We are pleased to submit our offer for the Comprehensive Health Care MediCard Select Package of your family.

The accompanying proposal includes in depth information on:

 Hospitalization / In-patient  Emergency Care

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

MediCard has over 30 years of experience in providing quality healthcare across a range of industries and have helped many of its customers
manage their healthcare. As the only HMO founded and run by doctors, you are assured that the plan we offer you is recommended and approved
by our industry experts on board.

MediCard stands tall – it has more than 43,000 accredited medical professionals in more than 1,000 accredited hospitals and clinics that serve its
more than 700,000 members across the archipelago. Add to that the prestige of being the first HMO in the country that is ISO-certified and has
taken steps to advance its Quality Management Systems so you are guaranteed of quality healthcare.

MediCard continues to play a role as an innovator and a leader in providing solutions to your needs so you can channel your administrative’ s time
and efforts to other more productive areas.

 MediCard is the first to introduce the E-corporate portal that lets you check your employees’ membership information, enroll new
members, view utilization and more.
 MediCard is also the first to introduce MyPocket Doctor, a telemedicine facility offered to its members that allows consultation with a
doctor via video or phone call anytime, anywhere
 MediCard is the first to offer occupational health services and corporate staffing for onsite clinics
 MediCard has its own network of free-standing clinics and pharmacies for total managed healthcare

On top of these, MediCard has a high renewal persistency rate among its satisfied clients.

We hope that you will find our proposal convincing and that the package meets your requirements. Should you need further clarification, please
call the undersigned at 8864-0907.

Thank you for allowing us the opportunity to present our offer.

We look forward to the pleasure of servicing the health care needs of your family.

Sincerely, Noted by:

JOSEPHER M. GILVERO RANDY V. VERDE

Membership Consultant – MediCard Select Senior Assistant Sales Director- Sales and Business Development II
MediCard Philippines, Inc.

MediCard Select Program – Family

A. Membership Eligibility
a. Principal Member

Any person at least 18 years old up to 60 years of age

b. Q u a l i fi e d D e p e n d e n t M e m b e r s

Legal Spouse up to age 60

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

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

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

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

B. Preventi ve Healthcare Services

The Preventive Health Care Services will be provided to MEMBERS by designated MediCard Medical Service Units
Health Care Benefits Coverage/Limit

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

Covered
a. Complete Blood Count

b. Urinalysis (urine examination) Covered

c. Fecalysis (stool examination) Covered

d. Chest X-Ray Covered

e. Electrocardiogram Covered

f. Pap Smear Covered

g. Eight Blood Chemistries:

Fasting Blood Sugar, Total Cholesterol, Uric Acid, Covered under APE; for members 30 years old and above
Creatinine, BUN, HDL, LDL and Triglycerides
h. Anti-flu vaccines Covered under APE; for members below 30 years old

2. Management of Health Problems Covered

3. Routine Immunization Covered

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

5. Record keeping of medical history Covered

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

List of MediCard Free Standing Clinics:

MEDICARD SELECT PROGRAM – FAMILY Page 2

MediCard Philippines, Inc.

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

C. Out-pati ent Care Services**

Out-patient Services will be provided to MEMBERS in any MediCard accredited hospital/clinics
Health Care Benefits Coverage/Limit

1. Referral to specialists Covered

2. Regular consultations & treatment Covered

3. Eye, Ear, Nose & Throat treatment Covered

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

6. Physical Therapy / Speech Therapy Covered

7. Laser treatment of Glaucoma & Retinal Detachment Covered

8. Cataract Extraction including phacoemulsification and cost
Covered
of lens

9. Cauterization of warts (including facial warts) Covered

10. Doses of anti-rabies, anti-venom, anti-tetanus Covered

11. Tuberculin Test (including screening) Covered

12. Pre & Post natal consults Covered; including labs

13. Sclerotherapy (including cost of sclerosing agent) Covered

14. Chronic Dermatoses Covered

15. Scabies Covered

16. Allergy Testing Covered

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

D. Dental Care Services

MEMBERS may avail of the following dental care services from any of the accredited dental clinics:

MEDICARD SELECT PROGRAM – FAMILY Page 3

MediCard Philippines, Inc.

Health Care Benefits Coverage/Limit

1. Oral prophylaxis Covered

2. Consultations and oral examinations Covered

3. Tooth extractions Covered; including surgery for impacted or ankylosed tooth

4. Temporary fillings Covered

5. Gum treatments for cases like inflammation or bleeding

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

7. Treatment of mouth lesions, wounds and burns Covered

8. Emergency out-patient dental treatment Covered

9. Temporomandibular Joint (TMJ) consultations Covered

10. Restorative and Prosthodontic consultations Covered

11. Dental Nutrition & Dietary Counseling Covered

12. Dental Health Education Covered

13. Prenatal & Postnatal consultations Covered

14. Light cure fillings Covered

15. Deep scaling Covered

16. Root canal Covered

17. Dental X-ray Covered

E. In-pati ent Care Services

The following hospitalization (In-Patient) services shall apply when MediCard physicians prescribe the hospitalization of
MEMBERS in any MediCard Accredited Hospitals:

Health Care Benefits Coverage/Limit

1. No deposit upon admission Covered

2. Room and board Regular Private Open

3. Use of operating theatre and Recovery Room Covered

4. Services of MediCard specialist like anesthesiologists,

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

7. X-ray and laboratory examinations Covered

8. Administered medicines Covered

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

10. ICU confinements Covered

MEDICARD SELECT PROGRAM – FAMILY Page 4

MediCard Philippines, Inc.

Health Care Benefits Coverage/Limit

11. Chemotherapy
Covered

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

15. Admission kit including wee bag Covered

16. Laparoscopic Procedures

Covered
a. Single Incision Laparoscopy Surgery (SILS)

17. Lithotripsy/ESWL Covered

18. Hysteroscopic Procedures Covered

19. Stereotactic Brain Biopsy / Stereotactic Breast Biopsy Covered

20. Gamma Knife Surgery Covered

21. Percutaneous Ultrasonic Nephrolithotomy Covered

22. Transurethral Microwave Therapy (TUMT) of the prostate Covered

23. Arthroscopically-guided Procedures Covered

24. CT Scan / MRI / Ultrasound guided excisions

Covered
a. CT Guided Percutaneous Discectomy

25. Endoscopically-guided excisions / treatments / procedures Covered

26. Intradiscal Electrothermal Therapy (IDET) Covered

27. Laser / Coblation Tonsillectomy Covered

28. Endovenous Laser Therapy/Endovenous Laser
Ablation/Radiofrequency Ablation (except for cosmetic Covered
purposes)
29. Coblation Procedures Covered

30. Ductoscopy (Breast) guided

Covered
excisions/treatment/procedures
31. Endoscopic Ultrasound guided
Covered
excisions/treatment/procedures

32. Infrared Coagulation Hemorrhoidectomy Covered

33. Mammotome/Vacuum Assisted Breast Biopsy Covered

34. Stereotactic Radiation Therapy / Stereotactic Radiosurgery Covered

35. Thyroplasty (implant not covered) Covered

36. Transarterial Hemorrhoidal Dearterialization (THD) Covered

37. Ultroid Hemorrhoid Management Covered

38. Any other modern therapeutic procedure not mentioned

Covered
above
39. Magnetic Resonance Imaging (MRI) / Magnetic Resonance Covered
Angiography (MRA)
a. Tractography / Diffusion Tensor Imaging

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MediCard Philippines, Inc.

Health Care Benefits Coverage/Limit

b. Superparamagnetic Iron Oxide (SPIO) enhanced MRI

40. CT scan
a. Multislice / multidetector / spiral / multirow CT Covered
b. Ultrafast Electron Beam Computed Tomography
41. Ultrasound
a. Intravenous Ultrasound / Intravascular Ultrasound Covered
b. Contrast Enhanced Ultrasound
42. Robotic Surgery / Robotically-assisted Surgery Covered

43. Photodynamic Therapy Covered

44. Acoustic Radiation Force Covered

45. Capsule Endoscopy Covered

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

50. Stapled Hemorrhoidectomy Covered

51. Cryosurgery Covered

52. Work-related illness/accidents Covered

53. Unprovoked/Provoked Assault Covered

54. Hyperventilation syndrome Covered

55. Congenital Illnesses (regardless of PEC limit) Covered

56. Slipped Disc, Scoliosis, Spondylosis, Spinal Stenosis Covered

57. Open heart surgery (including cost of stent and

Covered
pacemaker)
58. Organ transplant (including cost of organ and donor’s
Covered
expense)
59. The following complex diagnostic examinations and
Covered
therapeutic procedures:
a. Angiography (e.g. Coronary, cerebral, Covered
retinal/fluorescein, pulmonary, GI, etc.)
b. Serum chemistry panels (e.g. Chem 23, Spec M, etc.)
c. Pulmonary perfusion scan
d. Tests involving use of Nuclear Technologies (e.g.
Radionuclide Ventriculography / Thallium stress
testing / Radionuclide (Isotope) Scanning,
Pyrophosphate Scintigraphy, etc.)
e. Electromyography, Nerve Conduction Velocity
Studies
f. 24-Hour Holter Monitoring, 2-D Echo and Doppler
g. Treadmill Stress Test
h. Myelogram
i. Diagnostic Endoscopy (including one of video)
i.1 Multiphoton endoscopy
j. Diagnostic Arthroscopy
k. Diagnostic Hysteroscopy
l. Plasma/Urinary Cortisol, Plasma Aldosterone,
Adrenocortical Function, etc.

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MediCard Philippines, Inc.

Health Care Benefits Coverage/Limit

m. Mammogram and Sonomammogram

n. Bone densitometry scan (Dexascan)
o. Immunologic Studies:
o.1 Anti-nuclear antibody (ANA)
o.2 C-Reactive protein
o.3 Lupus cell exam
o.4 Enhanced Luciferase Complementation /
Luciferase Immunoprecipitation Assay
o.5 Enzyme-linked Immunosorbent Spot (ELISPOT)
Assay
o.6 ESAT-6 and CFP-10 Antigens
o.7 QuantiFERON Tuberculosis (QFTB)
p. Genetic studies:
p. 1 Alpha Globin / Globulin Genotyping
p. 2 Beta Globin / Globulin Genotyping
p. 3 BCR-ABL by Quantitative Real-time Polymerase
Chain Reaction (QRT-PCR, RT-PCR)
p. 4 Duolink In-Situ Fluoresence Hybridization (DISH) /
Array Comparative Genomic Hybridization (aCGH)
p. 5 Epidermal Growth Factor Receptor (EGFR)
Mutation Assay / Test
p. 6 Fluorescence In-Situ Hybridization (FISH)
p. 7 JAK-2 Mutation
p. 8 Karyotyping
p. 9 KRAS Testing
p. 10 Philadelphia chromosome
p. 11 Polymerase Chain Reaction (PCR) for katG and
rpoB
p. 12 Polymerase Chain Reaction Single Strand
Conformation Polymorphism (PCR-SSCP)
p. 13 Reverse Transcription Polymerase Chain
Reaction (RT-PCR)

q. Magnetic Resonance Spectroscopy Covered

r. Platelet Aggregation Test Covered

s. 3D & 4D Ultrasound (except for maternity cases) Covered

t. Ductoscopy (Breast) Covered

u. Endoscopic Ultrasound Covered

v. Peritoneal Dialysis Adequacy Test Covered

w. Peritoneal Equilibration Test Covered

x. Spinal Angiogram Covered

y. Any other complex diagnostic procedure not

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

61. Visitation of MediCard liaison officer Covered

F. Emergency Care Services

1. In Accredited Hospitals

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MediCard Philippines, Inc.

In cases of emergency where the MEMBER avails of the services of MediCard Accredited Hospitals/ Clinics, the
following will be provided:
Health Care Benefits Coverage/Limit

a. Doctor’s services Covered

b. Medicines used during treatment or for immediate relief Covered

c. Oxygen and intravenous fluids Covered

d. Dressings, plaster casts and sutures Covered

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

2. In Non-Accredited Hospitals

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

Health Care Benefits Coverage/Limit

a.When a MEMBER is in immediate danger of losing a

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

3. In Foreign Countries
In cases of emergency where a MEMBER avails of services in a foreign territory, members must advance payment
and later file reimbursement from MediCard. Reimbursement shall be based on the table below:
Health Care Benefits Coverage/Limit

Approved Hospital Bills

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

4. In Areas without Accredited Hospitals

In cases of emergency where the MEMBER avails of services in areas without accredited hospitals, members must
advance payment and later file reimbursement from MediCard. Reimbursement shall be based on the table below:
Health Care Benefits Coverage/Limit

Approved Hospital Bills

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

MEDICARD SELECT PROGRAM – FAMILY Page 8

MediCard Philippines, Inc.

5. Ambulance Services and Emergency Medical Assistance

Health Care Benefits Coverage/Limit

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

Health Care Benefits Coverage/Limit

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

G. Other Benefi ts & Considerati ons

Health Care Benefits Coverage/Limit

1. Medical evaluation for enrollees age 41 and above is waived for Principal and Dependent members.

Maternity assistance for all female members subject to the limits

on the table below:
Type of Delivery Coverage
Caesarean
Normal Delivery
D&C (For Miscarriage and Abortion)
Abnormal Pregnancies* Up to projected coverage
Maternity complications**
H.Mole/ Gestational Trophoblastic
2. Maternity Benefit (Outright Coverage) Disease (including D&C)
*Abnormal Pregnancy refers to all pregnancy related conditions whose onset
occurred from conception to puerperium (six weeks after delivery), including pre-
delivery availments / confinements. This is an additional limit on top of Manner
of Delivery/Termination.
** Maternity Complications refers to all maternity related conditions whose
onset occurred beyond puerperium, including but not limited to incisional
hernia, pelvic relaxation, rectocoele, uterine prolapse, etc.

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

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

H. Pre-Existi ng Conditi ons Coverage

Principal Members
Pre-existing conditions are covered

Dependent Members
Pre-existing conditions are covered

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

MEDICARD SELECT PROGRAM – FAMILY Page 9

MediCard Philippines, Inc.

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

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

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

b. Hypertension
c. Goiter (Hypo/Hyperthyroidism)
d. Cataracts/Glaucoma
e. ENT conditions requiring surgery
f. Bronchial Asthma /Allergy / Urticaria
g. Tuberculosis
h. Chronic Cholecystitis/Cholelithiasis (gall bladder stones)
i. Acquired Hernias
j. Prostate disorders
k. Hemorrhoids and Anal Fistulae
l. Benign Tumors
m. Uterine Myoma, Ovarian cysts, Endometriosis
n. Buergher's Disease
o. Varicose Veins
p. Arthritis
q. Migraine headache
r. Gastritis/duodenal or gastric ulcers

Dreaded Disease
Dreaded Diseases are potentially or actually life-threatening conditions or illnesses which may require prolonged or repeated
hospitalization or intensive care management. MediCard shall pay for hospitalization services up to the maximum limit subject to
the pre-existing conditions coverage.
The following are considered Dreaded Disease:
a. Cerebrovascular Accident (stroke)
b. Central nervous system lesions (Poliomyelitis/Meningitis/Encephalitis/Neurosurgical conditions)
c. Cardiovascular Disease(Coronary/Valvular/Hypertensive Heart Disease/Cardiomyopathy)
d. Chronic Obstructive Pulmonary Disease (Chronic Bronchitis/Emphysema), Restrictive lung disease
e. Liver Parenchymal Disease [Cirrhosis, Hepatitis (except type A), New growth]
f. Chronic Kidney/Urological disease (Urolithiasis, Obstructive Uropathies, etc.)
g. Chronic Gastrointestinal Tract Disease requiring bowel resection and/or anastomosis
h. Collagen diseases (Rheumatoid Arthritis, Systemic Lupus Erythematosus)
i. Diabetes Mellitus and its complications
j. Malignancies and Blood Dyscrasias (Cancer, Leukemia, Idiopathic Thrombocytopenic Purpura)
k. Injuries from accidents or assaults, frustrated homicide or frustrated murder
l. Complications of an apparent ordinary illness including MODS and SIRS (e.g. sepsis due to pneumonia, typhoid ileitis, cerebral
malaria, etc.)
m. Single or multiple organ dysfunction and failure (MODS and MOF)
n. Conditions that may require dialysis
o. Chronic pain syndrome (greater than six weeks)
p. Any illness other than the above which would require Intensive Care Unit confinement
q. Et cetera

I. Members Sati sfacti on Service

Benefit Remarks

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

Hospitals 456 nationwide

Direct Access to the MediCard

Clinics 512 nationwide
healthcare network

Doctor 19,567 nationwide

MEDICARD SELECT PROGRAM – FAMILY Page 10

MediCard Philippines, Inc.

Benefit Remarks

Dentists 776 nationwide

Hospital Satellite Clinics 8 satellite clinics

Referral desks 13 referral desks

Stand-alone Full Service

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

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

ROOM AND BOARD: REGULAR PRIVATE OPEN

FOR FAMILY ACCOUNT

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

WITH ACCESS TO ALL MALL-BASED CLINICS

WITHOUT AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY

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MediCard Philippines, Inc.

REVOLVING FUND**
Number of Family Members
(per family)
Family of 2-4 P 55,000.00
Family of 5 and up 75,000.00
**Possible fund adjustments after review of duly filled-out application form

WITH AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY

WITH ACCESS TO ALL MALL-BASED CLINICS
REVOLVING FUND**
Number of Family Members
(per family)
Family of 2-4 P 75,000.00
Family of 5 and up 95,000.00
*For a member age 61 and up, the member must apply for an individual account
**Possible fund adjustments after review of duly filled-out application forms

All enrolled members shall be provided with a MediCard ID. Availment of medical benefits shall be similar to our
usual procedures as outlined in our Medical and Health Care Handbook. All hospital bills and professional fees shall
be charged to MediCard and shall be subsequently paid through withdrawals from the FUND. MediCard shall bill all
hospital charges and professional fees as they are incurred, including therein corresponding administrative charges
and Value Added Tax (VAT). MediCard shall indicate in the billing statement the fund balance, which must be
replenished within seven (7) calendar days from the time it reaches 50% of its required level.

Legend:
AHMC Asian Hospital and Medical Center
MMC Makati Medical Center
SLMC-QC St. Luke’s Medical Center - Quezon City
SLMC-Global St. Luke’s Medical Center - Global City
TMC The Medical City
CSMC Cardinal Santos Medical Center

Limitations and Guidelines

HOSPITALIZATION

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

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

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

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

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

B. OUT-PATIENT SERVICES

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

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

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

C. ELIGIBILITY
1. Deadline for enrollment of dependents:

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

MEDICARD SELECT PROGRAM – FAMILY Page 12

MediCard Philippines, Inc.

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

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

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

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

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

Date of Receipt of Application/Endorsement Effectivity Date

11th to 25th of the month 1st of the following month
26th to 10th of the month 16th of the same month

CONFIRMATION:

This is to signify that all benefits, exclusions and premium incorporated to this proposal are amenable to us. By
this, we have decided to avail the services of MediCard Philippines, Inc. under the MediCard Select Program
effective _________________.

_____________________________
CONFORME
SIGNATURE OVER PRINTED NAME

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