2024 Maxicare Proposal For SMEs 3-99 Employees Nationwide Access & Provincial Access

1
TO: Sole Proprietors, Small Enterprise Business Owners, Family Owned Business Proprietors, Start up Businesses
Owners, Franchise Owners,
We hope this proposal finds you in good health!
As an industry forerunner, we pride ourselves of our more than 30 years of experience. With our strong financial
muscle, robust customer service and high caliber medical partners, we have turn to become the choice of the Top
2000 Corporations in the Philippines.
Maxicare has continued its legacy of providing quality healthcare benefits and this has been extended further with our
corporate program. Small sized companies with at least 3 employeesn now enroll under Maxicare’s MaxiPlus
G
Program and enjoy the following convenient features:
✔ Easy requirements. No individual medical examination and no individual application forms
✔ Access to more than 1000+ hospitals and clinics nationwide and 56,000 affiliated doctors
✔ Access to Maxicare’s own Primary Care Centers located in major hospitals and other strategic locations
✔ Access to My Health Clinics
✔ Optional Access to Top Major Hospitals (Asian Hospital & Medical Center, The Medical City, St. Luke's
Medical Center QC, St. Lukes Medical Center Global City, Makati Medical Center, Cardinal Santos Medical
Center, Cebu Doctors Hospital, Chong Hua Hospital & Davao Doctors Hospital)
✔ Optional Access to Healthway Clinics
✔ Customized and lower pricing for regional accounts (North Luzon, South Luzon, Visayas & Mindanao)
MWith Maxicare, members will experience seamless and worry-free availment through our innovations.
O
For inquiries you may contact us at: (02) 72151209; (02)76247010; 09178046277; 09178327044; program.omg@gmail.com
2
1st Year 2nd Year onwards
Access Size Pre Existing Pre Existing Pre Existing Pre Existing
Non Dreaded Dreaded Non Dreaded Dreaded
Conditions Conditions Conditions Conditions
3-9 Employees / Starter
Plan up to P5,000 up to P5,000 up to MBL up to P5,000
Nationwide 10-19 Employees /
Group Plan & 20-99 up to MBL
Employees / Small Plan
North Luzon
Platinum - Up to Php20,000; Gold -
Up to 15,000; Silver- Up to 10,000; up to MBL
10-19 Employees /
South Luzon Group Plan & 20-99 Bronze- Up to 5,000
Employees / Small Plan
G
Visayas
up to MBL
Mindanao
Comprehensive Medical Care Features

● Outpatient Care and Consultations
● In Patient Care and Confinement
● Emergency Care
● Preventive Care
M
Note: The package attached is only applicable to companies with 3-99 employees. For companies with 100
employees and up (or of the combined headcount of the employees and dependents exceeds 100), a separate
proposal will be drafted. Proposal is not applicable to accounts with previous experience with Maxicare. A separate
proposal will be drafted.
To proceed with the enrollment, kindly fill out the Maxicare Corporate Enrollment Sheet found in page 41- 48
of our proposal and email those back to us together with the rest of the initial requirements.
Requirements for Enrollment:

O
1. Filled out Maxicare Corporate Enrollment Sheet (page 41- 48 of this proposal). The Enrollment Sheet
has 3 categories
a. Company Info Sheet (Name of Company, Nature of Business, Company TIN etc)
b. Principals/Employees to be enrolled (fullnames/ birthdates/ positions/ gender/ civil status)
c. Dependents to be enrolled (fullnames/ birthdates/ positions/ gender/ civil status )
2. BIR 2303
3. Any gov’t issued ID of the signatory
4. KYC Requirements. See Pages 38-39 for the list of KYC Requirements. (to be submitted to us after
we prepare the conforme for your signature).
Should you have any other questions, you may call us at 02) 72151209; (02) 76247010; 09178046277; 09178327044
or email program.omg@gmail.com
Office of Mark Gastardo

Agency Unit Head
Code: A000494
3
TABLE OF CONTENTS
Introduction
Cover Letter 1-2
Table of Contents 3
Nationwide Access Rates
3-9 Employees Starter Plan Rates with Nationwide Access 4-5
10-19 Employees Group Plan Rates with Nationwide Access 6-7
20-99 Employees Small Plan Rates with Nationwide Access 8-9
Optional Riders Rates for Nationwide Access 10-11
G
Provincial Access Rates
10-99 Employees Provincial Access Rates (North Luzon, South Luzon, VisMin, Visayas & Mindanao) 12-16
Provincial Access Directory 17
Benefits & Limitations
Summary of Benefits 18-25
Rider Benefits Description & Inclusions 26-34
M
Exclusions and Limitations Provisions
Notes & Special Reminders
34-36
36
Pre Existing Non Dreaded & Dreaded Conditions 37-38
List of Providers
List of Hospitals & Clinics 39
List of Doctors 39
List of Dentists thru Dental Hub 39
List of ACU Annual Check Up Providers 39
O
Other Industries & Companies with 100 employees & up
Rated & Ineligible Industries 39
Ineligible Industries with less than 100 employees Requirements for Quotation 40
All Companies & Industries with 100 employees & up Requirements for Quotation 40
Enrollment Guidelines
Plan Types for Employees 41
Plan Types for Dependents 41
KYC Requirements for Employers 42-43
KYC Requirements for Employees 43
Enrollment Process Step by Step 44
Enrollment Form
Consent Form 45
Client Information Sheet 46-47
Employees' Masterlist 48
Dependents' Masterlist 49
4
2023-OCT to 2024-SEPT STARTER (3-9 EMPLOYEES)

PLAN
ROOM MBL STANDARD INDUSTRIES
TYPES
EMPLOYEES WITH 9 MAJOR HOSPITAL WITHOUT 9 MAJOR HOSPITAL
ANN SEMI ANN SEMI
PLATINUM 1 Small Suite 240,000 23,401 12,637 17,725 9,572
PLATINUM 2 Lrg Pvt 195,000 19,217 10,377 14,634 7,902
GOLD 1 Reg Pvt 170,000 17,215 9,296 13,111 7,080
GOLD 2 Reg Pvt 120,000 16,180 8,737 12,387 6,689
SILVER 1 Semi-Pvt 100,000 13,190 7,123 10,173 5,493
SILVER 2 Semi-Pvt 80,000 12,770 6,896 9,848 5,318
BRONZE Ward 70,000 10,575 5,711 8,232 4,445
DEPENDENTS
PLATINUM 2 Lrg Pvt 195,000 26,424 14,269 19,964 10,781
G
GOLD 1 Reg Pvt 170,000 23,647 12,769 17,866 9,648
GOLD 2 Reg Pvt 120,000 22,611 12,210 17,142 9,257
SILVER 1 Semi-Pvt 100,000 17,948 9,692 13,693 7,394
SILVER 2 Semi-Pvt 80,000 17,526 9,464 13,368 7,219
BRONZE Ward 70,000 14,392 7,772 11,056 5,970
2023-OCT to 2024-SEPT STARTER (3-9 EMPLOYEES)
PLAN
ROOM MBL RATED INDUSTRIES
TYPES
M
PLATINUM 1 Small Suite 240,000
ANN
28,081
SEMI
15,164
ANN
21,272
SEMI
11,487
PLATINUM 2 Lrg Pvt 195,000 23,060 12,452 17,560 9,482
GOLD 1 Reg Pvt 170,000 20,658 11,155 15,732 8,495
GOLD 2 Reg Pvt 120,000 19,416 10,485 14,865 8,027
SILVER 1 Semi-Pvt 100,000 15,828 8,547 12,209 6,593
SILVER 2 Semi-Pvt 80,000 15,324 8,275 11,818 6,382
BRONZE Ward 70,000 12,691 6,853 9,880 5,335
O
DEPENDENTS
PLATINUM 2 Lrg Pvt 195,000 31,709 17,123 23,957 12,937
GOLD 1 Reg Pvt 170,000 28,375 15,323 21,440 11,578
GOLD 2 Reg Pvt 120,000 27,133 14,652 20,572 11,109
SILVER 1 Semi-Pvt 100,000 21,537 11,630 16,431 8,873
SILVER 2 Semi-Pvt 80,000 21,033 11,358 16,041 8,662
BRONZE Ward 70,000 17,271 9,326 13,266 7,164
Note: Starter Plan is valid until September 30, 2024
*Standard Industries are companies whose nature of business are NOT Construction (office based), Education (except pre schools,
tutorials & review centers), Law Firms, Media, Pharmaceuticals (Distributors), Sauna, Turkish bath, massage parlors (except spa,
salons), Construction (Field Based or combined), Drillers (oil/water/gas), Firemen, Full Time athletes, Government Institutions,
Groups involving special hazards, Logging or Forestry, Manufacturers of Ammunitions, Medical Groups or any healthcare related,
Mining / Underground mine workers, NGOs, Foundations, Cooperatives, Associations, Oil production, Pharmaceutical
(manufacturing), Political groups, Private households, Protection services (security guards), Previous accounts of Maxicare
*Rated Industries are Construction (Combined), Education (except pre schools, tutorials & review center), Media, Pharmaceuticals
(Manufacturing), Sauna, Turkish bath, massage parlors (except spa, salons), Non-Government Organizations
(NGO)/Cooperative/Association/Foundation, Protection Services(Security Guards/Security Agency)
**9 Major Hospitals are: Asian Hospital & Medical Center, The Medical City, St. Luke's Medical Center QC, St. Lukes Medical
Center Global City, Makati Medical Center, Cardinal Santos Medical Center, Cebu Doctors Hospital, Chong Hua Hospital & Davao
Doctors Hospital
5
NO 2024 OPTIONAL RIDERS FOR STARTER PLAN Ann Semi

1 Annual Check up Routine (Clinic) 805 435
2 Standard Dental Package (1 oral prophylaxis) 369 199
3 Basic Dental Package 217 117
Life Insurance with AD&D (Php50,000) - for member ages up to
4 65 years old only 132 71
G
Hospicash (Php5,000 Personal Accident Benefit; Php250 Daily
M
13 Income Benefit) - for member ages up to 65 years old only
317 171
14 Income Benefit) - for member ages up to 65 years old only 381 206
Hospicash (Php20,000 Personal Accident Benefit; Php1,000
17 Daily Income Benefit) - for member ages up to 65 years old only 1,269 685
O
18 Daily Income Benefit) - for member ages up to 65 years old only 2,539 1,371
22 Semi Executive Check Up Outpatient Makati Medical Center 5,781 3,122
23 Executive Check Up Outpatient Makati Medical Center 17,523 9,462
24 Executive Check Up Inpatient Makati Medical Center 32,516 17,559
25 Semi Executive Check Up Outpatient The Medical City 16,000 8,640
26 Executive Check Up Outpatient The Medical City 43,806 23,655
27 Executive Check Up Inpatient The Medical City 53,381 28,826
6
2024 GROUP (10-19 EMPLOYEES)

PLAN
TYPES ROOM MBL STANDARD INDUSTRIES
ANN SEMI ANN SEMI
Platinum Open Suite 500,000 50,610 27,329 38,341 20,704
Platinum Small Suite 350,000 36,643 19,787 27,761 14,991
Platinum Open Private 250,000 31,125 16,808 23,660 12,776
Platinum Large Private 200,000 29,278 15,810 22,295 12,039
Gold Regular Private 200,000 26,473 14,295 20,218 10,918
G
Silver Semi-Private 90,000 20,097 10,852 15,500 8,370
Bronze Ward 70,000 16,152 8,722 12,583 6,795
DEPENDENTS
M
Platinum
Platinum
Gold
Open Private
Large Private
Regular Private
200,000
200,000
200,000
41,452
40,258
36,267
22,384
21,739
19,584
31,303
30,417
27,466
16,904
16,425
14,832
Bronze Ward 70,000 21,965 11,861 16,882 9,116
Note: Group Plan is valid until December 31, 2024 and based on a 12 - month coverage only
O
*Standard Industries are companies whose nature of business are NOT Construction (office based), Education (except pre
schools, tutorials & review centers), Law Firms, Media, Pharmaceuticals (Distributors), Sauna, Turkish bath, massage parlors
(except spa, salons), Construction (Field Based or combined), Drillers (oil/water/gas), Firemen, Full Time athletes, Government
Institutions, Groups involving special hazards, Logging or Forestry, Manufacturers of Ammunitions, Medical Groups or any
healthcare related, Mining / Underground mine workers, NGOs, Foundations, Cooperatives, Associations, Oil production,
Pharmaceutical (manufacturing), Political groups, Private households, Protection services (security guards), Previous accounts of
Maxicare
Doctors Hospital
7
2024 GROUP (10-19 EMPLOYEES)

PLAN
TYPES ROOM MBL RATED INDUSTRIES
ANN SEMI ANN SEMI
G
Bronze Ward 70,000 19,338 10,443 15,066 8,136
DEPENDENTS
M
Platinum Open Private
Platinum Large Private
Gold Regular Private
200,000
200,000
200,000
49,631
48,199
43,423
26,801
26,027
23,448
37,480
36,418
32,887
20,239
19,666
17,759
Bronze Ward 70,000 26,300 14,202 20,211 10,914
O
Maxicare
Doctors Hospital
8
2024 SMALL (20-99 EMPLOYEES)
PLAN
TYPES ROOM MBL STANDARD INDUSTRIES
ANN SEMI ANN SEMI
G
Bronze Ward 70,000 13,574 7,330 10,571 5,708
DEPENDENTS
M
Platinum
Platinum
Small Suite
Small Suite
350,000
250,000
42,409
41,683
22,901
22,509
32,128
31,375
17,349
16,943
O
Bronze Ward 70,000 18,459 9,968 14,185 7,660
Maxicare
Doctors Hospital
9
2024 SMALL (20-99 EMPLOYEES)
PLAN
TYPES ROOM MBL RATED INDUSTRIES
ANN SEMI ANN SEMI
G
Bronze Ward 70,000 16,250 8,775 12,657 6,835
DEPENDENTS
M
Platinum
Platinum
Small Suite
Small Suite
350,000
250,000
50,532
49,909
27,287
26,951
38,282
37,565
20,672
20,285
O
Bronze Ward 70,000 22,102 11,935 16,984 9,171
Maxicare
Doctors Hospital
10
2024
OPTIONAL RIDERS FOR
NO NATIONWIDE: Ann Semi Qtr
1 Annual Check up Routine (Clinic) 1,350 729 378
Annual Check Up – Mobile (at least
2 50 availing members per site) 1,704 920 477
3 Annual Check Up with Drug Testing 2,256 1,218 632
Standard Dental Package (1 oral
4 prophylaxis) 331 179 93
5 Alternative Basic Dental Package 195 105 55
6 Additional 1 Oral Prophylaxis 78 42 22
7 Additional 1 Permanent Filling 117 63 33
Life Insurance with AD&D
8 (Php50,000) 132 71 37
G
9 (Php75,000) 198 107 55
10 (Php100,000) 265 143 74
11 (Php125,000) 331 179 93
12 (Php150,000) 397 214 111
M 13 (Php175,000)
463 250 130
14 (Php200,000) 529 286 148

15 (Php225,000) 595 321 167
16 (Php250,000) 661 357 185
Executive Check up In Patient
17 Makati Medical Center 29,217 15,777 8,181
O
Executive Check up Out Patient
18 Makati Medical Center 15,745 8,502 4,409
Semi Executive Check Up Out
19 Patient Makati Medical Center 5,195 2,805 1,455
Executive Check up In Patient The
20 Medical City 47,966 25,902 13,430
Executive Check up Out Patient The
21 Medical City 31,490 17,005 8,817
Semi Executive Check Up Out
22 Patient Makati The Medical City 14,377 7,764 4,026
Executive Check up Out Patient
23 MyHealth Clinics 3,238 1,749 907
24 Wellness Program per session 8,488 4,584 2,377
Maternity Benefit (minimum of 10
25 female enrollees) 5,682 3,068 1,591
Cancer Benefit Php100,000 (can be
covered up to 1,000,000 depends
on the plan, offered only to
26 Accounts with Group life coverage) 566 306 158
11
27 International Assistance Rider 330 178 92

Hospicash (Php5,000 Personal
Accident Benefit; Php250 Daily
28 Income Benefit) 317 171 89
Income Benefit) - for member ages
29 up to 65 years old only 381 206 107
G
Accident Benefit; Php1,000 Daily
32 up to 65 years old only 1,269 685 355
33 up to 65 years old only 2,539 1,371 711
M Hospicash (Php60,000 Personal
34 up to 65 years old only 3,808 2,056 1,066
O
SPECIAL ACCOMMODATION FOR NON PHILHEALTH MEMBERS

FOREIGN NATIONALS WITHOUT PHILHEALTH MEMBERSHIP AND
NO 2024 FOR SENIOR CITIZEN EMPLOYEES
Non Philhealth Members Expats Foreign Nationals to waive filing of P2,400 on top of the
1 Philhealth premium
Premium Based Program for Senior Citizen Employees aged 66-70 x 3 of the premium.
2 yrs old. Dependents not entitled to this option. Riders not included
Premium Based Program for Senior Citizen Employees aged 71-75 x 4 of the premium.
3 yrs old. Dependents not entitled to this option. Riders not included
12
2024 PROVINCIAL NORTH LUZON (10-99 EMPLOYEES) SOUTH LUZON (10-99 EMPLOYEES)
PLAN TYPES ROOM MBL STANDARD INDUSTRIES STANDARD INDUSTRIES
EMPLOYEES ANN SEMI QTR ANN SEMI QTR
Platinum Open Suite 500,000 28,953 15,635 8,107 29,622 15,996 8,294
Platinum Small Suite 350,000 18,374 9,922 5,145 20,005 10,803 5,601
G
Platinum Open Private 250,000 15,388 8,310 4,309 16,866 9,108 4,722
Platinum Large Private 200,000 14,475 7,817 4,053 15,868 8,569 4,443
Gold Regular Private 200,000 13,091 7,069 3,665 14,352 7,750 4,019
M
Silver Semi-Private 90,000 9,945 5,370 2,785 10,903 5,888 3,053
Bronze Ward 70,000 7,994 4,317 2,238 8,762 4,731 2,453
DEPENDENTS
Platinum Open Suite 500,000 35,848 19,358 10,037 37,175 20,075 10,409
O
Platinum Large Private 200,000 19,899 10,745 5,572 21,812 11,778 6,107
Bronze Ward 70,000 10,866 5,868 3,042 11,912 6,432 3,335
13
NO OPTIONAL RIDER ANN SEMI QTR ANN SEMI QTR
1 Alternative Standard Dental Package 331 179 93 331 179 93
2 Annual Check-up (Basic 5) 2,123 1,146 594 2,824 1,525 791
Group Life with AD&D Php50,000 - for
3 132 71 37 132 71 37
members ages up to 65 years old only
Cancer Benefit Php100,000 (can be
covered up to 1,000,000 depends on
the plan, offered only to Accounts with
4 566 306 158 566 306 158
G
Group life coverage) - for Principal
ages 18 years old up to 65 years old
only
5 International Assistance Rider 330 178 92 330 178 92
6 Wellness program per session 8,488 4,584 2,377 8,488 4,584 2,377
Maternity Benefit (minimum of 10
7 5,682 3,068 1,591 5,682 3,068 1,591
female enrollees)
*Standard Industries are companies whose nature of business are NOT Construction (office based), Education (except pre schools, tutorials & review centers), Law Firms, Media,
M
Pharmaceuticals (Distributors), Sauna, Turkish bath, massage parlors (except spa, salons), Construction (Field Based or combined), Drillers (oil/water/gas), Firemen, Full Time
athletes, Government Institutions, Groups involving special hazards, Logging or Forestry, Manufacturers of Ammunitions, Medical Groups or any healthcare related, Mining /
Underground mine workers, NGOs, Foundations, Cooperatives, Associations, Oil production, Pharmaceutical (manufacturing), Political groups, Private households, Protection
services (security guards), Previous accounts of Maxicare
*Rated Industries are Construction (Combined), Education (except pre schools, tutorials & review center), Media, Pharmaceuticals (Manufacturing), Sauna, Turkish bath, massage
parlors (except spa, salons), Non-Government Organizations (NGO)/Cooperative/Association/Foundation, Protection Services(Security Guards/Security Agency)
***Visayas and Mindanao only has access to Cebu Doctors Hospitals and Chong Hua Hospital & Davao Doctors Hospital
***Visayas only access has access to Cebu Doctors Hospitals and Chong Hua Hospital***Mindanao only has access to Davao Doctors Hospital
O
14
2024 PROVINCIAL VISAYAS ONLY (10-99 EMPLOYEES) VISAYAS AND MINDANAO (10-99 EMPLOYEES)
PLAN
ROOM MBL STANDARD INDUSTRIES RATED INDUSTRIES STANDARD INDUSTRIES RATED INDUSTRIES
TYPES
EMPLOYEES ANN SEMI QTR ANN SEMI QTR ANN SEMI QTR ANN SEMI QTR
Open
Platinum 500,000 28,378 15,324 7,946 29,548 15,956 8,273 29,798 16,091 8,343 31,581 17,054 8,843
Suite
Small
G
Platinum 350,000 17,798 9,611 4,983 18,755 10,128 5,251 18,687 10,091 5,232 20,248 10,934 5,669
Suite
Small
Platinum 250,000 17,046 9,205 4,773 18,038 9,741 5,051 17,897 9,664 5,011 19,494 10,527 5,458
Suite
Open
Platinum 250,000 14,884 8,037 4,168 15,751 8,506 4,410 15,629 8,440 4,376 17,021 9,191 4,766
Private
Open
Platinum 200,000 14,464 7,811 4,050 15,307 8,266 4,286 15,188 8,202 4,253 16,541 8,932 4,631
Private
Large
Platinum 200,000 14,003 7,562 3,921 14,818 8,002 4,149 14,704 7,940 4,117 16,015 8,648 4,484
Private
M
Regular
Gold 200,000 12,664 6,839 3,546 13,401 7,237 3,752 13,297 7,180 3,723 14,483 7,821 4,055
Private
Regular
Gold 150,000 12,244 6,612 3,428 12,957 6,997 3,628 12,857 6,943 3,600 14,002 7,561 3,921
Private
Regular
Gold 110,000 11,794 6,369 3,302 12,480 6,739 3,494 12,383 6,687 3,467 13,488 7,284 3,777
Private
Semi-Priv
Silver 90,000 9,620 5,195 2,694 10,178 5,496 2,850 10,101 5,455 2,828 11,000 5,940 3,080
ate
Semi-Priv
Silver 80,000 9,349 5,048 2,618 9,893 5,342 2,770 9,815 5,300 2,748 10,692 5,774 2,994
ate
O
Bronze Ward 70,000 7,733 4,176 2,165 8,184 44,199 2,292 8,120 4,385 2,274 8,845 4,776 2,477
DEPENDENTS
Open
Platinum 500,000 35,045 18,924 9,813 36,604 19,766 10,249 36,797 19,870 10,303 39,204 21,170 10,977
Suite
Small
Platinum 350,000 24,466 13,212 6,850 25,810 13,937 7,227 25,689 13,872 7,193 27,871 15,050 7,804
Suite
Small
Platinum 250,000 23,713 12,805 6,640 25,093 13,550 7,026 24,899 13,445 6,972 27,117 14,643 7,593
Suite
Open
Platinum 250,000 20,240 10,930 5,667 21,416 11,565 5,996 21,251 11,476 5,950 23,145 12,498 6,481
Private
Open
Platinum 200,000 19,817 10,701 5,549 20,969 11,323 5,871 20,808 11,236 5,826 22,663 12,238 6,346
Private
15
Large
Platinum 200,000 19,246 10,393 5,389 20,367 10,998 5,703 20,207 10,912 5,658 22,011 11,886 6,163
Private
Regular
Gold 200,000 17,339 9,363 4,855 18,348 9,908 5,137 18,207 9,832 5,098 19,831 10,709 5,553
Private
Regular
Gold 150,000 16,922 9,138 4,738 17,907 9,670 5,014 17,767 9,594 4,975 19,351 10,450 5,418
Private
Regular
Gold 110,000 16,471 8,894 4,612 17,432 9,413 4,881 17,295 9,339 4,843 18,838 10,173 5,275
Private
Semi-Priv
G
Silver 90,000 13,079 7,063 3,662 13,841 7,474 3,875 13,732 7,415 3,845 14,958 8,077 4,188
ate
Semi-Priv
Silver 80,000 12,811 6,918 3,587 13,556 7,320 3,796 13,451 7,264 3,766 14,652 7,912 4,103
ate
Bronze Ward 70,000 10,507 5,674 2,942 11,120 6,005 3,114 11,033 5,958 3,089 12,019 6,490 3,365
M
3 Group Life with ADD&D (Php50,000)- for member ages up to 65 years old only 132 71 37 132 71 37
4 Cancer Benefit (Php100,000)- for Principal ages 18 years old up to 65 years old only 566 306 158 566 306 158
Hospicash (Php5,000 Personal Accident Benefit; Php250 Daily Income Benefit) - for member
5 317 171 89 317 171 89
ages up to 65 years old only
Underground mine workers, NGOs, Foundations, Cooperatives, Associations, Oil production, Pharmaceutical (manufacturing), Political groups, Private households, Protection services
(security guards), Previous accounts of Maxicare
O
16
2024 PROVINCIAL MINDANAO ONLY (10-99 EMPLOYEES) VISAYAS AND MINDANAO (10-99 EMPLOYEES)
PLAN TYPES ROOM MBL STANDARD INDUSTRIES RATED INDUSTRIES STANDARD INDUSTRIES RATED INDUSTRIES
EMPLOYEES ANN SEMI QTR ANN SEMI QTR ANN SEMI QTR ANN SEMI QTR
Platinum Open Suite 500,000 28,378 15,324 7,946 29,548 15,956 8,273 29,798 16,091 8,343 31,581 17,054 8,843
Platinum Small Suite 350,000 17,798 9,611 4,983 18,755 10,128 5,251 18,687 10,091 5,232 20,248 10,934 5,669
G
Platinum Open Private 250,000 14,884 8,037 4,168 15,751 8,506 4,410 15,629 8,440 4,376 17,021 9,191 4,766
Platinum Large Private 200,000 14,003 7,562 3,921 14,818 8,002 4,149 14,704 7,940 4,117 16,015 8,648 4,484
Gold egular Privat 200,000 12,664 6,839 3,546 13,401 7,237 3,752 13,297 7,180 3,723 14,483 7,821 4,055
M
Silver Semi-Private 90,000 9,620 5,195 2,694 10,178 5,496 2,850 10,101 5,455 2,828 11,000 5,940 3,080
Bronze Ward 70,000 7,733 4,176 2,165 8,184 4,419 2,292 8,120 4,385 2,274 8,845 4,776 2,477
DEPENDENTS
Platinum Open Suite 500,000 36,797 19,870 9,813 36,604 19,766 10,249 36,797 19,870 10,303 39,204 21,170 10,977
O
Platinum Large Private 200,000 20,207 10,912 5,389 20,367 10,998 5,703 20,207 10,912 5,658 22,011 11,886 6,163
Bronze Ward 70,000 11,033 5,958 2,942 11,120 6,005 3,114 11,033 5,958 3,089 12,019 6,490 3,365
17
3 Group Life with ADD&D (Php50,000)- for member ages up to 65 years old only 132 71 37 132 71 37
4 Cancer Benefit (Php100,000)- for Principal ages 18 years old up to 65 years old only 566 306 158 566 306 158
Hospicash (Php5,000 Personal Accident Benefit; Php250 Daily Income Benefit) - for member ages
5 317 171 89 317 171 89
only
G
Underground mine workers, NGOs, Foundations, Cooperatives, Associations, Oil production, Pharmaceutical (manufacturing), Political groups, Private households, Protection services
(security guards), Previous accounts of Maxicare
M
PROVINCIAL ACCESS DIRECTORY
NORTHERN LUZON WITHOUT NCR & BAGUIO
● Members may avail to any accredited hospital/clinics within the following provinces:
a) CAR: Abra, Apayao, Benguet (except Baguio), Ifugao, Kalinga, Mountain Province
b) Region 1: Ilocos Norte, Ilocos Sur, La Union, Pangasinan
c) Region 2: Batanes, Cagayan, Isabela, Nueva Vizcaya, Quirino
d) Region 3: Aurora, Bataan, Bulacan, Nueva Ecija, Pampanga, Tarlac, Zambales
Note: Accounts requesting for Baguio access should enroll under our Nationwide Program
O
SOUTHERN LUZON WITHOUT NCR & BATANGAS
● Members may avail to any accredited hospital/clinics within the following provinces:
a) Region IV-A: Batangas, Cavite, Laguna, Quezon, Rizal
b) Region IV-B: Marinduque, Occidental Mindoro, Oriental Mindoro, Romblon, Palawan
c) Region V: Albay, Camarines Norte, Camarines Sur, Catanduanes, Masbate, Sorsogon
Note: Accounts located in Batangas will not be allowed to enroll in this program and should enroll under Nationwide
VISAYAS and MINDANAO

●Members may avail to any accredited hospital/clinics within Visayas and Mindanao regions only.
VISAYAS
●Members may avail to any accredited hospital/clinics within Visayas regions only.
MINDANAO
●Members may avail to any accredited hospital/clinics within Mindanao regions only.
18
MAXICARE MAXIPLUS FOR 3-99 EMPLOYEES

SUMMARY OF BENEFITS & EXCLUSIONS
MAXIPLUS
HEALTHCARE BENEFITS COVERAGE/LIMIT
1. OUT-PATIENT (OP) CARE
All outpatient consultations and outpatient procedures
1.1 Subject to MBL
(as long as it medically necessary)
Eye laser therapy only for retinal tear, retinal hole,
retinal detachment and glaucoma prescribed by an
1.2 Up to P10,000/eye/member /year
Affiliated Physician/Specialist. Eye correction such as
Lasik, PRK and the like are not covered.
G
Electrocauterization of skin lesions such as plantar
warts, flat warts, periungual warts, filiform warts and
1.3 Up to P1,000/member/year
molluscum contagiosum, in any part of the body
prescribed by an Affiliated Physician/Specialist.
Sclerotherapy for varicose veins (except medicines
and for cosmetic purposes) as prescribed by an
1.4 Up to P5,000/leg/member/year
Affiliated Physician, to be availed through affiliated
vascular surgeons.
Allergy Testing/ allergy screening and other related
M
1.5 Up to P2,500/member/year
examinations prescribed by an Affiliated Physician.
Covered as charged up to P10,000 / member/year on
reimbursement basis.
1.6 Speech therapy for stroke patients only.
Note: Consultations shall be part of the limit and treated as
sessions.
1.7 Tuberculin test Up to P600/member/year
2. IN-PATIENT CARE
O
2.1 Room and Board Accommodation Subject to the Member’s Room and Board limit
All other items directly related in the medical
management of the patient, as deemed medically
2.2 Subject to MBL
necessary by the Attending Affiliated Physician and/or
Maxicare Coordinator
Room upgrade in case of room unavailability
2.3 Covered for the first 24 hours
(Emergency case leading to confinement)
3. PRE-EXISTING CONDITIONS
1 Dreaded Conditions Covered depending on the type of Product
2 Non-dreaded Conditions Covered depending on the type of Product
Notes:
If a Member is enrolled under a policy that covers pre-existing conditions from the Effective Date of the Member's coverage,
then the Member will be covered for any pre-existing condition from the Effective Date of the Member's coverage under that
same policy.
4. DIAGNOSTIC / THERAPEUTIC PROCEDURES WITH SPECIFIC LIMITS
19
All diagnostic / therapeutic procedures medically

4.1 100% of Actual Cost subject to MBL
necessary for treatment
Up to MBL for IP and Up to six (6) sessions subject to MBL
4.2 Arthrocentesis
for OP
Continuous Positive Airway Pressure (CPAP) titration
4.3 Up to P60,000 (shared limit for OP and IP)
for sleep study
4.4 Dialysis Up to MBL (shared limit for OP and IP)
4.5 Non-oral chemotherapy (for cancer treatment only) Up to MBL (shared limit for OP and IP)
4.6 Oral chemotherapy (for cancer treatment only) Up to P60,000 (shared limit for OP and IP)
Up to MBL for IP and up to twelve (12) sessions subject to
Physical therapy / Occupational therapy excluding MBL for OP
4.7 subspecialties such as cardiac rehabilitation,
pulmonary rehabilitation and the like. Note:Therapy of one(1) body area shall be considered as
one(1) session.
4.8 Therapeutic Radiology:
4.9 a. Brachytherapy Up to MBL (shared limit for OP and IP)
G
4.10 b. Cobalt Up to MBL (shared limit for OP and IP)
4.11 c. Linear Accelerator Therapy Up to MBL (shared limit for OP and IP)
4.12 d. Radioactive Cesium Up to MBL (shared limit for OP and IP)
4.13 e. Radioactive Iodine Up to MBL (shared limit for OP and IP)
Covered up to P25,000/member/year (shared limit for IP and
4.14 Transurethral Microwave Therapy of Prostate
OP)
M
4.15 Stapled Hemorrhoidectomy
OP)
4.16 Mammotome Up to MBL (shared limit for OP and IP)
4.17 4D Ultrasound except for maternity-related cases
OP)
4.18 Esophageal Manometry
OP)
O
4.19 Intensified Modulated Radiotheraphy
OP)
Botox which is not cosmetic in nature nor for Covered up to P5,000/member/year (shared limit for IP and
4.20
beautification purpose OP)
4.21 Positron Emission Tomography (PET) Scan
OP)
4.22 CT Pulmonary Angiography
OP)
4.23 Photodynamic Therapy
OP)
4.24 Acoustic Radiation Force Up to MBL (shared limit for OP and IP)
4.25 Alpha Globin/ Globulin Genotyping Up to MBL (shared limit for OP and IP)
4.26 Anchored Periplasmic Expression (APEx)-2 Hyrbid Up to MBL (shared limit for OP and IP)
Antivascular Endothelial Growth Factor (VEGF) drugs
4.27 Up to MBL (shared limit for OP and IP)
(Avastin, Lucentis, Macugen) for Retinopathy,
20
Macular Degeneration and other Optha indications

BCR-ABL by Quantitative Real-time Polymerase
Chain Reaction (QRT-PCR, RT-PCR)
4.29 Beta Globin/ Globulin Genotyping Up to MBL (shared limit for OP and IP)
4.30 Capsule Endoscopy Up to MBL (shared limit for OP and IP)
4.31 Coblation Procedures Up to MBL (shared limit for OP and IP)
4.32 Continuous Renal Replacement Therapy (CRRT) Up to MBL (shared limit for OP and IP)
4.33 Contrast Enhanced Ultrasound Up to MBL (shared limit for OP and IP)
Contrast Enhanced Fluorodeoxyglucose FDG PET
Scan
4.35 Ductoscopy (Breast) Up to MBL (shared limit for OP and IP)
4.36 Duolink In-Situ Fluoresence Hybridization (DISH) Up to MBL (shared limit for OP and IP)
4.37 Endoscopic Ultrasound Up to MBL (shared limit for OP and IP)
G
4.38 Endovenous Laser Treatment Up to MBL (shared limit for OP and IP)
4.39 Endovenous Laser Ablation Up to MBL (shared limit for OP and IP)
Enhanced Fluorescent Protein Voltage Sensor
(VPSP2.1)
4.41 Enhanced Luciferase Complementation Up to MBL (shared limit for OP and IP)
Enzymed-linked Immunosorbent Spot (ELLISPOT)
Assay
M
Epidermal Growth Factor Receptor (EGFR) Mutation
Assay / Test
4.44 ESAT-6 and CFP-10 Antigens Up to MBL (shared limit for OP and IP)
4.45 Fluorescence In-Situ Hybridization (FISH) Up to MBL (shared limit for OP and IP)
4.46 Gastric Electrical Stimulation Technology Up to MBL (shared limit for OP and IP)
4.47 Image-guided Surgery / Radiotherapy Up to MBL (shared limit for OP and IP)
4.48 Infrared Coagulation Hemorrhoidectomy Up to MBL (shared limit for OP and IP)
O
4.49 Infrared Thermography Up to MBL (shared limit for OP and IP)
4.50 Intravenous Ultrasound Up to MBL (shared limit for OP and IP)
4.51 JAK-2 Mutation Up to MBL (shared limit for OP and IP)
4.52 Karyotyping Up to MBL (shared limit for OP and IP)
4.53 KRAS Testing Up to MBL (shared limit for OP and IP)
4.54 Magnetic Resonance Spectroscopy Up to MBL (shared limit for OP and IP)
4.55 Mammotome or Vacuum Assisted Breast Biopsy Up to MBL (shared limit for OP and IP)
Monoclonal Antibody Therapy for Autoimmune
Up to MBL (shared limit for OP and IP)
conditions and Rheumatological Diseases
(Note: Certain Monoclonal Antibodies have
4.56 immunosuppressive properties and this led to their
therapeutic application (monoclonal antibody therapy) Up to MBL (shared limit for OP and IP)
in autoimmune conditions and rheumatologic
diseases, such as SLE, ankylosing spondylosis,
21
rheumatoid arthritis, etc.)

4.57 Multiphoton imaging Up to MBL (shared limit for OP and IP)
4.58 Multislice / multidetector/ spiral / multirow CT Up to MBL (shared limit for OP and IP)
4.59 Neutral Commet Assay Up to MBL (shared limit for OP and IP)
4.60 Optical Glutamate Sensor Up to MBL (shared limit for OP and IP)
4.61 Parkinson's Profile Up to MBL (shared limit for OP and IP)
Percutaneous Discectomy CT Guided Intradiscal
Electrothermal Ablation Technic (IDET)
4.63 Peritonial Dialysis Adequacy Test Up to MBL (shared limit for OP and IP)
4.64 Peritoneal Equilibrium Test Up to MBL (shared limit for OP and IP)
4.65 phaA and phaB genes test Up to MBL (shared limit for OP and IP)
4.66 Pharmacoscintigraphy Up to MBL (shared limit for OP and IP)
4.67 Philadelphia chromosome Up to MBL (shared limit for OP and IP)
G
4.68 Photodynamic Glutamate Sensor Up to MBL (shared limit for OP and IP)
4.69 Platelet Aggregation Test Up to MBL (shared limit for OP and IP)
4.70 Polymerase Chain Reaction (PCR) for katG and rpoB Up to MBL (shared limit for OP and IP)
Polymerase Chain Reaction Single Strand
Confirmation Polymorphism (PCR-SCCP)
4.72 QuantiFERON Tuberculosis (QFTB) Up to MBL (shared limit for OP and IP)
M
Radiofrequency Ablation (RFA) and other RF
procedures
4.74 Renal Denervation Up to MBL (shared limit for OP and IP)
Reverse Transcription Polymerase Chain Reaction
(RT-PCR)
4.76 Robotic Surgery / Robotically assisted Surgery Up to MBL (shared limit for OP and IP)
4.77 Single Incision Laparoscopy Surgery (SILS) Up to MBL (shared limit for OP and IP)
4.78 Spinal Angiogram Up to MBL (shared limit for OP and IP)
O
4.79 Stereotactic Breast Biopsy Up to MBL (shared limit for OP and IP)
Stereotactic Radiation Therapy/ Stereotactic
Radiosurgery
4.81 Supramagnetic Ion Oxide (SPIO)- enhanced MRI Up to MBL (shared limit for OP and IP)
4.82 Transarterial Hemorrhoidal Dearterialization (THD) Up to MBL (shared limit for OP and IP)
4.83 Terahertz Imaging Up to MBL (shared limit for OP and IP)
4.84 Three-Dimensional Conformal Radiotherapy (3DCRT) Up to MBL (shared limit for OP and IP)
4.85 Thyroplasty Up to MBL (shared limit for OP and IP)
4.86 Tomotherapy Up to MBL (shared limit for OP and IP)
4.87 Tractography Up to MBL (shared limit for OP and IP)
4.88 Ultrafast Electron Beam Computed Tomography Up to MBL (shared limit for OP and IP)
4.89 Ultroid Hemorrhoid Management Up to MBL (shared limit for OP and IP)
22
4.90 Vulcan EAS (Electro Thermal Arthroscopy System) Up to MBL (shared limit for OP and IP)
5. EMERGENCY CARE
Doctor services, X-Rays, laboratory and diagnostic
5.1 examinations, and other medical services related to Subject to MBL
the emergency treatment of the patient
Reimbursable up to 80% of hospital bills & professional fees
5.2 In Non-Affiliated Hospitals. based on Maxicare rates incurred during the first 24hrs. of
treatment up to P30,000/availment/member/year
Reimbursable up to 100% of actual cost up to
5.3 Outside the Philippines.
P30,000/availment/member/year
5.4 Areas without Affiliated Hospital Subject to MBL
Ambulance Service (Affiliated Hospital/Clinic to
5.5 Subject to MBL
Affiliated Hospital/Clinic).
Ambulance Service (Non-Affiliated Hospital/Clinic to
5.6 Reimbursable up to P2,500 per conduction
Affiliated Hospital/Clinic).
G
Note: The ambulance service provided herein shall be available regardless of the location within the Philippines.
6. CONDITIONS WITH SPECIFIC LIMITATIONS
Initial Treatment within 24 hours from time of bite of
6.1 Subject to MBL (except cost of vaccines)
Animal bites
Succeeding treatment after 24 hours from time of bite
6.2 Subject to MBL (except cost of vaccines)
of Animal bites
Vaccines for treatment of tetanus and animal bites
6.3 Up to P 40,000/member/year (shared limit for OP and IP)
(including administration fee but excluding ER Fees)
M
Scoliosis including necessary procedures, except
6.4 physical therapy sessions, whether congenital, Up to P60,000/member/year (shared limit for OP and IP)
pre-existing, developmental or acquired Note: Physical Therapy sessions shall form part of the
Congenital Conditions except physical therapy Physical therapy/ Occupational therapy limits
6.5
sessions and developmental disorders.
6.6 Chronic Dermatoses Consultations only
6.7 Hepatitis B except vaccines and screening Subject to MBL if acquired
O
7. COVERAGE FOR INFECTIOUS DISEASES THAT ARE DECLARED EPIDEMIC/PANDEMIC BY DOH
7.1 Pandemic declared diseases Covered up to MBL per member per year
8. ANNUAL CHECK-UP (ACU): OPTIONAL
The following Routine ACU program shall be conducted at a designated Maxicare Affiliated Clinic for Principals and
Dependents (except Healthway Medical Clinic) once a year:
8.1 Physical Examination Covered
8.2 Complete Blood Count Covered
8.3 Urinalysis Covered
8.4 Fecalysis Covered
8.5 Chest X-Ray Covered
8.6 Electrocardiogram (ECG) (Optional) For members 35 years old and above
8.7 Pap Smear (Optional) For female members 35 years old and above
23
9. GROUP LIFE INSURANCE WITH ACCIDENTAL DEATH, DISMEMBERMENT & DISABLEMENT (ADD&D)
BENEFITS-OPTIONAL
The Manufacturers Life Insurance Co. (Phils.), Inc.
9.1 Insurance Provider
(Manulife)
9.2 Death (Amount of Insurance) P50,000 up to 250,000 /member
Life and AD&D: Principal 18 to 65 years old
9.3 Age Eligibility Dependent: Spouse/ Parents: 18 to 65 years old; Children /
Children: 15 days to 23 years
10.DENTAL CARE: OPTIONAL
10.1 Dental Provider Maxicare Dental Hub
10.2 Package Standard
Procedures: Covered
a. Oral Consultation / Examination Covered
b. Oral Prophylaxis Covered - Once A Year
G
c. Simple Tooth Extraction Covered
d. Temporary Filling Covered
e. Simple Repair And Adjustment Of Dentures Covered
f. Recementation Of Jacket Crowns, Bridges, Inlay
Covered
And Onlay
g. Palliative Treatment Of Simple Mouth Sores And
Covered
Blisters
M
h. Desensitization Of Hypersensitive Teeth Covered
i. Permanent Fillings Covered - Up To Two Teeth
j. Gum Treatment For Cases Like Inflammation Or
Covered
Bleeding
k. Emergency Dental Treatment Covered
l. Oral Incision and drainage Covered
O
10.3 Other Procedures Not Covered
11. MAXICARE HOSPICASH OPTIONAL
11.1 Insurance Provider Allianz PNB Life Insurance Inc. (Allianz PNB Life)
11.2 Hospital Income Benefit (Per Day) Php 250 up to Php 5,000/member
11.3 Group Personal Accident Benefit (coverage per year) Php 5,000 up to Php 100,000/member
11.4 Eligibility Age Principal and Dependents: 0 to 65 years old
12. OTHER BENEFITS / SPECIAL INSTRUCTIONS
12.1 Other ACU Endorsements None
12.2 Routine Clinic Covered
Pre-employment is in lieu of ACU. Under Fee for Service
12.3 Pre-Employment Medical Examination (PEME)
with 13.5% Claims Handling Fee
12.4 List of Doctors Covered; Built-In
12.5 Hepatitis B (except vaccines) Acquired - Up to MBL
24
12.6 Prosthetic Devices Not Covered

13. ADDED PROGRAM FEATURES
13.1 24-Hour/7 Days a Week Customer Care Hotline √
13.2 Roving Customer Care Representative √
Manner of Access:
a. Hospitals 1000 Hospitals (65% are tertiary hospitals) and Clinics
b. Clinics
W Center BGC, Taguig
Ayala North Exchange, Makati
13.3 Bridgetowne IT Park QC
c. Maxicare Primary Care Centers
Northgate Cyberzone Filinvest, Alabang
My Health Clinics (EDSA Shangri-La, Festival Supermall,
North EDSA, Filomena Building, Calamba, Cebu)
G
d. Maxicare Centers Cebu, Bacolod, Iloilo, General Santos, Davao
e. Accredited Doctors 43,000 doctors with specializations
13.4 PayorLink System √
Applicable for Maxicare Plus Rated Small Account only with
13.5 Orientations minimum 50 Principals.
13.6 VAT Charges 12% VAT in the membership fees

M
13.7 ID Processing Fee (Initial) at no additional cost
13.8 Booklets & Summary of Coverage (SOC) 1 per principal member
14. MEMBERSHIP GUIDELINES
Age Eligibility
Principals 18 up to 65 years old
14.1
Adult Dependents 18 up to 65 years old
O
Minor Dependents 15 days old up to 23 years old
* Dependents should be the same plan or lower than the Principals, on a per level basis.
* No coverage for extended dependents.
Enrollment of dependents must follow hierarchy guidelines.
Legal spouse must be enrolled first, followed by the eldest to
a. Eligible dependents of Married employees:
the youngest child
14.2 Both parents (anyone ahead of the other) and then the
b. Eligible dependents of Single employees:
siblings (eldest to the youngest)
Children (eldest to youngest) and/ or Parents (anyone ahead
c. Eligible dependents of single parent employees:
of the other) and Siblings (eldest to the youngest)
There will be a thirty (30) days grace period to enroll their eligible dependents. Otherwise, only newly wed, newly
* born and dependents of newly regularized employees shall be considered for enrollment after the 30 days grace
period.
Overage principals shall have the following rates:
14.3
25
66-70 years old – Thrice (3X) the rate

71-75 years old – Four time (4X) the rate
76 years old and above – Not allowed to enroll
Members' Participation Requirement
100% of all eligible employees should enroll all the eligible
a. Non-contributory accounts dependents under the program or the number of dependents
should reach 75% of the total number of principals.
14.4
At least 75% of all eligible employees should enroll all the
eligible dependents under the program or the number of
b. Contributory accounts
dependents should reach 75% of the total number of
principals.
MBL on top of Philhealth. Philhealth portion not deductible to
14.5 Philhealth Integration
the member's MBL. Required to file Philhealth
Additional Philhealth fee on the onset of enrollment: Php 2,400 per Non-Philhealth member per year. For Expat
*
Members only and subject for approval
G
15. ESCALATION CLAUSE
at least 75% standard rates
60% -74.9% +10% to standard rates
40%-59.9% +20% to standard rates
Below 40% +35% to standard rates
Above escalation clause shall apply and subject to change to the following cases:
M
a. If there is a significant decrease from initial count to actual number of enrollees. Participation requirement is computed as
total number of actual enrollees divided by total number of initial count prior effectivity of the account.
b. If enrollment of dependents is open to all employees then participation requirement is below 75%. This is regardless if
account is contributory or non contributory. Participation requirement is computed as total number of eligible dependents
divided by the number of principals that has eligible dependents only.
c. If the account limits the dependents enrollment on a per rank classification, participation requirement is computed as total
number of eligible dependents divided by the total number of principals of the account
16. ENROLLMENT GUIDELINES
O
16.1 Application Forms Waived
16.2 Masterlist of Enrollees Maxicare Format
16.3 Medical Requirements* (at the applicant's account) Waived
16.4 KYC REQUIREMENTS REQUIRED
16.5 Other medical requirements if deemed necessary Waived
NOTES:
The coverage for the Special Diagnostic Procedures are subject to the recommendation of the accredited physician
1
if medically necessary and the provisions of the dreaded and non dreaded pre-existing conditions.
Above limits are inclusive of room & board, operating room charges, professional fees and other incidental expenses
relative to the procedure. The maximum benefit limit shall be inclusive of consultations, routine procedures,
2
diagnostic and therapeutic procedures and hospitalization. All procedures or benefits are subject to the limitations on
pre-existing conditions as stated in this proposal.
26
RIDERS BENEFITS AND INCLUSIONS DESCRIPTION

NO RIDER INCLUSIONS & DESCRIPTIONS
CLINIC
・to be availed at an Maxicare accredited ACU provider
・lab inclusions are Physical Examination, Chest Xray, Urinalysis, Fecalysis, Complete Blood
Count, ECG (for 35 & above) & Papmsmear (for female 35 & above)
・can be availed anytime for accounts under Annual & Semi Annual mode and only after 6 months
from effective date of the agreement for Quarterly mode of payment
・to be scheduled at least 2 weeks in advance by filling out the ACU Request Form
Annual Check up Routine ACU results are strictly for member's pick up. Member must get his/her own results. However,
1 he/she may assign an authorized representative to get the results on his/her behalf, provided that
(ClinicMobile)
Authorization Letter, Copy of the member's valid ID card and a copy of the representative's valid ID
card will be presented. The results will be given in a sealed envelope with the name of INDIVIDUAL
MEMBER. Any request for delivery should be directly coordinated with the provider.
MOBILE
G
・similar with ACU Routine Clinic except that this is done in the premises of the account
・There must be a minimum of 50 confirmed members that will avail the Mobile ACU.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.
・through Dental Hub. Availment is done through individual appointment by calling the dentist
directly
・Dental examination and consultation
・Emergency out-patient dental treatment - to be availed at accredited dental clinics only
M
・Oral Prophylaxis once a year
・Simple tooth extractions
・Restorative and prosthodontic treatment planning
・Temporary fillings
Standard Dental (1 oral ・Desensitization of hypersensitive teeth up to 2 teeth
2
propahylaxis)
・Simple adjustment and repair of dentures.
・Re-cementation of loose crowns, bridges, inlays and onlays.
O
・Permanent fillings 2 teeth
・Palliative treatment for simple mouth sores and blisters
・Open incision and drainage (intraoral)
・Pre-natal check of teeth and gums
・Temporo Mandibular Joint Consultation (Initial consult only, referral to specialist not covered)
・Gum Treatment for cases like inflammation or bleeding
The Manufacturers Life Insurance Co.
Insurance Provider
(Phils.), Inc. (Manulife)
100% of insurance/depends on the

Death (Amount of Insurance)
availed insurance plan
Manulife will pay an insured member’s designated beneficiary/ies an amount equal to his/her Basic
Life Insurance coverage in lumpsum upon the death of the covered member from ANY CAUSE
(can be covered up to 250,000
3 WHATSOEVER, except suicide on the first year of coverage.
depends on the chosen plan
type) Accidental Death & Dismemberment (ADD&D)
27
Should an insured member suffer a loss directly and independently of all other causes, any bodily
injury affected solely through external, violent and accidental means, within one hundred eighty
(180) days from the said accident, Manulife will pay such member, if living, otherwise to his/her
designated beneficiary/ies an amount equal to the benefits stated in the Schedule of Losses:
A. Schedule of Losses for ADD&D Coverage
i.) Loss of Life 100% of amount of insurance
ii.) Both hands or both feet 100% of amount of insurance
iii.) One hand and one foot 100% of amount of insurance
iv.) One hand or one foot 50% of Amount of Insurance
v.) Sight of both eyes 100% of Amount of Insurance
vi.) Sight of one eye 50% of Amount of Insurance
vii.) One hand and sight of one eye 100% of Amount of Insurance
viii.) One foot and sight of one eye 100% of Amount of Insurance
G
ix.) Hearing of both ears 100% of Amount of Insurance
x.) Hearing of one ear 50% of Amount of Insurance
xi.) Speech 100% of Amount of Insurance
xii.) All four fingers and thumb of either hand 40% of Amount of Insurance
xiii.) Whole arm 60% of Amount of Insurance
xiv.) Lower arm 50% of Amount of Insurance

M
xv.) Whole leg 50% of Amount of Insurance
xvi.) Lower leg 40% of Amount of Insurance
xvii.) Thumb 20% of Amount of Insurance
xviii.) Fingers of one hand
- Index finger 10% of Amount of Insurance
- Middle finger 5% of Amount of Insurance

O
- Ring finger 3% of Amount of Insurance
- Little finger 2% of Amount of Insurance
xix.) Toes of one foot
- All 10% of Amount of Insurance
- Big toe 5% of Amount of Insurance

- Any toe other than big, each 1% of Amount of Insurance
Note: Loss of hands and feet shall mean dismemberment by severance at or above the wrist or
ankle joints respectively; loss of eyesight should be total and irrecoverable.
Conversion privilege
A member whose insurance coverage terminates due to separation from employment, has the
privilege of converting his/her individual Group Term coverage to an Individual Permanent plan
without having to submit any evidence of insurability subject to the following conditions:
28
The written application for the individual policy and the first premium payment for such were made
within thirty-one (31) days from date of separation.
The individual policy selected shall be any plan customarily issued by Manulife Philippines except
term and other supplemental plans.
The sum assured on the individual policy must not be more than the amount on the member’s life
insurance that was terminated and must not be less than the minimum required by Manulife for the
plan selected.
The premium rate on the individual policy applied for shall be based on the company’s rate
applicable to both the class of risk to which the member belongs and his/her then attained age.
The policy will become effective at the end of 31 days after the date of termination of the member’s
employment.
Free Insurance Coverage
A member whose coverage terminates is covered for an additional thirty-one (31) days from date of
termination of membership, free of charge, whether or not he/she avails of the conversion privilege.
Termination
This benefit will automatically terminate on the first of the following events:
G
The date of termination of the group master policy.
Non-payment of premiums beyond the grace period.
The policy anniversary immediately following the 66th birthday of the employee/spouse/parent and
22nd birthday of the child/sibling.
The date a member becomes ineligible.
Exclusions
M
No benefit shall be made for any loss resulting from or caused by:
· Suicide or intentionally self-inflicted injury or any similar attempt whether sane or insane, or
· Any drug, poison, gas or fumes, voluntarily or otherwise taken, administered, absorbed or inhaled
other than or as a result of an accident arising from a hazard incident to the member’s occupation,
or
· War or any act incident to war, whether declared or undeclared, or
· Riot, civil commotion or insurrection, or
· Travel or flight in or descent from any aircraft, if the insured person is a member of the crew or a
O
pilot of the aircraft, or if the flight is made for instructional or training purposes, or
· Travel or flight in or descent from any aircraft of military, naval or air force, or
· Murder, or
· Provoked assault or participation in an assault or brawl, or
· Any violation or attempt of violation of the law or resistance to arrest.
General Guidelines
A. Eligibility Age
Life with AD&D
Principals 18-65 years old
All active, regular and full time employees, and are in good health at the inception of the policy,
shall be eligible for coverage under the plan. Future full time employees shall be enrolled upon
eligibility
29
If an enrolled person is an employee, and if, on account of injury or disease, the enrolled person is
not actively working in full-time employment on the date his insurance would otherwise become
effective as provided above, the insurance shall not become effective until the date such person
returns to full-time active work for a continuous period of 30 days.
“Full-time employment” means employment on a regular schedule of at least thirty hours per week,
at his employer’s regular place of business or other location where his employer’s business
specifically requires him to be in performance of such work.
Spouse/Parent 18-65 years old

Children/Sibling Not more than 21 years old
B. Eligible Dependents
Legal spouse and Children who are in

i.) Dependents of Married employees good health at the inception of the
policy.
Parents and siblings who are in good

ii.) Dependents of Single Employees
health at the inception of the policy.
G
Children and Parent/Siblings who are
iii.) Dependents of Single Parent Employees in good health at the inception of the
policy.
Note: Coverage and exclusions shall still subject to the terms and conditions of the Insurance
provider.
1. Daily Hospital Income Benefit – provides a daily cash benefit for everyday of hospitalization due
to accident or illness
M
Daily Hospital Income Benefit is covered up to:
a. 30 days per hospital confinement or per illness or accdent
b. 60 days per year
2. Group Personal Accident Benefit – Covered, both applicable for accidental death or accidental
dismemberment or disablement.
Eligibility:
O
Boxed Type Products for Small Medium Enterprise (SME): 18 up to 65 years old
4 Hospicash Plan Limitations and Hierarchy of Benefits:
a. Standard hierarchy of Benefits shall apply wherein order of benefits should be superior
according to their rank classification.
b. Rank and file members can be covered for a Maximum Daily Hospital Income Benefit of 2,000
pesos.
c. A rank above Rank and File up to Managers can be covered for a Maximum Daily Hospital
Income Benefit of 3,000.
d. The classification or Rank of the members., e.g Rank and File, Managers, Officers, shall follow
the declaration of the clients of Maxicare that they are classified to have such rank.
3. Exclusions and Limitations:
Subject to the list of exclusion indicated on the contract per account
30
The Philippine American Life &

Insurance Provider General Insurance Company (Philam
Life)
100% Amount of Insurance / depends
Cancer Benefit
on the plan
Death Benefit
i.) If not diagnosed as terminally ill Php20,000/member
ii.) If diagnosed as terminally ill Php10,000/member
Terminal Illness Benefit Php10,000/member
Definition of Terms
Cancer - the occurrence of a histologically confirmed invasive malignant tumor involving the spread
of malignant cells. Spread of malignant cells means spread of malignant cells to lymph nodes or
distant parts of the body which is also known as metastatic stage. This criterion must be satisfied if
cancer is diagnosed within the 7th to 24th month of coverage; but this criteria is not required if the
cancer is first diagnosed after the Contract has been in force for two (2) years from the Effective
Date or the latest date of any Reinstatement, whichever is the latest. Any stage of cancer is
qualified for coverage on the 25th month and onwards.
G
Cancer Benefit – the lump sum amount to be paid to the Member if the Member is diagnosed by an
accredited physician to have contracted a cancer illness after the waiting period.
Death Benefit - the amount to be paid to the beneficiaries of the Member if the Member dies while
still a member of Maxicare.
Terminal Illness Benefit – portion of Death Benefit that will be advanced in lump sum to the Member
if the Member is medically diagnosed as terminally ill with a life expectancy of twelve (12) months
or less.
Cancer Benefit (can be Waiting Period – refers to the length of time after the member’s effective date within which Cancer
Benefit is not payable to the Member.
M covered up to 1,000,000
5
depends on the chosen plan No Evidence Limit (NEL) – is the limit within which no evidence of insurability will be required. If
type) coverage is beyond this limit, then a health statement will be required and from the declarations on
this health statement, shall assess if medical examinations will be required.
Waiting Period
Cancer illness diagnosed after member’s effective date shall be payable in accordance to the
following waiting period:
i.) Cancer is diagnosed to be in metastatic stage after one hundred eighty (180) days from
member’s effective date; or
O
ii.) Cancer is diagnosed in any stage after two (2) years from member’s effective date or latest
reinstatement date.
No Evidence Limit (NEL) is Php1,000,000
For any amount of insurance in excess of NEL, proof of good health must be submitted (i.e.
accomplished Health Statement, Medical exam).
Eligible Members
Principals 18-65 years old
(regular, full time and actively at work)
Actively performing daily normal chores with standard occupational risk up to Class B medical
rating.
Spouse/Parent 18-65 years old
Children/Sibling 5 - 21 years old
Eligible Dependents
31
Legal spouse who are actively

performing the daily normal chores of
i.) Dependents of Married employees
life and fully dependent on the
principal for support
Children who are unmarried, actively
Parents who are actively performing
the daily normal chores of life and and
ii.) Dependents of Single Employees
fully dependent on the principal for
support
Siblings who are unmarried, actively
Children who are unmarried, actively
iii.) Dependents of Single Parent Employees principal for support and/or Parents
G
who are actively performing the daily
normal chores of life and fully
dependent on the principal for support
Siblings who are unmarried, actively
Exclusions
Cancer Benefit shall not be payable under the following circumstances:
M
i.) Diagnosed cancer/tumor is of the following nature:
a. Tumors treated by endoscopic procedures alone;
b. Tumors classified as carcinoma in situ;
c. Prostate tumors classified as T1 (TNM classification system);
d. Malignant melanomas other than those greater than 1.5 mm in depth;
e. Other skin cancers;
f. Tumors that are a recurrence or metastases of a tumor that first manifested within the
O
Waiting Period;
g. Kaposi’s Sarcoma;
h. Other tumors associated with Human Immuno-Deficiency Virus (HIV) infection; and
i. Tumors that pose no threat to life and for which no treatment is required.
ii.) Pre-existing conditions are excluded within the first twelve (12) months of a Member’s coverage.
Pre-existing conditions are conditions for which the Member received treatment, diagnosis,
consultation or prescribed drugs in the six (6) months preceding Member’s effective date.
iii.) Any illness or surgery, other than a diagnosis of, or surgery for cancer.
iv.) Cancer was diagnosed prior to, or within one hundred eighty (180) days following the Effective
Date or the latest date of any reinstatement of the respective Member whichever is later.
v.) If the Member seeks medical advice or treatment for any signs or symptoms for such illness
which, based on the findings of Philam, first manifested or occurred prior to, or within one hundred
eighty (180) days following the Effective Date of Coverage or the latest date of reinstatement of the
respective Member whichever is later.
vi.) Cancer which was diagnosed due, directly or indirectly, to a congenital defect or disease which
has manifested or was diagnosed before the Member reached seventeen (17) years of age.
32
vii.) Cancer caused directly or indirectly, wholly or partly, by

a. self-inflicted injury; or
b. addiction to alcohol or drugs not prescribed by a medical doctor; or
c. while under the influence of alcohol or unprescribed drugs; or
d. atomic or nuclear radiation; or
e. Acquired Immunodeficiency Syndrome (AIDS) or Human Immunodeficiency Virus(HIV); or
f. pregnancy and resulting childbirth, miscarriage or abortion; or
g. cosmetic or plastic surgery, except as a result of injury; or
h. war or any acts thereof; or acts of terrorism; or
i. homicide, frustrated homicide or any attempt thereof, or physical injuries; or
j. automobile and motorcycle racing, judo, karate and similar martial arts, scuba diving,
hang-gliding and sky gliding.
Note: Coverage and exclusions shall still subject to the terms and conditions of the Insurance
provider.
G
Female Employees (Married or
Covered Members Single/Married only) and Spouse of
Male Employees
Maxicare shall cover the hospital bills and professional fees incurred by covered Member for
maternity services/procedures, up to the following limit:
Normal Delivery Php5,000

Caesarian Php10,000
Miscarriage and Abortion Php5,000
M
Maternity Benefit (must have LOA-facilitated if availed within the
6 20 Minimum female enrollees network; and shall be on
to avail) reimbursement basis based on actual
Type of Availment
amount and subject to above
mentioned limits if availed outside the
network
Philhealth benefits On top of Maternity Limit
280 days Waiting Period Not Applicable
Laboratory procedures/work-ups Not Covered
O
For availments in Accredited Hospitals but with Non-Accredited Physicians, Maxicare shall provide
outright coverage for the hospitals bills and the professional fees of Non-Accredited Physicians
shall be on a reimbursement.
Insurance Provider Assist America Asia Limited

Worldwide Travel Assistance Covered
7 International Assistance Medical Necessary Expenses (Sickness and Accident) Php1,000,000

Emergency Medical Evacuation and Repatriation of Mortal
Remains Php1,000,000
Personal Accident Php250,000
・can only be availed at the chosen ACU Provider at the onset of the agreement
・member has to choose a specific date at least 2 weeks in advance by filling out the ACU Request
Semi Executive Check Up Form
8
Outpatient
・Lab tests may include the following. Actual lab tests at the time of availment may vary depending
on the provider:
33
Physical Examination
Urinalysis
Fecalysis
Chest X-ray
CBC (Complete Blood Count)
Blood Chemistry (FBS, SGPT, Cholesterol, Creatinine, Uric Acid)
12-Lead ECG
Papsmear
・can only be availed at the chosen ACU Provider at the onset of the agreement
・member has to choose a specific date at least 2 weeks in advance by filling out the ACU Request
Form
・Lab tests may include the following. Actual lab tests at the time of availment may vary depending
on the provider:
Physical Examination
G
Routine Urinalysis
RoutineFecalysis
Executive Check Up Chest X-ray
9
Outpatient
Blood Chemistry (Fasting Blood Sugar, Potassium,
Creatinine, SGOT/AST, Alkaline Phosphatase, Total Protein, Albumin, Calcium, uric Acid, BUN,
Total Bilirubin, Sodium, Chloride/CO2 and Cholesterol)
M
Ultrasound of Kidney: Renal Sonogram
Cardiac Work-up: 12 Lead ECG, Treadmill Stress Test
Abdominal Work-up: Ultrasound of Liver, Gallbladder and Pancreas
Pap Smear (slides) for female members regardless of age
Blood Chemistry (Fasting Blood Sugar, Potassium,
Total Cholesterol HDL, LDL, VLDL Cholesterol, Triglycerides, Urea, Creatinine, SGOT (AST),
SGPT (ALT), Alkaline Phosphatase, Total Bilirubin, Total Protein, Albumin, Globulin, Calcium, Uric
O
Acid)
Thyroid Function: TSH-IRMA
Hepatitis Screening: HBsAG, Anti-HBs
Routine Urinalysis
Routine Fecalysis
10 Executive Check Up Inpatient
Cardiac Work-up: 12 Lead ECG; Treadmill Stress Test
Chest X-Ray
Abdominal Work-up: Upper Gastrointestinal series or
Barium Enema, Ultrasound of Liver, Gallbladder &
Pancreas, Proctosigmoidoscopy_
Pap’s Smear for female members regardless of age
Prostate Ultrasound for male members regardless of age
Consultations to a Gastroenterologist,Gynecologist/Urologist and Cardiologist
34
30-45 min lecture
11 Wellness Session Conducted at the premises of the account by a Maxicare accredited doctor
Topic to be chosen by the account
EXCLUSIONS AND LIMITATIONS PROVISIONS
Notwithstanding any provisions to the contrary, the following shall not be covered:
a. Non-Affiliated Physicians in non-Affiliated Hospitals
1 b. Non-Affiliated Physicians in Affiliated Hospitals Not covered
c. Affiliated Physicians in non-Affiliated Hospitals or other non-Affiliated healthcare facility.
Additional hospital charges and physician’s professional fees resulting from:
a. Room-upgrading beyond Member’s allowable time during emergency care
G
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
2 items are necessarily and ordinarily included in the Member’s Room & Board Accommodation Not covered
e. Extra food
M
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. Not covered
O
Long-term rehabilitation and psychiatric care and/or psychological illnesses and conditions including
4 Not covered
neurotic and psychotic behavior disorders; anxiety disorders.
Treatment for injury and its complications resulting from self-inflicted injuries including infections as a
5 result of tattoos, piercing of the ear or in any body part, whether self-inflicted or done by a third party Not covered
or attempted suicide or self-destruction, whether sane or insane.
Developmental disorders including functional disorders of the mind, such as but not limited to
6 Attention-Deficit Disorder (ADD)/Attention-Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Not covered
Disorders, Central Auditory Processing Disorder (CAPD), and Mental Retardation
Treatment of any injury received when there is:

a. Negligence
b. Unauthorized use of prohibited drugs or regulated drugs
7 c. Alcoholic liquor intake Not covered
d. Direct or indirect participation in the commission of a crime whether consummated or not

e. Violation of a law or ordinance
35
f. Unnecessary exposure to imminent danger, knowingly or unknowingly or hazard to health, by the

member
Note: Maxicare shall be given a copy 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.
Aesthetic, cosmetic and reconstructive surgery or any consultation or treatment for any beautification
8 purposes except if necessary to treat a functional defect due to accidental injury within the initial Not covered
confinement.
Oral surgery following accidental injury to teeth for purposes of beautification.
Dental examinations, extractions, fillings, other dental treatment and their complications except to the
9 extent that are medically necessary for repair or alleviation of damage to the Member caused solely Not covered
by an accident.
Medical care resulting from any dental related conditions.
G
Maternity care and all other conditions (except pre and post natal consultations) related to and/or
10 resulting from pregnancy and/or delivery which affect the conditions of the Member and the unborn Not covered
child.
Circumcision (except for treatment of urological conditions), sex transformation, diagnosis, treatment
11 and procedures related to fertility or infertility, artificial insemination, sterilization or reversal of such Not covered
and their complications.
12 Experimental medical procedures and its complications. Not covered
13 Acupuncture, chirotherapy and other forms of therapies and its complications. Not covered
M
All expenses incurred in the process of organ donation and transplantation if the Member is the donor
14 Not covered
of such donation or transplantation, and its complications.
Routine physical examinations required for obtaining or continuing employment, requirement in

15 Not covered
school, insurance/travel or government licensing, health permit and other similar purposes
Purchase or lease of any medical equipment, oxygen dispensing equipment, and oxygen except
16 Not covered
during covered in-patient care
O
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,
17 vascular grafts, titanium thread, myringotomy tube, intravascular catheters, vascular stents, bone Not covered
screws/plates, pins, wires, balloons, orthopedic internal fixator/fixation systems, orthopedic external
fixator or fixation systems, intraocular lens, braces, crutches
Take-home medicine and out-patient medicine except

18 ● Anti-neoplastic chemotherapy medicine (except for cancer treatment) Not covered
● Medicine administered during an emergency treatment.
19 Congenital, genetic and hereditary diseases and their complications (except for hernias) Not covered
20 All physical deformities prior to enrollment Not covered
Treatment of injuries/illnesses caused directly or indirectly by engaging in any professional sport or
hazardous activity such as but not limited to scuba diving, surfing, water skiing, mountain climbing,
21 Not covered
rock climbing, mountaineering, parachuting, airsoft, drag racing, paintballing, wakeboarding and
bungee jumping, except for activities under company-sponsored sports activities.
22 Injuries resulting from direct participation in riots, strikes, and other civil disturbances. Not covered
36
Treatment of injuries or illnesses resulting from war or any combat-related activities while in military
23 Not covered
service.
24 Sexually transmitted diseases, genital warts, AIDS and AIDS related diseases Not covered
25 Treatment for chronic dermatoses (except consultations) Not covered
26 Pre-existing Hepatitis B and screening and vaccines for all types of Hepatitis. Not covered
Benefits covered by PhilHealth and all other government funded healthcare entitlements as provided
27 Not covered
for by law.
28 Speech therapy for developmental and congenital diseases Not covered
Weight reduction programs, surgical operation or procedure for treatment of obesity, including gastric
29 Not covered
stapling or balloon procedures and liposuction.
30 Cost of medico-legal cases Not covered
Routine medical examination or check up or medical examination for employment or medical
31 Not covered
examination for travel
32 Intravenous Immunoglobulin (IVIG). Not covered
G
Treatment of work-related injuries of high-risk occupations such as but not limited to construction
33 Not covered
workers, miners, loggers and drillers.
34 Cost of the medical services and professional fees in excess of the MBL. Not covered
Notes & Special Reminders:
● Rates are only applicable for virgin accounts or those with no previous enrollment with Maxicare. A separate
proposal will be drafted upon submission of requirements for quotation.
M
● Rates and benefits are valid until December 31, 2022 and based on a 12-month coverage only. Rates for Starter
Plan are valid until September 30, 2022.
● Rates presented are inclusive of 12% VAT. For VAT Exempt companies, they must present a PEZA Certicate to be
exempted for VAT
● Maxicare must receive the signed Conforme, final masterlist, other enrollment requirements and payment of the
total amount due on the Statement of Account (SOA) at least five (5) calendar days from intended effective date of
coverage.
● Payment first before activation of account/effectivity of membership
● Effectivity date both for Starter and MaxiPlus account shall be 3 working days after OR date. ID numbers will be sent
once account has been activated. Delivery of ID Kits may take 10-15 days from effectivity date.
O
● ACU Annual Check up can only be availed at designated ACU Providers
● Enrollment of Dependents must follow hierarchy
● There will be a 30 days grace period from the date of effectivity to enroll their eligible dependents. Otherwise, only
newly wed, newly born, and dependents of newly regularized employees shall be considered for enrollment after 30
days grace period. If the account did not enroll dependents at the onset, account will not be allowed to enroll
dependents in the middle of the coverage. Enrollment of dependents will only be accommodated upon renewal.
● Rated rates will apply to companies whose nature of business falls under Rated Industries. Companies whose
nature of business falls under Ineligible will not be allowed to enroll under this program. A separate proposal will be
drafted upon submission of requirements for quotation.
● In case an extraordinary inflation or deflation of the Philippine Peso should supervene during the term of this
agreement, Maxicare shall be authorized to adjust the Membership fees accordingly or shall be released in whole or
in part, from performance of its obligation, when such has become so difficult on its part as to be manifestly beyond
that contemplated in this Agreement. Extraordinary inflation or deflation shall be conclusively presumed to have
supervened if the exchange rate of the Philippine Peso to the U.S. Dollar should change by more than twenty-five
percent (25%) during any twelve (12) month period.
● In case accredited hospitals increase their rates by more than thirty percent (30%), Maxicare shall be authorized to
adjust the membership fees accordingly or exclude such accredited hospital where a Member can seek medical
services from, according to the option chosen by the Client. In this circumstance, Maxicare shall notify the Client in
writing at least fifteen (15) days from effectivity of membership fee adjustment or exclusion of such accredited
hospital.
37
● All terms not mentioned are assumed to be based on Maxicare standard provisions.
G
M
O
38
PRE-EXISTING CONDITIONS
Such dreaded conditions are as follows, but not limited to:

a. All malignancies (including indicated chemotherapy or radiotherapy)
b. Arthritis
c. Blood Dyscrasias such as but not limited to Leukemia, Idiopathic
Thrombocytopenic PurpuraLymphoma
d. Chronic Cardiovascular Diseases and its complications such as but not limited
to Uncontrolled Hypertension of whatever etiology, Aortic Dissection, Abdominal
Aortic Aneurysm, Myocardial infarction, Cardiac Arrest, Congestive Heart Failure,
Cardiac Arrhythmia, Cardiac Tamponade, Coronary Artery Disease,
Cardiomyopathies and Valvular Heart Disease except Mitral Valve Prolapse, Aortic
Dissection, Abdominal Aortic Aneurysm and Peripheral Vascular Disease and its
complications such as but not limited to Buerger’s Disease
e. Chronic Glomerulonephritis
f. Cataract and Glaucoma
G
g. Cerebrovascular Diseases such as but not limited to Stroke, Cerebral,
Cerebellar, Thrombosis, Embolism and Ruptured aneurysm and all Intracranial
Hemorrhage and related conditions
h. Cholecystolithiasis and Choledocholithiasis
i. Chronic Endocrine Disorders and its complications such as but not limited to
Dyslipidemia, Obesity, Diabetes Mellitus, Hormonal Dysfunctions excluding
surgical treatment/procedures for obesity
j. Chronic Gastrointestinal Diseases such as but not limited to Irritable Bowel
M
DREADED CONDITIONS Syndrome, Crohn’s disease
k. Chronic Genito-urinary Disorders
l. Chronic Kidney Disease/Failure & its complications
m. Chronic Liver Parenchymal Diseases such as but not limited to Liver Cirrhosis,
Chronic hepatitis, Non-alcoholic Fatty Liver Disease/Steatohepatisis (NASH),
Newgrowth
n. Chronic Pulmonary Diseases such as but not limited to Bronchial Asthma,
Chronic Obstructive Pulmonary Disease (COPD), emphysema, and other chronic
O
lung disease
o. Collagen Vascular/Connective Tissue/Immunologic Disorders such as but not
limited to Systemic Lupus Erythematosus and its complications
p. Complications of immuno-compromised clinical conditions except HIV/AIDS
q. Extrapulmonary Tuberculosis including Pott’s disease and Multi-Drug

Resistance Case (MDR) case
r. Multiple Organ Failure
s. Muscular Dystrophies such as but not limited to Duchenne, Becker, limb girdle,
facioscapulohumeral, myotonic, oculopharyngeal, distal, and Emery- Dreifuss
t. Neuro-surgical interventions and/or major neurological diseases such as but not
limited to Poliomyelitis/Meningitis/Encephalitides, Demyelinating Neurologic
diseases and its complications/sequelae and Peripheral Nervous Ssystem
Disorders/disease;Neurosurgical conditions: brain tumors, arteriovenous fistula,
aneurysm and other
39
u. Previous craniotomy sequelae

v. Slipped disc
w. Spinal Stenosis
x. Thyroid Dysfunctions due to disease of thyroid such as but not limited to
Hypothyroidism and Hyperthyroidism
y. Any illness other than above which would require Critical Care/Intensive Care
Unit (ICU) Confinement
z. All complications resulting from above list of conditions
Such non-dreaded conditions are as follows, but not limited to:
a. All benign tumors, except those causing compression and obstructive
symptoms or complications
b. Anal Fistulae
c. Cervical Polyps (if benign biopsy)
d. Conjunctivitis (except chemical, complicated)
G
e. Endometrioses/Controlled Dysfunctional Uterine Bleeding (except if caused by
uterine malignancies)
f. Hearing Impairment
g. Hemorrhoids
h. Uncomplicated Hepatitis A
i. Gastritis, Duodenitis or Uncomplicated Gastric / Duodenal Ulcer
M
NON-DREADED CONDITIONS j. Inactive Pulmonary Tuberculosis
k. Migraine
l. Non-surgical Ear-Nose-Throat conditions such as but not limited to Sinusitis,
Rhinitis, Tonsillopharyngitis, Laryngitis, Parotitis,
Otitis Media, Otitis Externa and Surgical Ear- Nose-Throat conditions such as but
not limited to Tonsillectomy, Nasal Polypectomy, Tympanoplasty, Sialolithotomy,
Sialodochoplasty.
m. Non-Toxic Goiter (if uncomplicated)
O
n. Ovarian cysts Uncomplicated Cholecystitis, Cholelithiasis
o. Uncomplicated Hernias (Congenital Hernia will have coverage as listed in the
Congenital Clause)
p. Uncomplicated Hypertension
q. Uncomplicated Urinary Tract Infection, Stones/Calculi
r. Urinary Incontinence
40
List of Providers
You may download the lists of providers at these links or request these from us.
DOCUMENT TINYURL LINK

List of Hospitals & Clinics https://tinyurl.com/accreditedhospitalsandclinics
List of Doctors https://tinyurl.com/accrediteddoctors
List of Dental Providers https://tinyurl.com/accrediteddentalproviders
List of ACU Annual Check Up Providers https://tinyurl.com/accreditedacuproviders
RATED & INELIGIBLE INDUSTRIES

Industries not listed as either Rated and Ineligible will fall under Standard Industries and will enjoy the Standard rates
presented in this proposal. Rated Industries will will have an additional 20% on top of the standard rate while Ineligible
Industries will have to submit some requirements for quotation before a proposal can be submitted.
CATEGORY INDUSTRIES
G
Construction (Combined – Regardless of the number of office based and non office based)
Non-Government Organization (NGO)/Cooperative/Association/Foundation/Religious group – Note:

Annual mode of payment and payment first provision applies and must be KYC supported. There
should be an employee-employer relationship. ONLY employees and their dependents are allowed to
enroll.
Protection Services – Security Guards/Security Agency Note: Security Guards – Industry tagging in
Rated BIR 2303 is agency, will under this category.
M
Education (except pre schools, tutorials & review centers)
Media – Note: Advertising, Events Management Services and Printing & Publishing are not
considered part of Media.
Pharmaceuticals (Manufacturing)
Sauna, Turkish bath, massage parlors (except spa, salons)
Government Institutions/Government Agency
Groups involving special hazards
O
Manufacturers of Ammunitions or explosive
Medical Groups or any healthcare related services (except Veterinary services) Note: Manpower –
Ineligible
offering Medical/healthcare related service may fall under this category
Political groups
Private households
Protection services (e.g Military Groups) except Security Guards/Security Agency
41
INELIGIBLE INDUSTRIES
This proposal is not applicable to companies who fall under the list of Ineligible Industries. Requirements must be submitted
for quotation before a proposal can be submitted.
INELIGIBLE INDUSTRIES WITH LESS THAN 100 EMPLOYEES

Requirements for Quotation:
All Ineligible Industries mentioned
1. minimum of 20 employees enrolling
2. Signed Maxicare Prospective Account Form. You may download the form at http://tinyurl.com/maxicarepcaf
3. BIR 2303
4. Filled out Corporate Enrollment Sheet (found at the last 3 pages of this initial proposal)
HOW TO SUBMIT THE REQUIREMENTS:
(Via Email) You may scan the document and email it back to us.
G
COMPANIES & INDUSTRIES WITH 100 EMPLOYEES & UP
This proposal is not applicable to companies who have more than 100 employees. Requirements must be submitted for
quotation before a proposal can be submitted.
ALL COMPANIES & INDUSTRIES WITH 100 EMPLOYEES & UP (OR EMPLOYEES AND DEPENDENTS IF
COMBINED REACHES 100)
M
Mandatory Requirements to Generate a Pricing Proposal:
All companies with 100 employees & up
1. Signed Maxicare Prospective Account Form. You may download the form at
https://tinyurl.com/maxicarecorpaccountform
2. Excel Softcopy of Company Masterlist (with birthdates or age, gender, ranks/classification)
3. Terms of Reference
O
HOW TO SUBMIT THE REQUIREMENTS:
(Via Email) You may scan the document and email it back to us.
42
PLAN TYPES FOR EMPLOYEES
The following enrollment set up can be applied when choosing a plan type for all the employees. Note that the enrollment set up cannot be modified in the middle
of the coverage. Creation of additional plan types not chosen at the onset is not allowed.
1.) Same Plan for all Employees regardless of rank classification (eg. Everyone under Gold 3 Plan)
Example:
Level Employees Plan Type Comments
Executives Gold 3
Managers Gold 3 Uniform plan for all employees
Staff Gold 3
2.) Different Plan Types. Higher Positions must have higher plans. Lower Positions must have lower plans. Employees with the same position must have the
same plan type.
Example:
Level Employees Plan Type Comments
Executives Platinum 1
Managers Gold 1
Choosing different plan types must be consistent
Staff Silver 1 with respect to the rank/level.
G
PLAN TYPES FOR DEPENDENTS
Dependents’ enrollment is optional. If the client did not enroll any dependents at the onset, enrollment of dependents will only be entertained during renewal.
a) Same Plan for the dependents and employees

Level Employees Plan Dependents Plan Type Comments
Type
Executives Platinum 1 Platinum 1 Same plan with employee
Managers Gold 1 Gold 1 Same plan with employee

M Staff Silver 1 Silver 1 Same plan with employee
b) 1 plan lower based from the plan type assigned to each rank classification

Type
Executives Platinum 1 Platinum 2 1 plan lower from Platinum 1
Managers Gold 1 Gold 2 1 plan lower from Gold 1
Staff Silver 1 Silver 2 1 plan lower from Silver 2

O
c) The dependents’ plan for all dependents can be the same plan with that of the lowest plan assigned to the employees

Type
Executives Platinum 1 Silver 1 Silver 1 is the lowest plan assigned to the

employees
Managers Gold 1 Silver 1
Staff Silver 1 Silver 1
d) The dependents’ plan for all dependents can be the same plan 1 plan lower (only) with that of the lowest plan assigned to the employees

Type
Executives Platinum 1 Silver 2 Silver 2 is 1 plan lower from the lowest plan of the
employee
Managers Gold 1 Silver 2
Staff Silver 1 Silver 2

Escalation Clause: Should there be a significant decrease in the number of enrollees per membership type and/ or did not meet the existing participation
requirement in enrolling of eligible dependents, the following adjustment clause shall apply:
43
at least 75% standard rates
60% - 74.9% + 10% to standard rates
40% - 59.9% + 20% to standard rates
Below 40% + 35% to standard rates
KYC REQUIREMENTS FOR EMPLOYERS
1. SEC Certificate
2. Articles of Incorporation
3. General Information Sheet
4. Photocopy of at least one (1) valid Government issued ID of owner/authorized signatory (Drivers,
GSIS-E Card, Passport, Philhealth, PRC, SSS, TIN, UMID, Voter's)
ADDITIONAL REQUIREMENTS FOR SPECIAL CASES:

A. If Signatory is not the President / CEO or the highest ranking officer, any of the following as proof
of authority to sign in behalf of the entity:
CORPORATIONS AND ORGANIZED
G
i. Board Resolution duly certified by the Corporate Secretary
UNDER FOREIGN LAWS
ii. Notarized Appointment Letter
iii. Special Power of Attorney or similar document
B. For entities registered outside of the Philippines:
i. similar documents and/or information shall be obtained duly authenticated by the Philippine
Consulate where said entities are registered
C. For companies that are VAT Exempt or Zero Rated:
M
i. Philippine Economic Zone Authority (PEZA) and/or Board of investments (BOI) certificate / VAT
Exemption Certificate
ii. BIR Certificate of Registration (Form 2303)
1. SEC Certificate
2. Articles of Partnership
O
PARTNERSHIPS
C. For companes that are VAT Exempt or Zero Rated
NON GOVERNMENT ORGANIZATIONS /
1. Certificate of Registration issued by Cooperative Development Authority (CDA)
COOPERATIVES
44

C. For companes that are VAT Exempt or Zero Rated:
G
2. DTI Certificate

A. If Signatory is not the President / CEO or the highest ranking officer, proof of authority to sign in
M behalf of the entity
SOLE PROPRIETORSHIP
i. Notarized appointment letter
ii. Special Power of Attorney or similar document
B. For companies that are VAT-Exempt or Zero-Rated
i. Philippine Economic Zone Authority (PEZA) and/or Board of investments (BOI) certificate
ii. BIR Certificate of Registration (BIR 2303)

O
KYC REQUIREMENTS FOR EMPLOYEES & SUBSEQUENT ADDITIONS
a. BIR 1604 / Alphabetical List (latest with stamped received by the BIR), or
b. Philhealth Remittance Report with Payment Receipt/ePAR (Generation date must not exceed 3
months from the date of enrollment)
c. Philhealth Members Data Record (Generation date must not exceed 3 months from the date of
Employees (any of the following) enrollment)
d. SSS R3 with Special Bank Receipt (SBR) or screenshot of the online facility that shows details of
payment (employer name/SSS employer ID, month covered, amount paid, paymenr ref no. Matched
with SSS) -Generation date must not exceed 6 months from the date of enrollment
Board Members a. Latest General Information Sheet and/or Articles of Incorporation

Consultants a. BIR Form 2307
a. Alient Employment Permit Issued by DOLE (required); or
Foreign Nationals (Expats) b. Photocopy of Alient Certificate of Registration Identity Card issued by BIR
c. BIR 2307
45
Note: The above mentioned KYC Requirements for Employees are the only acceptable KYCs. Other documents such as payslips, employment
contracts, company IDs etc are not allowed
ENROLLMENT PROCESS STEP BY STEP

Client submits the Maxicare enrollment sheet (Masterlist & Info sheet) together with the Bir 2303 and
1
Valid Id of the Signatory.
2 Maxicare will send Conforme for signature of the Signatory through email.
3 Client will send back through email the Signed Conforme together with the KYC requirements.
G
4 Maxicare will send SOA within 5-7 working days from the receipt of complete documents.
Client will settle the SOA at an accredited payment center and will send a copy of the payment slip to
5
Maxicare.
Maxicare will issue a copy of O.R once payment has been validated and will activate the membership
6 after 3 working days after the issuance of the Official Receipt. The client will receive their ID numbers
via email and may already use the benefit.
M
7 Maxicare will send the ID kits to Client after 10-15 calendar days from the effective date.
8 Maxicare will send a hard copy of Service Agreement for signatute of Client.
9 Client will send back the Signed Service Agreement to Maxicare.

O
Payment Provision & Effective Date
STARTER GROUP SMALL
Payment Provision Payment First
Annual and Semi Annual, Semi Annual &

Mode of Payment Annual & Semi Annual
Annual Only Quarterly
Billing Schedule Within 5-7 working days upon receipt of complete documents and signed conforme
Plan Effective Date 3 working days from O.R. issuance
ID Kits Delivery 10-15 Days from the effectivity date
46
ENROLLMENT FORM
CONSENT FORM
By accomplishing the Maxicare Client Information Sheet you agree to the following: You freely, knowingly, voluntarily give
your consent, in accordance with Republic Act No. 10173, otherwise known as the “Data Privacy Act of 2012”, its
Implementing Rules and Regulations, and related issuances of the National Privacy Commission (“Data Privacy Laws”) to
Maxicare, its affiliates, subsidiaries, parent company, service providers and third party providers (“Representatives”),
G
to:Obtain, collect, examine, process, and store copies of your personal information, including sensitive personal information,
privileged information, or any other information that is necessary for the processing of your response. Except as otherwise
stated hereon, any information obtained relative to the authority herein given shall be strictly confidential. The extent of the
processing of the Personal Data shall be limited to what is necessary, appropriate or incidental to the Declared
Purpose.Process Disclose such information to Maxicare and its Representatives, 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"), 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 you to effectively administer or manage your account, enhance customer
M
services, or to communicate with you for any marketing purposes. Processing is hereby understood to include any operation
or any set of operations performed upon personal information organization, storage, updating or modification, retrieval,
including, but not limited to, the collection, recording, consultation, use, consolidation, blocking, erasure or destruction of
data. Processing would include both manual and automated handling of personal information and storage and data transfers
using various means including but not limited to physical methods as well as electronic via information and communications
systems employed by Maxicare and its Representatives. You acknowledge and understand that Maxicare has security
measures in place that will ensure that personal and sensitive data are safeguarded and protected against loss, unauthorized
access, destruction, modification, leakage, and disclosure. You hereby warrant that you understand your rights and
obligations pursuant to the Data Privacy Act and its implementing rules and regulations. You understand that you retain the
right to be informed, to object, access, erasure or blocking and rectify, to request for filtering of certain information, and to the
corresponding damages in case of violation of your rights within the corresponding limitations as set forth in the pertinent
O
laws.You hereby agree to hold Maxicare and its Representatives 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
information pursuant to Maxicare reliance your representation and warranty that Maxicare and its representatives have the
authority to examine, use, process, store, share, or disclose, as the case may be, said information for the above-mentioned
purposes. If you have any questions and /or concerns regarding your personal information, you may contact our Data Privacy
Officer thru the following contact details: Data Protection Officer Jose Michael Tagle, CISM Tel #: (02) 908-6989 Email
address: dpo@maxicare.com.ph *
I Agree Yes No
All information provided are true and correct. Yes No
47
Note: Please ensure to capture final details of the account and salient features of the program to avoid
unnecessary revisions in the conforme
MAXICARE CLIENT INFORMATION SHEET
Complete Company name:
Complete Company address:
Nature of Business (based on BIR 2303):
Type of Organization :
TIN:
With existing HMO?
If Yes, Please provide number of years :
HMO Provider:
Expiration Date of existing HMO:
G
Intended Effective date :
*Payment first policy prior to activation. Activation of account's membership is 3 working days from release of official receipt.
Company Signatory 1 (President and CEO):

Note: If the President / CEO is not the assigned signatory, the client will provide proof of authority of the signatory to sign on behalf of the
entity.
Name of signatory:
Position:
M
Email:
Contact Number
Company Signatory 2 (Optional):
Name of signatory:
Position:
Email:
O
Contact Number
Contact Person 1:
Position:
Email:
Contact Number
Contact Person 2:
Position:
Email:
Contact Number
Main Billing Contact:
Position:
Email:
Contact Number
48
Other Billing contacts:
Billing Contact 1:
Position:
Email:
Contact Number
Billing Contact 2:
Position:
Email:
Contact Number
ZIP CODE:
Member Count
Principals
G
Dependents
Eligibility of Additional Enrollees

VIP List: (Enrollees to be included in the VIP list should be
Account Signatory/ Board of Directors/ President)
VIP 1:
Name:
M
Position:
VIP 2:
Name:
Position:
VIP 3:
Name:
Position:
O
VIP 4:
Name:
Position:
VIP 5:
Name:
Position:
All information provided are true and correct. Yes No
ALL FIELDS ARE REQUIRED, incomplete data will cause delay of processing.
49
PRINCIPALS
SALIENT FEATURES
Number of
Rank Plan type Room and Board MBL
Enrollees
G
M
*** RANK - Executive, Manager, Supervisor or Rank & File
*** PLAN TYPE – Platinum, Gold, Silver or Bronze
*** No. of Enrollees – Tentative headcount of employees per rank classification
** Room & Board – depends on the chosen plan type
** MBL - depends on the chosen plan type
RIDERS
O
● Indicate Yes if account would like to avail below riders, No if not.
Life with AD
HospiCash &D
ACU/ for member Others
Dental
ECU Personal
Daily Hospital ages up to
Income
Accident
Benefit 65 years old
only
50
**** Others - Indicate if would like to avail the other available riders indicated in the Proposal
DEPENDENTS
SALIENT FEATURES
Number of
Rank Plan type Room and Board MBL
Enrollees
G
M
*** RANK - Dependents of Executive, Dependents of Manager, Dependents of Supervisor or Dependents of Rank & File
*** PLAN TYPE – Platinum, Gold, Silver or Bronze
*** No. of Enrollees – Tentative headcount of employees per rank classification
** Room & Board – depends on the chosen plan type
** MBL - depends on the chosen plan type
O
RIDERS
● Indicate Yes if account would like to avail below riders, No if not.
Life with AD
HospiCash &D
ACU/ for member Others
Dental
ECU Personal
Daily Hospital ages up to
Income
Accident
Benefit 65 years old
only
51
**** Others - Indicate if would like to avail the other available riders indicated in the Proposal
MAXICARE CLIENT INFORMATION SHEET
I. ID Printing
Delivery Address:
(Pls. include Barangay
address)
Recipient's Name:
Recipient's Mobile Number:
G
ID printing if per affiliate
II. Billing Set up

VAT Status:
M
*Issued certificates for Non-
VAT, VAT Exempt, Zero
Rated are valid within the
contract year.
Billing Arrangement:
Per Affiliate (if applicable) yes/ no

O
52
EMPLOYEES
Phic
Employ Extensi BirthDa Memb
MiddleNa Gend CivilStat Position Plan
ee LastName FirstName on te er
me er Type
No. Name Yes/N
o
G
Legend:
1 Employee
M
No
2 Last Name
3 First Name
4 Middle Name
5 Extension Jr. / Sr. / I, II, III, IV etc.
Name
6 Gender Either F for female or M for male
O
7 Date of Birth mm/dd/yyyy format
8 Civil Status Single / Married / Separated / Widowed / Divorced
9 Position
10 Plan Platinum1, Gold2, Silver2 , Bronze
DEPENDENTS
C
Relatio
iv Phic
nship
il Memb Name of
FirstNam MiddleN Exten Gend BirthDate to the
LastName S er Plan Type Principal/Employ
e ame sion er Princip
ta Yes/N ee
al
t o
53
Legend:
1 Last
Name
2 First
Name
G
3 Middle
Name
4 Extension Jr. / Sr. / I, II, III, IV etc.
Name
5 Gender Either F for female or M for male
6 Date of mm/dd/yyyy format
M
Birth
7 Civil Single / Married / Separated / Widowed / Divorced
Status
8 Plan Platinum1, Gold2, Silver2 , Bronze
9 Relations Either spouse, child, parent or siblings
hip
10 Principal Name of the Employee
O

2024 Maxicare Proposal For SMEs 3-99 Employees Nationwide Access & Provincial Access

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2024 Maxicare Proposal For SMEs 3-99 Employees Nationwide Access & Provincial Access

Uploaded by

Copyright:

Available Formats

1

1st Year 2nd Year onwards

Comprehensive Medical Care Features

Requirements for Enrollment:

Office of Mark Gastardo

2023-OCT to 2024-SEPT STARTER (3-9 EMPLOYEES)

NO 2024 OPTIONAL RIDERS FOR STARTER PLAN Ann Semi

2024 GROUP (10-19 EMPLOYEES)

2024 GROUP (10-19 EMPLOYEES)

14 (Php200,000) 529 286 148

27 International Assistance Rider 330 178 92

SPECIAL ACCOMMODATION FOR NON PHILHEALTH MEMBERS

VISAYAS and MINDANAO

MAXICARE MAXIPLUS FOR 3-99 EMPLOYEES

All diagnostic / therapeutic procedures medically

Macular Degeneration and other Optha indications

rheumatoid arthritis, etc.)

12.6 Prosthetic Devices Not Covered

13.6 VAT Charges 12% VAT in the membership fees

66-70 years old – Thrice (3X) the rate

RIDERS BENEFITS AND INCLUSIONS DESCRIPTION

100% of insurance/depends on the

A. Schedule of Losses for ADD&D Coverage

i.) Loss of Life 100% of amount of insurance

ii.) Both hands or both feet 100% of amount of insurance

iii.) One hand and one foot 100% of amount of insurance

iv.) One hand or one foot 50% of Amount of Insurance

v.) Sight of both eyes 100% of Amount of Insurance

vi.) Sight of one eye 50% of Amount of Insurance

x.) Hearing of one ear 50% of Amount of Insurance

xi.) Speech 100% of Amount of Insurance

xiii.) Whole arm 60% of Amount of Insurance

xiv.) Lower arm 50% of Amount of Insurance

xvi.) Lower leg 40% of Amount of Insurance

xvii.) Thumb 20% of Amount of Insurance

xviii.) Fingers of one hand

- Index finger 10% of Amount of Insurance

- Middle finger 5% of Amount of Insurance

- Little finger 2% of Amount of Insurance

xix.) Toes of one foot

- All 10% of Amount of Insurance

- Big toe 5% of Amount of Insurance

Spouse/Parent 18-65 years old

Legal spouse and Children who are in

Parents and siblings who are in good

4 Hospicash Plan Limitations and Hierarchy of Benefits:

3. Exclusions and Limitations:

Subject to the list of exclusion indicated on the contract per account

The Philippine American Life &

Legal spouse who are actively

vii.) Cancer caused directly or indirectly, wholly or partly, by

Normal Delivery Php5,000

Insurance Provider Assist America Asia Limited

7 International Assistance Medical Necessary Expenses (Sickness and Accident) Php1,000,000

30-45 min lecture

Topic to be chosen by the account

EXCLUSIONS AND LIMITATIONS PROVISIONS

Treatment of any injury received when there is:

d. Direct or indirect participation in the commission of a crime whether consummated or not

f. Unnecessary exposure to imminent danger, knowingly or unknowingly or hazard to health, by the

Routine physical examinations required for obtaining or continuing employment, requirement in

Take-home medicine and out-patient medicine except

Notes & Special Reminders: