertakes to arrange the availment of the Members' healthcare benefits in Affiliated
Hospitals, Clinics and Staff as specified in the Agreement, subject to the exclusions, limitations
and conditions specified in this Agreement.
4. The benefits mentioned in the Agreement, shall be subject to the following general conditions:
a. OUT-PATIENT CARE: Coverage of Out-patient Medical Services, shall be subject to the

following conditions:
i. The service availment shall be in an Affiliated Hospital / Clinic and in accordance

with benefits and coverage set out in this Agreement.
ii. Professional services shall be provided only by Affiliated Physicians.
iii. Maxicare shall issue the requisite Letter of Authorization (LOA) and other necessary
documents prior to the availment of any Out-patient care.

b. IN-PATIENT CARE. Coverage of in-patient benefits, except for emergency conditions,

wherein the emergency provisions of this Agreement will apply, shall be subject to the
following conditions:
i. The hospital confinement must be recommended by an Affiliated Physician and

approved by the duly authorized representative of Maxicare in that Affiliated Hospital
prior to confinement.
ii. The confinement shall be in an Affiliated Hospital and in accordance with the
Member's Room and Board Accommodation.
iii. Professional services shall be provided only by Affiliated Physicians and/or Maxicare
Coordinator.
iv. If a Member for whom discharge order has been issued by the Attending Physician
refuses to be discharged, Maxicare shall no longer be responsible for all hospital
expenses and professional fees incurred after the specific time or hour the Member
should have been discharged. Such expenses shall be charged to the personal
account of the Member.
v. Maxicare shall issue the requisite Letter of Authorization (LOA) and other necessary
documents prior to the availment of any In-patient Care.
c. ANNUAL CHECK-UP (ACU): Coverage of ACU shall be subject to the following:
i. If the number of Members to undergo the ACU is at least fifty (50) active Members in
one day, arrangements may be made for a mobile laboratory to conduct the ACU at
Client's worksite. In case the number of actual mobile ACU availers falls below the
minimum required number, Client shall shoulder the additional cost attributable to
such shortfall.
ii. The Members may avail of the ACU at any time for Annual and Semi-Annual mode
of payment; and only after six (6) months from effectivity of this Agreement for other
modes of payment. ACU benefits shall be availed within the coverage year;
otherwise, it shall be forfeited.
iii. Additional Members with less than two (2) months remaining coverage within the
term of this Agreement shall not be entitled to ACU.
iv. Client shall notify Maxicare's Annual Check-Up (ACU) Unit at least one (1) month
prior to preferred schedule. Any request for rescheduling or change of venue must
be in writing and should be forwarded to the ACU Unit one (1) week prior to the
original ACU schedule. Maxicare, at its best effort, shall negotiate with providers for
the rescheduling. However, Maxicare reserves the right to disapprove such
requests.
v. In the event of rescheduling, change of venue, or cancellation, the ACU benefits

shall be forfeited and the corresponding charges of the ACU provider shall be
shouldered by the Client unless the rescheduling, change of venue, or cancellation
is approved by Maxicare pursuant to the provisions of this Agreement.
vi. Newly regularized employees who have already completed pre-employment

examination under Maxicare shall no longer be entitled to the ACU, unless otherwise

specified in the Annex B.
d. EMERGENCY CARE
i. In Affiliated Hospital
If the emergency treatment has been administered in an Affiliated Hospital and the
Member still requires confinement, Maxicare shall provide the in-patient benefits
subject to the provisions of this Agreement.
If at the time of the confinement, the Affiliated Hospital has no available room in
accordance with the Member's Room and Board Accommodation, the Member may
opt to avail of a room accommodation which is higher than his Room and Board
Accommodation but Maxicare will only cover the incremental rate differences for the
room upgrade, professional fees, diagnostic and laboratory examinations, and other
ancillary medical services based on the benefit stipulated in Annex B (Benefits
Summary, In-patient Care, Room Upgrade). The said charges and expenses shall
be subject to the Member's ABL/MBL. All incremental costs incurred after the said
limit shall be for the personal account of the Member.
ii. In Non- Affiliated Hospital
If emergency treatment has been administered in Non-Affiliated Hospital and the

Member still requires confinement, he or his representative, as a pre-requisite for
in-patient coverage, must notify Maxicare's Head Office in writing 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.
iii. In all these circumstances, Maxicare reserves the right to validate whether the
treatment received is emergency in nature and/or the illness or condition is covered
under the provisions of this Agreement.
5. PHILHEALTH COVERAGE: It is hereby declared and agreed that this Agreement is integrated
with PhilHealth.
a. All Enrollees must be members of PhilHealth. In case a Member fails to file and process his
PhilHealth benefits, the PhilHealth portion must be paid by the Member directly to the
hospital.
b. The benefits accruing under this Agreement may be utilized only after the exhaustion of
PhilHealth benefits.
c. For Members who are qualified to receive PhilHealth benefits, the computation of their
ABL/MBL shall not include the amount of PhilHealth benefits which they are entitled to
receive.
d. Additional one-time fee of P2,400 per Member per year shall be paid by a non-PhilHealth
Member subject to Maxicare Underwriting and Enrollment Fulfillment Department's
evaluation and acceptance. The additional PhilHealth fee must be paid together with the
initial modal Membership Fees and is non-pro-ratable and non-refundable. For
Non-PhiHealth Members, where additional one-time fee is not paid, the PhilHealth portion
shall be for the personal account of the Member and shall pay the PhilHealth portion
directly to the hospital/clinic.

e. For Members who are not entitled to receive PhilHealth benefits but have paid the
additional fee to Maxicare, the computation of their ABL/MBL shall be inclusive of
PhilHealth benefits which they would have been entitled to receive had they been
PhilHealth members.
f. In case PhilHealth benefits are not applied in the manner indicated above, the same shall
be for the personal account of the Member and shall be paid by him unless otherwise
expressly provided in this Agreement.
6. AREAS WITHOUT AFFILIATED HOSPITALS: In areas without Affiliated Hospitals as identified

by Maxicare, Maxicare will reimburse the following:
a. 100% on room and board charges according to the Member's Room and Board
accommodation.
b. 100% on other hospital bills.
c. Professional fees based on Maxicare rates for an Affiliated Physician rendering the service
in an Affiliated Hospital.
7. DOWNGRADING OF ROOM ACCOMMODATION: Availment of a room accommodation lower

than the Member's Room and Board Accommodation can be done at the option of the Member
but there shall be no refund or offsetting for the cost difference in room accommodation and
other related medical benefits.
8. ROOM UPGRADING/INCREMENTAL RATE DIFFERENCES AND EXCESS CHARGES: If a

Member is confined in a hospital room of higher category than his Room and Board
Accommodation within the Maxicare network for whatever reasons, except during Emergency
Care referred to under Benefits Provisions, incremental rate difference and excess charges due
to voluntary room upgrading shall be charged to the Member, in accordance with the following:
a. For covered hospital charges or ancillaries, the Member shall pay the amount equivalent to
thirty percent (30%) of such charges.
b. For Professional Fees, the Member shall pay the difference between the allowable
Professional Fees (PF) based on Maxicare's fee schedule of the upgraded room and the
Member's room entitlement.
c. For Room and Board charges, the Member shall pay the difference between the actual rate
of the room occupied and the allowable room rate.
d. PhilHealth portion for which the Member is eligible shall be applied to or deducted from
allowable charges.
9. EXCESS CHARGES
a. Any availment that is not covered but is advanced by Maxicare shall be charged to the
Member and the Member shall be liable to pay such advances within thirty (30) days from
receipt of Statement of Account (SOA) from Maxicare. These shall include but are not
limited to the following:
i. Benefit availment of lapsed or cancelled Members even if approved by Maxicare.

ii. Hospital bills and professional fees that are in excess of Maxicare rates.
iii. Availment that is not intended to be covered by Maxicare, such as exclusions,

fraudulent availments, uncoverable items, telephone calls, additional beds, etc.
iv. Member's personal preference to prolong confinement beyond the attending

physician's prescribed duration of hospitalization.
v. Benefit availment found to be not covered and deemed excluded by the Agreement,
including concealment of relevant medical information, even if unintentional or
unrelated to the current availment, and those in excess of Benefit Limits set out in
the Agreement, even if conditionally approved by Maxicare. If at the time of issuance
of the LOA, the amount of the Member's previous availment is not reflected yet,
Maxicare reserves the right to re-adjudicate the Member's coverage based on the
total remaining balance of the benefit limit; and
vi. Other expenses and charges analogous to the foregoing.
If the Excess Charges are not paid after the due date, Maxicare reserves the right to
suspend all services to the Member until the excess charges due, including penalty charge,
have been paid and settled. Penalty charge is equivalent to one percent (1%) or a fraction
thereof of the unpaid excess charges due, computed from the due date, subject to clearing
of checks, whichever is later ("Waiting Period"). Suspension shall be lifted after three (3)
banking days from receipt of payment inclusive of the penalty charge.
b. Claims incurred during the Suspension and Waiting Period shall not be reimbursed. In no
case shall the suspension exceed two (2) months. Otherwise, Maxicare has the option to
automatically cancel the Membership without prior notice to Client or Member.
c. REACTIVATION: Upon lifting of the suspension, Maxicare shall initiate the reactivation of
Client's Membership to the effect that Members can access Maxicare's network of medical
providers.
10. BALANCE BILLING: Maxicare shall maintain a list of preferred Affiliated Physicians and
Specialists. Upon availment, the Member shall be directed by Maxicare to the appropriate
Affiliated Physician/Specialist on the list. If the Member insists on availing the services of an
Affiliated Physician/Specialist not referred by Maxicare and Balance Billing results, the Member
shall be responsible for the additional charges. In no case shall the Member demand
reimbursement from Maxicare for the Balance Billing charged by the Affiliated
Physician/Specialist to the Member.
ARTICLE V - CLAIMS PROCEDURE
1. CLAIMS SUBMISSION
a. Certification, Information and Evidence. All certificates, accounts, receipts, information and
evidence required by Maxicare shall be furnished in such forms as Maxicare may require.
b. Sufficiency of Notice. Written notice of any given by or on behalf of the Member or

Beneficiary to Maxicare to any authorized representative of Maxicare, with information
sufficient to identify the Member, shall be deemed notice to Maxicare.

c. Notice of Claims
i. In cases wherein Maxicare covered costs were not deducted from the medical bills
and a Member is made to pay for the health care cost, a Member may request
reimbursement of such costs which are covered under the Agreement. The request
must be made on the prescribed claim form to which shall be attached official
receipts, together with supporting charge slips, detailed itemized accounts and other
necessary documents. No reimbursement shall be made to the Member unless such
original documents are submitted by the Member or if the Member has otherwise
been fully indemnified or reimbursed of the medical bill or costs incurred under any
other health care coverage or insurance policy or any other similar contracts or
Agreements. Such request for benefits must be presented within thirty (30) days
after the expiration of the period ofconfinement for which claims for benefits is being
made. Failure to submit within the time required shall not invalidate nor reduce any
claim if it was not reasonably possible to give proof within such time.
ii. Payment of the approved claims shall be made directly to the Principal unless
otherwise agreed upon by the Parties. Maxicare shall pay the approved Member
reimbursement claims within fifteen (15) days from receipt of all the supporting
documents. Any outstanding excess charges shall be offset against the approved
claim. In case of death of the Member, payment shall be made to Client in trust for
the person entitled thereto. In the latter case, the Head of the Human Resources or
any authorized personnel of Client shall be required to sign or execute an affidavit of
satisfaction of claim, which shall discharge Maxicare from any and all obligations
arising out of the same.
d. Fraudulent Claims: If any claim under this Agreement is in any respect fraudulent, all
benefits payable and/or paid in relation to that claim shall be forfeited and if deemed
appropriate, recoverable respectively.
e. Physical Examination and Autopsy: Maxicare shall have the right and opportunity to
examine the Member when and as often at is may reasonably require during the pendency
of claim hereunder, and the right and opportunity to make an autopsy in case of death,
where is it not forbidden by law.
2. BENEFIT PAYMENT
All benefits payment shall in PHILIPPINE PESO.
a. Payment of Benefits. If a Member incurs Eligible Expenses during the effectivity of this
Agreement, Maxicare will pay benefits in accordance with the Benefits and Coverage of
this Agreement. Maxicare will pay the Eligible Expenses after application of any stipulated
co-payment or other deductions may apply.
b. Coordination of Benefits. Benefits will not exceed the total medical expenses when
combined with other health care or medical coverage in force or organizations or which are
provided free of charge in government or private facilities.
3. REIMBURSEMENT CLAIMS FOR EMERGENCY CASES
a. LIMITATION: The claims for reimbursement shall apply only in emergency treatments,
whether out-patient or in-patient, rendered in non-Affiliated Hospitals.
b. FILING OF CLAIMS: All claims for reimbursement must be filed using the Maxicare

reimbursement form and submitted to Maxicare Makati, Cebu or Davao Offices within thirty
(30) days from the date of availment for out-patient availment or from date of discharge for
in-patient availment. The claim must be accompanied by the following:
i. Completely filled-out Maxicare reimbursement form;

ii. Original Bureau of Internal Revenue "BIR" registered Official Receipt(s) / Sales
Invoice;
iii. Clinical abstract / history;
iv. Operative reports for surgical cases;
v. Histopathological result;
vi. Medical certificate indicating the diagnostic and procedure(s) done (if any);
vii. Charge slips or detailed itemized/breakdown of charges (charges per item paid);
viii. Police report for cases of assault and vehicular accidents; and
ix. Certification of non-availability of medicines from hospital pharmacy and original
prescriptions signed by the Attending Physician (for IP medicines bought outside the
Hospital).
c. RESERVATION: During the pendency of the claim, Maxicare reserves the right and
opportunity to conduct a comprehensive examination of the Member who is claiming for
reimbursement.
d. PAYMENT OF CLAIMS: Payment of the approved claims shall be made directly to the
Principal unless otherwise agreed upon by the Parties. Maxicare shall pay the approved
Member reimbursement claims within fifteen (15) days from receipt of all the supporting
documents. Any outstanding excess charges shall be offset against the approved claim. In
case of death of the Member, payment shall be made to Client in trust for the person
entitled thereto. In the latter case, the Head of the Human Resources or any authorized
personnel of Client shall be required to sign or execute an affidavit of satisfaction of claim,
which shall discharge Maxicare from any and all obligations arising out of the same.
e. REQUEST FOR RECONSIDERATION: If a claim for reimbursement is denied, or the

Member is not satisfied/agreeable to the reimbursement paid by Maxicare, a written
request for reconsideration must be filed with the claims department of Maxicare Head
Office not later than ten (10) days from receipt of such denial or questioned
reimbursement. Otherwise, the claim shall be deemed satisfied or terminated. The request
for reconsideration shall contain all the reasons upon which reconsideration is sought and
shall be decided upon by an authorized personnel of Maxicare, whose decision shall be
final. Maxicare reserves the right to deny claims for reimbursement if the procedures and
requirements have not been strictly complied with.
5. RESERVATION: During the pendency of the claim, Maxicare reserves the right and opportunity
to conduct a comprehensive examination of the Member who is claiming for reimbursement.
6. PAYMENT OF CLAIMS: Payment of the approved claims shall be made directly to the Principal
unless otherwise agreed upon by the Parties. Maxicare shall pay the approved Member
reimbursement claims within fifteen (15) days from receipt of all the supporting documents. Any
outstanding excess charges shall be offset against the approved claim. In case of death of the
Member, payment shall be made to Client in trust for the person entitled thereto. In the latter
case, the Head of the Human Resources or any authorized personnel of Client shall be required
to sign or execute an affidavit of satisfaction of claim, which shall discharge Maxicare from any
and all obligations arising out of the same.
7. REQUEST FOR RECONSIDERATION: If a claim for reimbursement is denied, or the Member is

not satisfied/agreeable to the reimbursement paid by Maxicare, a written request for

reconsideration must be filed with the claims department of Maxicare Head Office not later than
ten (10) days from receipt of such denial or questioned reimbursement. Otherwise, the claim
shall be deemed satisfied or terminated. The request for reconsideration shall contain all the
reasons upon which reconsideration is sought and shall be decided upon by an authorized
personnel of Maxicare, whose decision shall be final. Maxicare reserves the right to deny claims
for reimbursement if the procedures and requirements have not been strictly complied with.
ARTICLE VI - LIMITATIONS IN SERVICES
The rights of the Member and obligations of Maxicare are subject to the following limitations:
1. If a major disaster or epidemic causes unavailability of facilities or personnel, or if circumstances

not within the control of Maxicare such as complete or partial destruction of facilities, war, riot,
civil insurrection, labor disputes, or similar causes occur, Maxicare shall not be held liable for
any delay or failure to provide services to the Member. Maxicare shall, however, exert its best
effort to provide services to the Member, as the circumstances permit.
2. Maxicare's aggregate liability for Out-patient, In-patient and Emergency Care Benefits for any
one-year period with respect to any particular disease/condition and their complications shall be
limited to the Member's ABL/MBL.
3. Maxicare's obligation with respect to the professional fees of Affiliated Physician/Specialist for
specific Medical Services shall be limited to the agreed Maxicare standard professional fees.
4. If the Member refuses to follow the recommended treatment or procedures and the Affiliated
Physician believes that no professionally acceptable alternative exists, then Maxicare shall no
longer be responsible to provide care for the condition under treatment while such refusal exists.
Further, if the earlier refusal resulted in the aggravation of the medical condition, Maxicare shall
no longer be responsible for the treatment thereof.
5. If a Member refuses to comply with established rules, regulations and procedures of the chosen
hospitals or clinics and by reason of which services are denied, Maxicare shall not be liable for
any claims, charges or damages caused to the Member.
6. Maxicare is not liable for any claims, charges or damages, legal fees or litigation cost incurred
by or caused to the Member by the acts of the doctors or physicians in the course of the
delivery of the Medical Services, whether In-Patient, Out-Patient or Emergency. It is hereby
understood that the liability of Maxicare is limited to the payment of hospital bills, professional
fees and all medical expenses directly related to the medical management of the Member.
ARTICLE VII - MEMBERSHIP FEES
1. AMOUNT OF MEMBERSHIP FEES: For the services covered in this Agreement, Client shall
pay Maxicare a Membership Fee per Member as specified in Annex A.
2. PAYMENT OF MEMBERSHIP FEES: The Membership Fees are due on the Effective Date of
this Agreement and every month, quarter or semester thereafter for monthly, quarterly or
semi-annually mode of payment, respectively. The Membership Fees payable on any due date
shall be the aggregate of the Membership Fees for all the persons enrolled under this
Agreement.

In case of any information, event, condition or change which materially and adversely affects or
could reasonably be expected to materially and adversely affect the assets, liabilities, financial
results of operations, financial conditions, business or prospects of Client, the entire
Membership Fees and/or other Maxicare obligations shall become due and demandable.
The Membership Fees of Members added after any due date and any adjustments in the
Statement of Account (SOA), such as addition or deletion of Members, upgrading or
downgrading of plan, errors and changes still under process, shall be reflected in another SOA
to be given within thirty (30) days from the date the advice from Client is received by Maxicare.
Should there be any dispute, contest or conflict regarding the SOA on any substantial matter
appertaining thereto, Client shall pay ninety percent (90%) of the sum demanded on or before
the due date, notwithstanding such dispute, contest or conflict, unless Client shows proof of
significant error on any substantial matter stated in the SOA, in which case, Client shall pay fifty
percent (50%) of the sum demanded or the uncontested amount, whichever is higher, on or
before the due date. Significant error means an error that would affect at least twenty-five
percent (25%) of the total amount due. Upon resolution of the dispute, contest or conflict, the
adjustments, if any, shall be reflected in another SOA to be given within fifteen (15) days from
the date the dispute, contest or conflict was settled by the Parties. In this regard, FULL payment
of such adjusted SOA shall be made fifteen (15) days from the time of receipt of such adjusted
SOA.
The absence of any written notice to Maxicare regarding any dispute, contest or disagreement
in the details contained in the SOA within fifteen (15) days from the receipt thereof shall
constitute Client's absolute agreement thereto.
3. GRACE PERIOD FOR PAYMENT OF MEMBERSHIP FEES: Client is given a thirty (30) day
grace period within which to pay the amount due under the SOA. The grace period shall
commence from Effective Date or due date. Client is obligated to pay for the coverage during
the grace period.
4. APPLICATION OF PAYMENT: All payments received by Maxicare from Client shall be applied
to the statements of account, in the order of their respective issue dates, starting from the
earliest, and thereafter, in the following order of priority: (a) first, to costs, expenses and
indemnities due, if any; (b) then, against default interest and penalties; and (c) finally, to the
principal amount of any unpaid Membership Fees.
5. EFFECTS OF NON-PAYMENT OF MEMBERSHIP FEES: Non-payment of the Membership

Fees due after the Grace Period shall entitle Maxicare to:
a. Suspend all services under this Agreement or services to Members whose Membership
Fees have not yet been received, until full payment of all Membership Fees due, including
penalties and interests;
b. Terminate this Agreement without prejudice to collect the amount due and the
corresponding penalties and interests that have accrued thereon; and
c. Collect penalty charges equivalent to two and a half percent (2.5%) a month or a fraction
thereof on the unpaid Membership Fees due, computed from the due date.
6. LIFTING OF SUSPENSION: The suspension shall be in force until Client shall have paid the
Membership Fees due plus the two and a half percent (2.5%) per month penalty charge.
Suspension shall be lifted after three (3) banking days from receipt of payment inclusive of the
penalty charge, subject to clearing of checks, whichever is later ("Waiting Period").

7. REFUND/CREDIT OF MEMBERSHIP FEE: If the Membership of a Member is terminated or

cancelled, the unused pro rata Membership Fee paid shall be refunded to the Client only if no
availment had been made prior to the termination or cancellation. Refund is available only if the
Client has fully paid its annual or semi-annual Membership Fees.
There shall be no refund of membership fees in the event that:
a. Membership Fee is payable on a quarterly or monthly basis;

b. The Member'/s' remaining coverage is six (6) month or less;
c. The Member has availed of any of the benefits under this Agreement;
d. Termination is attributable to default of Client;
e. The total number of Members falls below the minimum Membership requirement.
If the Membership Fees are unpaid prior to the cancellation or termination of Membership,
Client shall settle the pro rata Membership Fee, inclusive of penalty charges if applicable.
8. MEMBERSHIP FEE OF MEMBERS ADDED AFTER THE EFFECTIVE DATE OF THE

AGREEMENT: The Membership Fee of Members added after the Effective Date of this
Agreement shall be computed on a pro rata basis equivalent to the ratio between the number of
months from the Effective Date of the Member's coverage until the end of the contract year and
twelve (12) months. A fraction of a month is considered as one (1) month.
9. MINIMUM NUMBER OF ENROLLEES: Should the number of enrolled principal Members fall
below the minimum membership requirement due to cancellation and/or termination of
coverage, Maxicare shall not refund the Membership fee for such cancelled Member
(hereinafter referred to as the "Cancelled Member"). Notwithstanding on the provision, Client
shall pay the Membership fees in order to complete the minimum membership requirement
(hereinafter referred to as the "Fill-in Member").
Minimum Membership Requirement
Account Size No. of Initial Enrolees Minimum Membership

Requirement
Group 10 - 19 principals 10 principals
Small 20 - 99 principals 20 principals
Corporate 20 principals 20 principals
However, the corresponding Membership fee for a Cancelled or Fill-in Member can be offset for
additional principal Members in accordance with the following:
a. For Clients paying in Annual mode of payment:

i. Cancelled members should have not availed any of the benefits under this Agreement;
ii. Membership fee dues of the Cancelled Member or the Fill-in Members, are fully paid;
iii. The remaining term of the Agreement is six (6) months or more; and
iv. The minimum headcount requirement is still met for the duration of the coverage
period.
b. For Clients paying in Semi-Annual and Quarterly mode of payment:

i. Cancelled members should have not availed any of the benefits under this Agreement;
ii. Subsequent Semi-Annual or Quarterly billings shall include the Membership fees for
the Fill-in Members to satisfy the minimum headcount requirement;

iii. Membership fee dues of the Cancelled Member or the Fill-in Members, are fully paid;
iv. Minimum headcount requirement is still met for the duration of the coverage period;
and
v. With respect to the subsequent Semi-Annual or Quarterly payments, the reckoning
point of the additional Member's coverage shall be the succeeding half or quarter of
the Agreement's term.
If any of the above conditions were not met, billing of additional principal Members within the
coverage year shall be billed according to the provision stated under Article VII.8 (Membership
fee of Members added after Effective Date of the Agreement).
10. PARTICIPATION REQUIREMENT: When payment of Membership Fees is non-voluntary /

non-contributory, one hundred percent (100%) enrollment of all regular employees is required.
On the other hand, when payment of Membership Fees is voluntary/contributory, at least
seventy five percent (75%) of regular employees must enroll. If Client has coverage for the
dependents, it should enroll all the eligible dependents under the program or the number of
dependents should reach at least seventy five percent (75%) of the total number of Principals.
Participation requirement shall be met upon the Effective Date. If participation requirement is
not met or should there be a decrease in number of enrollees per membership type, the
following adjustment in rates shall apply:
% of Final count in relation to Initial count per Applicable Rates

membership type or % of Dependents
participation in relation to Principal count
at least 75% Annual/ Semi-Annual/ Quarterly/ Monthly
Membership Fees
60% - 74.9% additional 10% to Annual/ Semi-Annual/
Quarterly/ Monthly Membership Fees
40% - 59.9% additional 20% to Annual/ Semi-Annual/
below 40% additional 35% to Annual/ Semi-Annual/
ARTICLE VIII - MEMBERSHIP
1. MEMBERSHIP ELIGIBILITY: The persons described in Annex A are eligible to enroll under this
Agreement when their Membership Application Forms are accepted and approved by Maxicare.
The ages shall refer to the age of the Member upon Effective Date of this Agreement. The
Member may therefore maintain his Membership until the expiration of this Agreement.
Maxicare reserves the right to approve or disapprove on reasonable grounds the application for
Membership of Client's employees. In this regard, Maxicare shall conduct medical evaluation of
the general status of health of the Applicant and shall principally consider the result thereof in
the approval or disapproval of the aforesaid Application for Membership.
Submission of the Membership Application Form and other requirements shall be regarded as a
condition precedent for coverage under this Agreement. Membership Application Forms shall no
longer be accepted beyond one (1) month after the Effective Date of this Agreement without
prejudice to the provisions in Section 3 below.
Contributory Members are required to fill-up the Membership Application Forms while the
Non-contributory Members shall be endorsed for enrollment thru Maxicare masterlist format.

The hierarchy or order of dependents set forth herein must be strictly observed and followed
and non-compliance therewith without justifiable reasons shall be a ground for disapproval of
the application for Membership.
2. INDIVIDUAL EFFECTIVE DATE OF A MEMBER'S COVERAGE:
a. If no Membership Fee contribution from Members is required, coverage shall become

effective on the Effective Date of this Agreement or the date on which the person first
becomes eligible, whichever is later.
b. If Membership Fee contributions from Members are required, coverage shall become
effective on the Effective Date of this Agreement, the date of enrollment provided that it is
not more than one (1) month after the Effective Date of this Agreement, or the date on
which the person first becomes eligible, whichever is latest.
3. ADDITION AND CANCELLATION OF MEMBERSHIP: The procedure on addition and

cancellation of Members shall be in accordance with this Agreement.
a. Client shall indicate the data of additional enrollees in the Data Change Form (DCF) or in
an electronic mail, and transmit the same to the assigned Maxicare representative prior to
the intended Effective Date of enrollment. Maxicare's Underwriting and Enrollment
Fulfillment Department shall secure the information needed to enroll additional Members or
change Membership data from the DCF or electronic mail.
b. In cases when the volume of additional enrollees is substantial, Client shall attach a list, in
accordance with Maxicare's required format, of the additional Applicants in the DCF or
electronic mail that will be transmitted to Maxicare.
c. Maxicare shall only honor the list of Applicants that are provided and endorsed by Client's
authorized representative, and accompanied by prescribed supporting documents, to
ensure accuracy and security of data that will be submitted to and processed by Maxicare.
Maxicare shall be rendered free and harmless from any liability arising from
non-acceptance of the list provided by an unauthorized representative of Client.
d. DCF and/or Member lists that are clearly faxed may be accepted to meet the cut-off date or
endorsement date prior to the intended Effective Date of enrollment, subject however to the
submission of the original copy or transmission through electronic mail of a copy of the
documents within twenty four (24) hours.
e. The Effective Date of coverage or the assignment of Effective Date for new / additional
applications shall be subject to the following conditions:
i. Change of Effective Date of coverage within the coverage period shall not be allowed.
ii. Maxicare reserves the right to deny or accommodate requests for late enrollment.
iii. Effective Date of an enrollee's coverage whose coverage is being held pending the
submission of additional requirements/verifications shall be based on the completion
and receipt by Maxicare of the said requirements/verifications, applying the Effective
Date of additional enrollees as specified in Annex A.
Pending requirements shall be completed within thirty (30) days from date of notice by
Maxicare. Non-submission within said period would result to automatic forfeiture of

enrollment within the coverage year.
iv. Should the Effective Date of coverage depend on the date of regularization of the
employee, Client shall ensure that the endorsement is made prior to the intended
Effective Date of enrollment but not later than thirty (30) days from the date of
regularization. The Effective Date of coverage shall then follow the date of
regularization. Failure to submit the prescribed requirements, if any, within thirty (30)
days after the date of regularization would result to the disapproval of the application.
Certain considerations on late submission, but in no case later than sixty (60) days
from the date of regularization, may be given on a case-to-case basis due to reasons
deemed acceptable and approved by the Head of Maxicare's Underwriting Enrollment
and Fullfillment Department.
v. UPGRADING/DOWNGRADING OF PLAN: Upgrade or downgrade of a Member's

plan as a result of promotion or demotion shall be subject to the following conditions:
v.i. Client notifies Maxicare in writing.
v.ii. The Effective Date of the upgrading/downgrading of the plan shall be the date of
promotion/demotion of the Member or from endorsement of Client, whichever is
later.
v.iii. In case of upgrade of plan, Client shall pay the additional Membership Fee
corresponding to the effectivity period of the upgraded plan. In case of
downgrade, Maxicare shall refund the excess Membership Fee corresponding
to the effectivity period of the downgraded plan. There shall be no refund of
excess Membership Fee if the member has availed any benefits pursuant to this
Agreement.
vi. All additional enrollees/dependents must be endorsed within thirty (30) days from the
Effective Date and they shall follow the original /renewal Effective Date of coverage.
Additional enrollees beyond this period shall be considered in the next renewal period
except for newly regularized employees, newly-wed spouse and newly-born
dependents whose coverage is effective from the date of eligibility.
f. In case of a Member's resignation, termination, separation or retirement, Client shall notify

Maxicare in writing prior to the Effective Date of the cancellation of Membership. The
Effective Date of the cancellation shall be based on the date as endorsed by Client or after
Maxicare's receipt of the cancellation notice, whichever is later. Client shall also cause the
return and surrender of the ID card.
In case Client failed to cause the return and surrender of the ID Cards of cancelled
Members, the cost of all medical services arising out of an unauthorized use of the ID
Cards shall be charged accordingly to Client's account.
For any delays in the processing of cancellation of membership due to incomplete

submission or incomplete mandatory information resulting to utilization, the Client shall be
liable for continued payment of premium and the availments shall be charged to the
Account's utilization.
4. INVALIDATION OF MEMBERSHIP: Failure to disclose any material information about a

Member, including but not limited to gender, date of birth, hierarchy, dependent's relationship or
medical information, whether intentional or unintentional, shall automatically invalidate the
coverage of the Member effective from the date of coverage. An information is deemed material
if its disclosure would have resulted in the (a) declination of the application for Membership of

the Applicant, (b) the assessment of a higher Membership Fee or (c) the inclusion of additional
restrictions and exclusions to the benefits of the Member under this Agreement. Client shall
reimburse Maxicare the difference between the costs of Medical Services rendered to such
Member and the Membership Fee.
5. TERMINATION OF MEMBERSHIP: The rights of the Member shall be extinguished at any of

the following dates:
a. Expiry date of this Agreement;
b. When obligations to Maxicare are not paid within the Grace Period;
c. Effective immediately, when the Member has fraudulent availment or material

misrepresentations or misstatements for the purpose of availing Maxicare benefits;
d. Effective immediately, when the Member enters military, naval or air service of any country
or international authority;
e. Upon endorsement of Client that the Member retires or resigns or has been terminated or
separated from Client;
f. For a Dependent Member, on the expiration or termination of coverage of the Principal

Member;
g. Effective immediately, when the Member fails to observe the terms and conditions of this
Agreement or fails to act with utmost good faith.
6. REACTIVATION: If a Member's coverage is suspended due to non-payment of Membership

Fees, the Member may reapply for coverage after payment of all fees due to Maxicare plus
penalties and interest, if applicable. The reactivation shall be effective upon Maxicare's approval
of his application, subject to the submission by such Member of satisfactory evidence of good
health. Upon lifting of the suspension, Maxicare shall initiate the reactivation of Client's
Membership to the effect that Members can access Maxicare's network of medical providers.
7. PROCESSING FEE: For lost ID Cards, filled-out Maxicare statement of loss ID card form,
photocopy of front and back portion of a valid ID with picture or notarized affidavit of loss and a
valid proof of payment of processing fee of P200 per card shall be submitted to Maxicare within
thirty (30) days from the date of loss.
ARTICLE IX - TERM AND TERMINATION
1. EFFECTIVE DATE: Unless otherwise provided herein, this Agreement shall commence on the
date specified in this Agreement and shall be effective for a term of one (1) year. It may be
renewed on a yearly basis subject to mutually agreed upon terms and conditions. This
Agreement shall be automatically renewed every year thereafter unless otherwise terminated
upon the request of either Party, by giving the other Party a written notice at least one (1) month
in advance.
2. PRE-TERMINATION OF AGREEMENT
a. The Parties may pre-terminate this Agreement for justifiable reasons at any time by giving
a written notice to other Party at least thirty (30) days prior to the intended termination date.

Client may only pre-terminate this Agreement if it is not in default in the performance of its
obligations or it has not violated any of its warranties and representations. Starting on the
termination date, Maxicare shall be free from all liabilities to Client, Members and their
dependents. This shall be without prejudice to the right of Maxicare to collect Client's
obligations which have become due and demandable.
b. Client shall be entitled to a refund equivalent to the amount of paid Membership Fees of
Members who have not availed of any of the benefits under this Agreement and in
accordance with the following:
i. For Client paying in Annual mode of payment:
If the Agreement has been in force from Effective Date for Percentage of Refund Based on
Mode of Payment
Less than one (1) month 80%
At least one (1) 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
ii. For Client paying in Semi-annual mode of payment:
If the Agreement has been in force from Effective Date for Percentage of Refund Based on
Mode of Payment
At least one (1) month but less than two (2) months 50%
At least two (2) months but less than three (3) months 30%
Three (3) months or more No refund
Client shall not be entitled to a refund in the event that:
i. It availed of the quarterly and monthly mode of payments;

ii. The remaining term of the Agreement is six (6) months or less;
iii. It is in default in the performance of its obligations; or
iv. It has violated any of its warranties and representations.
c. If Membership Fees due are not fully paid, Client shall be required to settle the
corresponding Membership Fees of Members, inclusive of penalty charges, if applicable, in
accordance with the following provisions:
i. For Members who have not availed of any of the benefits under this Agreement, Client
shall pay the corresponding unpaid amount of Membership Fees in accordance with
the schedule hereunder:
i.i. For Client paying in Annual mode of payment:
If the Agreement has been in force from Effective Date for Percentage of Membership Fees
corresponding to the Mode of
Payment
At least one (1) month but less than three (3) months 30%
At least three (3) months but less than six (6) months 60%

Payment
Six (6) months or more 100%
i.ii. For Client paying in Semi-annual mode of payment:
Payment
At least one (1) month but less than two (2) months 50%
At least two (2) months but less than three (3) months 70%
Three (3) months or more 100%
With respect to the second (2nd) semi-annual payment, the reckoning point shall
be the second (2nd) half of the Agreement's term.
ii. For Members who have availed of any of the benefits under this Agreement, Client is
required to pay their entire Membership Fees, including penalty charges if applicable.
3. TERMINATION OF AGREEMENT
a. Maxicare shall have the right to immediately terminate this Agreement in the event that:
i. Client is declared insolvent, is placed under receivership, or voluntary or involuntary

bankruptcy proceedings have been commenced, or there are information, event,
condition or change which materially and adversely affects or could reasonably be
expected to materially and adversely affect the assets, liabilities, financial results of
operations, financial conditions, business or prospects of Client;
ii. Account's participation becomes fifty percent (50%) and below anytime during the
contract period, subject to evaluation of Maxicare's Underwriting and Enrollment
Fulfilment Department;
iii. Any material representation or warranty made by Client is false or untrue when made;
or if Client commits any act with the intent to defraud Maxicare;
iv. Non-payment of Membership Fees and other Maxicare obligations subject to agreed
payment terms; and
v. If Client is in material breach of the Agreement and has failed to cure such breach
within thirty (30) days after its receipt of written notice from Maxicare.
b. All Medical Services and coverage under this Agreement shall terminate on the termination
date, without prejudice to any claim for covered Medical Services rendered to a Member
prior to the termination date.
ARTICLE X - OTHER PROVISIONS
1. ENTIRE CONTRACT: This Agreement, Conforme Letter and Annexes, the master list of
enrollment, and/or any stipulation or endorsement attached to this Agreement, shall constitute
the entire contract between Maxicare, Client and the Members. All statements and information

contained in the Membership Application Form shall be deemed representations and warranties
made by the Member himself for purposes of applying the provisions of this Agreement. The
execution of the Conforme Letter, Annexes, Renewal Letter or any other agreement between
the Parties shall constitute as execution of this Agreement by the Parties. This Agreement
supersedes all prior undertakings, arrangements, representations, agreements, whether verbal
or written between the Parties.
2. NON-TRANSFERABILITY: All benefits in this Agreement are not transferable or assignable.

Client may not assign any of its rights or delegate any of its obligations under this Agreement
without the prior written consent of Maxicare. Maxicare may assign any of its rights or delegate
any of its obligations upon written notice to Client. Any purported assignment or delegation in
violation of this Agreement is null and void.
3. AUTHORITY TO PROCESS AND DATA PRIVACY: Client hereby agrees and understands that
in the course of providing service/s to the Member and/or his Dependents, Maxicare shall
engage the services of, and/or interact with, other third parties, such as, but not limited to its
parent company, affiliated companies, subsidiaries, financial advisors, affiliated third parties or
independent/non-affiliated third parties and service providers, whether local or foreign
(collectively referred to as "Representatives").
Client hereby represents and warrants that, at the time of the effectivity of this Agreement and
effectivity of coverage of each Member and his Dependents, it has obtained from the Member
and his Dependents the required consents pursuant to the Data Privacy Laws authorizing
Maxicare, Client, and any of their authorized representatives to:
a. Obtain, collect, examine, process, and store the Member's and his Dependent/s' personal
information, including sensitive personal information and privileged information, medical
records, or any other information relative to the Member and his Dependents'
hospitalization, consultation, and treatment or any medical advice in connection with the
benefit/claim availed under the Agreement, as may be deemed necessary by Maxicare.
Except as otherwise stated hereon, any information obtained relative to the authority herein
given shall be strictly confidential. The extent of the collection and processing shall be
necessary and incidental to the performance of the services contemplated in the
Agreement.
b. Disclose the aforementioned information to the Client, its representatives, agents and
brokers, Maxicare and its Representatives, including the service providers which will
perform the services contemplated in the Agreement, for any legitimate business purpose
as Maxicare may deem appropriate, including but not limited to outsourced processing of
Maxicare transactions, profiling or historical statistical analysis, providing advice or
information which Maxicare and its Representatives believe may be of interest to the
Member or the Client, to effectively administer or manage their accounts, enhance
customer services, or to communicate with the Member or the Client for any purpose.
Consent, as herein specified, shall at all times comply with the requirements of the Data Privacy
Laws and the obligation to ensure that the same is in fact compliant shall devolve upon the
Client. It is hereby agreed that it is the sole responsibility of Client to obtain from the Member
the consent herein specified and that Maxicare shall have all the right to rely on the
representation by Client that this consent shall have been duly and timely obtained prior to
Effective Date of this Agreement.
Client shall hold Maxicare free and harmless from and against any and all suits or claims,
actions, or proceedings, damages, costs and expenses, including attorney's fees, which may be
filed, charged or adjudged against Maxicare or any of its directors, stockholders, officers,
employees, agents, or representatives in connection with or arising from the use, processing,

and disclosure by Maxicare or its representatives of the aforementioned, pursuant to Maxicare's

reliance on Client's representation and warranty that Maxicare has the authority to examine,
use, process, or disclose, as the case may be, said medical records or personal information for
the purpose of performing services contemplated in this agreement.
4. CONFIDENTIALITY:
a. A Party ("Receiving Party"), including its employees, agents or representatives, shall not
use or reproduce, directly or indirectly any Confidential Information for the benefit of any
person, or disclose to anyone such Confidential Information without the written
authorization of the other Party ("Disclosing Party"), whether during or after the term of this
Agreement, for as long as such information retains the characteristics of Confidential
Information.
"Confidential Information" means any data or information, that is proprietary to the Parties
and not generally known to the public, whether in tangible or intangible form, whenever and
however disclosed, including, without limitation, (i) personal information, treatments or
operations undergone by its Members, (ii) trade secrets, confidential or secret formulae,
special medical equipment and procedures, (iii) medical utilization reports, directly or
indirectly useful in any aspect of the business of Maxicare, (iv) any vendor names, Member
and supplier lists, (v) marketing strategies, plans, financial information, or projections,
operations, sales estimates, business plans and performance results relating to the past,
present or future business activities of the Parties, (vi) all intellectual or other proprietary
information or material of Maxicare; (vii) all forms of Confidential Information including, but
not limited to, loose notes, diaries, memoranda, drawings, photographs, electronic storage
and computer print outs; (viii) any other information that should reasonably be recognized
as confidential information of Maxicare.
All information which the Receiving Party acquires or becomes acquainted with during the
period of this Agreement, whether developed by the Disclosing Party or by others, which
the Receiving Party has a reasonable basis to believe to be Confidential Information, or
which is treated, designated and/or identified by the Disclosing Party as being Confidential
Information, shall be presumed to be Confidential Information. Confidential Information
need not be novel, unique, patentable, copyrightable or constitute a trade secret in order to
be designated Confidential Information.
Anything herein to the contrary, notwithstanding, Confidential Information shall not include
information which:
i. was known by the Receiving Party prior to receiving the Confidential Information from
the Disclosing Party;
ii. becomes rightfully known to the Receiving Party from a third-party source not known,
after diligent inquiry by such Party to be under an obligation to from the Disclosing
Party to maintain confidentiality;
iii. is or becomes publicly available through no fault of or failure to act by a Party in

breach of this Agreement;
iv. is required to be disclosed by law or regulation or in any judicial or administrative

proceeding provided, however, that:
iv.i. the Receiving Party has provided the Disclosing Party with prompt written notice
thereof so that the Disclosing Party may seek appropriate remedy and/or
injunctive relief prior to such disclosure by the Receiving Party;

iv.ii. the Receiving Party has taken all reasonable actions and/or steps to narrow
down the information to be disclosed;
iv.iii. Should partial disclosure be required, the Receiving Party furnishes only that
portion that is legally required to be disclosed; and
iv.iv. the Receiving Party shall not oppose and shall cooperate with the Disclosing
Party with respect to any such request for any protective order or other relief;
v. is or has been independently developed by employees, consultants or agents of the

Receiving Party without violation of the terms of this Agreement or reference or
access to any Confidential Information; and
vi. is disclosed with the Disclosing Party's prior written consent.
b. The Receiving Party agrees not to use the Confidential Information belonging to the
Disclosing Party for any purpose other than those contemplated by the Parties and in
furtherance of this Agreement. Any other use of such Confidential Information shall be
made only upon prior written consent of the Disclosing Party.
c. For purposes of this Agreement, the Parties agree that their obligations herein shall be
binding upon their directors, officers, employees, agents, representatives, and all other
natural and juridical persons acting for and on their behalf, including, but not limited to their
subsidiaries, affiliates, subcontractors and partners.
d. The obligations provided under this Agreement shall include taking steps to:
i. restrict disclosure of Confidential Information solely to either Party's directors, officers,

employees, agents, and representatives, on a need to know basis;
ii. advise either Party's directors, officers, employees, agents, and representatives with
access to the Confidential Information of the obligation to protect Confidential
Information; and
iii. use the Confidential Information only for purposes directly related to this Agreement.
The obligations imposed herein shall survive even after the termination of the Agreement.
e. The Receiving Party agrees that all Confidential Information shall remain the exclusive
property of the Disclosing Party and its successors.
f. Notwithstanding any right granted hereunder, this Agreement shall not grant the Receiving
Party a right under any patent, copyright, trade secret, or other intellectual property right.
g. In the event that the Receiving Party discloses, disseminates or releases any Confidential
Information received from the Disclosing Party, except as provided above, such disclosure,
dissemination or release will be deemed a material breach of this Agreement.
5. NEWLY AFFILIATED HOSPITAL/CLINIC: A newly Affiliated Hospital/clinic by Maxicare shall not

be automatically included in the network of medical providers that can be accessed by Client.
Inclusion of such newly Affiliated Hospital/Clinic shall be subject to Maxicare's evaluation.
Maxicare shall notify Client in writing of the options regarding access to the newly Affiliated

Hospital/Clinic.
6. TAXES, LEVIES AND GOVERNMENT IMPOSITION: Client shall directly answer and be liable
for all taxes, fees, charges and penalties that may be assessed against Maxicare and shall,
upon notice or demand from Maxicare, immediately settle and pay all such taxes, penalties and
charges as may be assessed, in the event that:
a. The fees and benefits provided under this Agreement are made subject to new taxes, fees,
charges or penalties as may be required by law after the execution of this Agreement;
b. A new interpretation of the law, regulation or its equivalent should result to changes in the
formula or manner of computing taxes thereby resulting in additional tax obligations on the
part of Maxicare;
c. Client warranted that the transaction contemplated herein is not subject to a particular tax,
such as Value Added Tax, and the Membership Fee was computed pursuant to such
representation;
d. This Agreement is subjected to such other taxes, fees, charges or penalties, not otherwise
contemplated between the Parties but to which the Parties may become liable under the
law.
For the avoidance of any doubt, the taxes, levies or fees referred to herein are only those that
affect the quoting of Membership Fees.
7. GOVERNING LAW: This Agreement shall be governed by and construed in accordance with the
laws of the Republic of the Philippines.
8. ARBITRATION: Any difference arising between the Client or any Member andMaxicare shall be
referred to an arbitrator to be appointed by the parties to the dispute. If the parties are unable to
agree on a single arbitrator, two (2) arbitrators shall be appointed (one by each party). In the
event of further disagreement, the arbitrators shall select an umpire. If the difference between
the parties required medical knowledge(including any question regarding the appropriate
maximum indemnity for any medical service or an operation not listed in the schedule of surgical
fees) the arbitrators at the discretion of Maxicare, may be registered medical practitioners and
the umpire in suchan instance, shall be a consultant Specialist, Surgeon, or Physician.
Determination of an award shall be a Condition Precedent to any Liability or right of action
against Maxicare.
9. SETTLEMENT OF DISPUTES: Any disputes or disagreements arising out of or relating to this

Agreement, which cannot be settled by the Parties on a mutually satisfactory basis shall be
resolved exclusively before the proper courts in Makati City in accordance with the laws of the
Republic of the Philippines.
10. AUTHORIZED SIGNATORY. The Parties hereby represent that their respective representatives
been duly authorized by the Board of Directors to sign, execute and deliver this Service
Agreement.
11. REFUND: All the provisions pertaining to refund, payment and reimbursement shall not apply if
Client, Member or its dependents, commits any act prejudicial to Maxicare, with or without intent
to defraud, including, but not limited to:
a. Creating an account or entity for the sole purpose of qualifying for enrollment or availing
the health medical coverage;
b. Representing to be a bona fide employee of Client;
c. Using the card of a Member to avail of the Medical Services;

d. Availing unauthorized/unprescribed services or services not related to the diagnosis;

e. Consenting to billing for services not rendered;
f. Duplicating claims; and
g. Other analogous circumstances.
12. SEPARABILITY: If any term or provision of this Agreement is declared invalid, illegal or
unenforceable under Philippine laws, such invalidity, illegality or unenforceability shall not affect
or render unenforceable any other term or provision of this Agreement.
13. AGENCY: Nothing in this Agreement creates any agency, joint venture, partnership or other
form of joint enterprise, employment or fiduciary relationship between the Parties. Neither Party
has any express or implied right or authority to assume or create any obligations on behalf of or
in the name of the other Party or to bind the other Party to any contract, agreement or
undertaking with any third party.
14. NOTICES: All notices, demands and other communications required or permitted hereunder
shall be made in writing and sent to the Client, Principal, Members or its Authorized
Representative.
15. COUNTERPARTS. This Agreement may be executed in several counterparts that together shall
constitute one and the same instrument.
16. RIGHTS OF SUBROGATION. The coverage under this Agreement is extended to cover injuries
of the Member caused by third party(ies) whether liability is determinable or not as in cases of
vehicular accidents and other similar instances or related incidents limited to the availed
healthcare services which have been paid by Maxicare pursuant to the Terms and Conditions of
the Agreement and that the Member will subrogate his rights of recovery from any other party to
the extent of the value of the services so rendered to Maxicare and will undertake to assist
Maxicare in the successful recovery of the total cost of those services.
17. CIVIL CODE ARTICLE 1250 WAIVER: The provisions of Article 1250 of the Civil Code of the
Republic of the Philippines (Republic Act No. 386) which reads, "In case an extraordinary
inflation or deflation of the currency stipulated should supervene, the value of the currency at
the time of establishment of the obligation shall be the basis of payment", shall not apply in
determining the extent of liability under the provisions of this Agreement.
18. IMPORTANT NOTICE: The Insurance Commission, with offices in Manila, Cebu and Davao, is
the government office in charge of the enforcement of all laws related to Health Maintenance
Organization (HMO), and has supervisions over HMOs. It is ready at all times to assist the
general public in matters pertaining to HMO, pre-need and insurance. For any inquiries or
complaints, please contact the Public Assistance and Mediation Division (PAMD) of the
Insurance Commission at 1071 United Nations Avenue, Manila with telephone numbers
+632-5238461 and email address publicassistance@insurance.gov.ph. The official website of
the Insurance Commission is www.insurance.gov.ph.
Maxicare Healthcare Corporation

Maxicare Tower, 203 Salcedo Street, Legazpi Village, Makati City, 1229 | Corporate Trunkline: (632)7908-6900
24/7 Customer Care Hotline: (632)8582-1900 / (632)7798-7777

Zendesk Incorporated - 2020 Conforme As of 4.23.2021

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Zendesk Incorporated - 2020 Conforme As of 4.23.2021

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April 23, 2021

Ms. MARIA ISABEL PEREZ

Dear Ms. Perez:

Annex A: Salient Features

Annex B: Benefits Summary

Annex C: General Provisions

A. REQUIREMENTS FOR ENROLLMENT

1. Acceptance of enrollment of the Client shall be subject to evaluation and approval of

2.1. Signed Conforme Letter with attached Annex A, B and C

SAP_CORP_FR_RB_CONFORME LETTER - 10070719 Page 1 of 72

B. RENEWAL MEMBERSHIP GUIDELINES

3.2. Member Movement (Addition, Cancellation, Change of Plan, Correction of Details)

3.3. Additional Enrollees

3.4. Cancellation of Members

SAP_CORP_FR_RB_CONFORME LETTER - 10070719 Page 2 of 72

3.5. Change of Plan

Please feel free to communicate with us for any clarifications.

SAP_CORP_FR_RB_CONFORME LETTER - 10070719 Page 3 of 72

MAXICARE HEALTHCARE CORPORATION ZENDESK INCORPORATED

Jay-Ar Gutierrez Maria Isabel Perez

Fiona Marie Victoria

SAP_CORP_FR_RB_CONFORME LETTER - 10070719 Page 4 of 72

A.1. AGREEMENT NUMBER : 10070719

Enrollee Minimum Age Maximum Age

B.2.1. Hierarchy of Dependents

ENROLLEE STATUS OF HIERARCHY DEPENDENTS MINIMUM MAXIMUM

SAP_CORP_FR_RB_ANNEX A - SALIENT FEATURES - 10070719 Page 5 of 72

ENROLLEE STATUS OF HIERARCHY DEPENDENTS MINIMUM MAXIMUM

SAP_CORP_FR_RB_ANNEX A - SALIENT FEATURES - 10070719 Page 6 of 72

ENROLLEE STATUS OF HIERARCHY DEPENDENTS MINIMUM MAXIMUM

MEMBERSHIP ELIGIBILITY FOR NEWBORNS

Plan Type ANNUAL

SAP_CORP_FR_RB_ANNEX A - SALIENT FEATURES - 10070719 Page 7 of 72

REGULARIZED (Regular 260,000.00 28,239.75 28,239.75

SAP_CORP_FR_RB_ANNEX A - SALIENT FEATURES - 10070719 Page 8 of 72

RIDER RIDER FEE

SAP_CORP_FR_RB_ANNEX A - SALIENT FEATURES - 10070719 Page 9 of 72

RIDER RIDER FEE

SAP_CORP_FR_RB_ANNEX A - SALIENT FEATURES - 10070719 Page 10 of 72

RIDER RIDER FEE

SAP_CORP_FR_RB_ANNEX A - SALIENT FEATURES - 10070719 Page 11 of 72

RIDER RIDER FEE

E.1. Effective Date and Application Form

ENROLLEE EFFECTIVE DATE OF APPLICATION EFFECTIVE MEMBER'S

SAP_CORP_FR_RB_ANNEX A - SALIENT FEATURES - 10070719 Page 12 of 72

1. Effective Date Proviso

Grace Period for enrollment of additional enrollees is 30 Days for EMPLOYEES

Grace Period for enrollment of additional enrollees is 30 Days for DEPENDENTS

SAP_CORP_FR_RB_ANNEX A - SALIENT FEATURES - 10070719 Page 13 of 72

Grace Period for enrollment of additional enrollees is 30 Days for DEPENDENTS OF

Grace Period for enrollment of additional enrollees is 30 Days for DEPENDENTS

Grace Period for enrollment of additional enrollees is 30 Days for DEPENDENTS

Grace Period for enrollment of additional enrollees is 30 Days for DEPENDENTS OF

Grace Period for enrollment of additional enrollees is 30 Days for DEPENDENTS OF

Grace Period for enrollment of additional enrollees is 30 Days for DEPENDENTS OF

Grace Period for enrollment of additional enrollees is 30 Days for DEPENDENTS (

Grace Period for enrollment of additional enrollees is 30 Days for DEPENDENTS OF

E.3. Maximum Number of Dependents

Maximum number of Dependents is 4 for DEPENDENTS Company Paid.

Maximum number of Dependents is 4 for DEPENDENTS OF REGULARIZED FIXED

SAP_CORP_FR_RB_ANNEX A - SALIENT FEATURES - 10070719 Page 14 of 72

A. BENEFITS AND COVERAGE

PLAN TYPE NETWORK WITHOUT ACCESS TO: