2016 Maxicare MaxiPlus Healthcare Program For 5-99 Heads

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 28 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.
Companies with at least and only 5 employees can now enroll under Maxicares Corporate Program. Our options
and plan types have the following features:
Convenient Features
Easy requirements. No individual medical examination. No individual application forms, all applications are
considered approved
Access to more than 1000+ hospitals and clinics nationwide and 30,000 affiliated doctors
Access to Maxicares own Primary Care Centers located in major hospitals
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)
Coverage for Pre Existing Conditions subject to the package chosen:

o MaxiPlus Group (10-19 employees) & Small (20-99 employees) both Nationwide access and Provincial
access
Covered up to Maximum Benefit Limit

o Starter Plan (Nationwide Access with 5-9 employees)
1st Year
Pre Existing Non Dreaded Conditions up to P5,000
Pre Existing Dreaded up to P5,000
2nd Year onwards
Pre Existing Non Dreaded Conditions up to Maximum Benefit Limit
Pre Existing Dreaded up to P5,000

Comprehensive Medical Care Features
Outpatient Care and Consultations
In Patient Care and Confinement
Emergency Care
Preventive Care
To proceed with the enrollment, kindly fill out the Maxicare Corporate Enrollment Sheet found at the last 3 pages
of our proposal and email those back to us. Kindly submit to us as well a copy of your BIR 2303 and company ID
of the contact person and signatory through email or fax at (02) 819-9899.
Requirements for Enrollment:
1. Filled out Maxicare Corporate Enrollment Sheet (found at the last 3 pages of this proposal). The
Enrollment Sheet has 3 sheets
a. 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. Scanned company IDs of contact person and signatory
4. KYC Requirements (to be submitted later together with the signed conforme).
Note: The package attached is only applicable to companies with 5-99 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.
Should you have any other questions, you may call us at (02) 622-8892 Mobile 09178046275 or email
mark.gastardo@gmail.com
Thank you.
For inquiries you may contact us at: (02) 622 8892; 0917 804 6275; proposal.omg@gmail.com
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Office of Mark Gastardo
Accredited Agent License Code: A000494
Toasts Awards Nationwide Top 3 Best Performing AIA for 2015
TABLE OF CONTENTS
NO
SECTION
PAGE/S
I.
Cover Letter & Requirements for Enrollment
1-2
II.
Starter Plan Rates for 5-9 Employees
2-3
III.
Group Plan Rates for 10-19 Employees
3-4
IV.
Small Plan Rates for 20-99 Employees
5-6
V.
Optional Riders for Nationwide
6-7
VI.
Provincial Rates (North Luzon, South Luzon, Visayas & Mindanao)
7-9
VII.
Summary of Benefits
10-19
VIII.
Exclusions and Limitations Provisions
19-20
IX.
Notes & Special Reminders
21
X.
List of Providers
21
XI.
Plan Types for Dependents
21-22
XII
Provincial Access Directory
22
XIII.
Rated & Ineligible Industries
22-23
XIV.
Pre Existing Non Dreaded & Dreaded Conditions
23-24
XV.
KYC Requirements for Employers
24-26
XVI.
KYC Requirements for Employees
26
XVII.
Ineligible Industries with less than 100 employees Requirements for Quotation
26-27
XVIII.
All Companies & Industries with 100 employees & up Requirements for Quotation
27
XIX.
Company Info Sheet
28
XX.
Employees' Masterlist
29
XXI.
Dependents' Masterlist
30
STARTER (5-9 EMPLOYEES)

PLAN
TYPES
ROOM
STANDARD INDUSTRIES
NATIONWIDE WITHOUT
HEALTHWAY
NATIONWIDE WITH HEALTHWAY
MBL
EMPLOYEES
Without 9 Major
Ann
Semi
With 9 Major
Without 9 Major
Ann
Semi
Ann
Ann
Semi
PLATINUM 1
Small Suite
220,000
16,196
8,746
21,380
11,545
17,007
9,184
22,447
12,121
PLATINUM 2
Lrg Pvt
175,000
13,370
7,220
17,558
9,481
14,038
7,581
18,434
9,954
GOLD 1
Reg Pvt
150,000
11,978
6,468
15,729
8,494
12,584
6,795
16,522
8,922
GOLD 2
Reg Pvt
100,000
11,317
6,111
14,783
7,983
11,882
6,416
15,522
8,382
SILVER 3
Semi-Pvt
80,000
9,295
5,019
12,052
6,508
9,760
5,270
12,655
6,834
SILVER
Semi-Pvt
60,000
8,999
4,860
11,667
6,300
9,451
5,104
12,252
6,616
BRONZE
Ward
50,000
7,523
4,062
9,663
5,218
7,899
4,265
10,148
5,480
Semi
With 9 Major
3
DEPENDENTS
PLATINUM 1
Small Suite
220,000
22,390
12,091
29,746
16,063
23,510
12,695
31,234
16,866
PLATINUM 2
Lrg Pvt
175,000
18,241
9,850
24,142
13,037
19,153
10,343
25,348
13,688
GOLD 1
Reg Pvt
150,000
16,325
8,815
21,604
11,666
17,148
9,260
22,689
12,252
GOLD 2
Reg Pvt
100,000
15,662
8,457
20,658
11,155
16,446
8,881
21,690
11,713
SILVER 3
Semi-Pvt
80,000
12,511
6,756
16,398
8,855
13,138
7,095
17,218
9,298
SILVER
Semi-Pvt
60,000
12,213
6,595
16,012
8,647
12,825
6,926
16,815
9,080
BRONZE
Ward
50,000
10,101
5,454
13,150
7,101
10,606
5,727
13,807
7,456
OPTIONAL RIDERS FOR STARTER PLAN:
Ann
Semi
Standard Dental (1 prophylaxis and 2 Lightcure)
369
199
Annual Check Up Routine Clinic
805
435
51
28
Life AD&D (Php25,000)

Note: Starter Plan is valid until September 30, 2017
GROUP (10-19-Employees)
PLAN TYPES
ROOM
STANDARD INDUSTRIES
MBL
EMPLOYEES
NATIONWIDE WITHOUT HEALTHWAY
Without 9 Major
Without 9 Major
With 9 Major
Ann
Semi
Ann
Semi
With 9 Major
Ann
Semi
Ann
Semi
PLATINUM 1
Small Suite
230,000
19,233
10,386
25,389
13,710
20,196
10,906
26,656
14,394
PLATINUM 2
Open Pvt
230,000
16,849
9,098
22,165
11,969
17,691
9,553
23,273
12,567
PLATINUM 3
Open Pvt
185,000
16,384
8,847
21,540
11,632
17,203
9,290
22,615
12,212
PLATINUM 4
Lrg Pvt
185,000
15,877
8,574
20,849
11,258
16,669
9,001
21,891
11,821
GOLD 1
Reg Pvt
185,000
14,397
7,774
18,852
10,180
15,117
8,163
19,793
10,688
GOLD 2
Reg Pvt
130,000
13,935
7,525
18,226
9,842
14,630
7,900
19,138
10,335
GOLD 3
Reg Pvt
110,000
13,438
7,257
17,555
9,480
14,110
7,619
18,433
9,954
SILVER 1
Semi-Pvt
90,000
11,038
5,961
14,312
7,728
11,590
6,259
15,028
8,115
SILVER 2
Semi-Pvt
80,000
10,741
5,800
13,911
7,512
11,279
6,091
14,606
7,887
Ward
DEPENDENTS
70,000
8,961
4,839
11,502
6,211
9,408
5,080
12,079
6,523
PLATINUM 1
Small Suite
230,000
26,588
14,358
35,324
19,075
27,917
15,075
37,090
20,029
PLATINUM 2
Open Pvt
230,000
22,756
12,288
30,146
16,279
23,891
12,901
31,654
17,093
PLATINUM 3
Open Pvt
185,000
22,292
12,038
29,520
15,941
23,405
12,639
30,995
16,737
PLATINUM 4
Lrg Pvt
185,000
21,661
11,697
28,669
15,481
22,744
12,282
30,101
16,255
GOLD 1
Reg Pvt
185,000
19,559
10,562
25,827
13,947
20,536
11,089
27,117
14,643
GOLD 2
Reg Pvt
130,000
19,094
10,311
25,200
13,608
20,050
10,827
26,459
14,288
GOLD 3
Reg Pvt
110,000
18,598
10,043
24,531
13,247
19,529
10,546
25,757
13,909
SILVER 1
Semi-Pvt
90,000
14,857
8,023
19,472
10,515
15,601
8,425
20,446
11,041
SILVER 2
Semi-Pvt
80,000
14,559
7,862
19,071
10,298
15,286
8,254
20,024
10,813
BRONZE
Ward
70,000
12,022
6,492
15,642
8,447
12,621
6,815
16,423
8,868
BRONZE
GROUP (10-19-Employees)
4
PLAN TYPES
ROOM
RATED INDUSTRIES
MBL
EMPLOYEES
Without 9 Major
Without 9 Major
With 9 Major
Ann
Semi
Ann
Semi
With 9 Major
Ann
Semi
Ann
Semi
PLATINUM 1
Small Suite
230,000
26,723
14,430
35,276
19,049
28,062
15,153
37,038
20,001
PLATINUM 2
Open Pvt
230,000
23,410
12,641
30,797
16,630
24,581
13,274
32,337
17,462
PLATINUM 3
Open Pvt
185,000
22,767
12,294
29,929
16,162
23,904
12,908
31,423
16,968
PLATINUM 4
Lrg Pvt
185,000
22,059
11,912
28,970
15,644
23,162
12,507
30,417
16,425
GOLD 1
Reg Pvt
185,000
20,005
10,803
26,194
14,145
21,003
11,342
27,503
14,852
GOLD 2
Reg Pvt
130,000
19,362
10,455
25,324
13,675
20,328
10,977
26,591
14,359
GOLD 3
Reg Pvt
110,000
18,671
10,082
24,393
13,172
19,605
10,587
25,612
13,830
SILVER 1
Semi-Pvt
90,000
15,337
8,282
19,887
10,739
16,104
8,696
20,881
11,276
SILVER 2
Semi-Pvt
80,000
14,926
8,060
19,329
10,438
15,671
8,462
20,294
10,959
Ward
DEPENDENTS
70,000
12,451
6,724
15,982
8,630
13,071
7,058
16,784
9,063
PLATINUM 1
Small Suite
230,000
36,944
19,950
49,081
26,504
38,792
20,948
51,536
27,829
PLATINUM 2
Open Pvt
230,000
31,617
17,073
41,886
22,618
33,196
17,926
43,982
23,750
PLATINUM 3
Open Pvt
185,000
30,975
16,727
41,017
22,149
32,522
17,562
43,067
23,256
PLATINUM 4
Lrg Pvt
185,000
30,097
16,252
39,834
21,510
31,602
17,065
41,824
22,585
GOLD 1
Reg Pvt
185,000
27,179
14,677
35,886
19,378
28,535
15,409
37,678
20,346
GOLD 2
Reg Pvt
130,000
26,531
14,327
35,016
18,909
27,859
15,044
36,764
19,853
GOLD 3
Reg Pvt
110,000
25,842
13,955
34,085
18,406
27,136
14,653
35,787
19,325
SILVER 1
Semi-Pvt
90,000
20,644
11,148
27,056
14,610
21,677
11,706
28,409
15,341
SILVER 2
Semi-Pvt
80,000
20,229
10,924
26,498
14,309
21,239
11,469
27,822
15,024
BRONZE
Ward
70,000
16,704
9,020
21,735
11,737
17,537
9,470
22,821
12,323
BRONZE
SMALL (20-99 Employees)

PLAN TYPES
ROOM
STANDARD INDUSTRIES
MBL

EMPLOYEES
Without 9 Major
With 9 Major
Without 9 Major
With 9 Major
Ann
Semi
Qtr
Ann
Semi
Qtr
Ann
Semi
Qtr
Ann
Semi
Qtr
PLATINUM 1
Small Suite
230,000
16,163
8,728
4,526
21,334
11,520
5,974
16,972
9,165
4,752
22,402
12,097
6,273
PLATINUM 2
Open Pvt
230,000
14,159
7,646
3,965
18,626
10,058
5,215
14,865
8,027
4,162
19,556
10,560
5,476
PLATINUM 3
Open Pvt
185,000
13,770
7,436
3,856
18,100
9,774
5,068
14,458
7,807
4,048
19,005
10,263
5,321
PLATINUM 4
Lrg Pvt
185,000
13,342
7,205
3,736
17,521
9,461
4,906
14,008
7,564
3,922
18,397
9,934
5,151
GOLD 1
Reg Pvt
185,000
12,098
6,533
3,387
15,842
8,555
4,436
12,703
6,860
3,557
16,633
8,982
4,657
GOLD 2
Reg Pvt
130,000
11,709
6,323
3,279
15,316
8,271
4,288
12,295
6,639
3,443
16,081
8,684
4,503
GOLD 3
Reg Pvt
110,000
11,291
6,097
3,161
14,754
7,967
4,131
11,857
6,403
3,320
15,490
8,365
4,337
SILVER 1
Semi-Pvt
90,000
9,277
5,010
2,598
12,028
6,495
3,368
9,741
5,260
2,727
12,630
6,820
3,536
SILVER 2
Semi-Pvt
80,000
9,028
4,875
2,528
11,690
6,313
3,273
9,478
5,118
2,654
12,275
6,629
3,437
BRONZE
Ward
DEPENDENTS
70,000
7,528
4,065
2,108
9,666
5,220
2,706
7,906
4,269
2,214
10,150
5,481
2,842
PLATINUM 1
Small Suite
230,000
22,343
12,065
6,256
29,684
16,029
8,312
23,460
12,668
6,569
31,168
16,831
8,727
PLATINUM 2
Open Pvt
230,000
19,120
10,325
5,354
25,332
13,679
7,093
20,077
10,842
5,622
26,598
14,363
7,447
PLATINUM 3
Open Pvt
185,000
18,732
10,115
5,245
24,807
13,396
6,946
19,670
10,622
5,508
26,048
14,066
7,293
PLATINUM 4
Lrg Pvt
185,000
18,202
9,829
5,097
24,092
13,010
6,746
19,112
10,320
5,351
25,294
13,659
7,082
GOLD 1
Reg Pvt
185,000
16,436
8,875
4,602
21,703
11,720
6,077
17,257
9,319
4,832
22,787
12,305
6,380
GOLD 2
Reg Pvt
130,000
16,048
8,666
4,493
21,176
11,435
5,929
16,849
9,098
4,718
22,235
12,007
6,226
GOLD 3
Reg Pvt
110,000
15,629
8,440
4,376
20,614
11,132
5,772
16,411
8,862
4,595
21,646
11,689
6,061
SILVER 1
Semi-Pvt
90,000
12,485
6,742
3,496
16,363
8,836
4,582
13,109
7,079
3,671
17,181
9,278
4,811
SILVER 2
Semi-Pvt
80,000
12,234
6,606
3,426
16,025
8,654
4,487
12,845
6,936
3,597
16,827
9,087
4,712
BRONZE
Ward
70,000
10,102
5,455
2,829
13,145
7,098
3,681
10,608
5,728
2,970
13,802
7,453
3,865
6
SMALL (20-99 Employees)
PLAN TYPES
ROOM
RATED INDUSTRIES
MBL

EMPLOYEES
Without 9 Major
With 9 Major
Without 9 Major
With 9 Major
Ann
Semi
Qtr
Ann
Semi
Qtr
Ann
Semi
Qtr
Ann
Semi
Qtr
PLATINUM 1
Small Suite
230,000
22,458
12,127
6,288
29,664
16,008
8,300
23,582
12,734
6,603
31,128
16,809
8,716
PLATINUM 2
Open Pvt
230,000
19,674
10,624
5,509
25,881
13,976
7,247
20,656
11,154
5,784
27,172
14,673
7,608
PLATINUM 3
Open Pvt
185,000
19,132
10,331
5,357
25,149
13,580
7,042
20,089
10,848
5,625
26,408
14,260
7,394
PLATINUM 4
Lrg Pvt
185,000
18,583
10,011
5,191
24,345
13,146
6,817
19,465
10,511
5,450
25,564
13,805
7,158
GOLD 1
Reg Pvt
185,000
19,810
9,077
4,707
22,012
11,886
6,163
17,650
9,531
4,942
23,112
12,480
6,471
GOLD 2
Reg Pvt
130,000
16,270
8,786
4,556
21,281
11,492
5,959
17,084
9,225
4,784
22,344
12,066
6,256
GOLD 3
Reg Pvt
110,000
15,689
8,472
4,393
20,499
11,069
5,740
16,475
8,897
4,613
21,524
11,623
6,027
SILVER 1
Semi-Pvt
90,000
12,891
6,961
3,609
16,713
9,025
4,680
13,534
7,308
3,790
17,549
9,476
4,914
SILVER 2
Semi-Pvt
80,000
12,543
6,773
3,512
16,243
8,771
4,548
13,169
7,111
3,687
17,056
9,210
4,776
BRONZE
Ward
DEPENDENTS
70,000
10,460
5,648
2,929
13,430
7,252
3,760
10,986
5,932
3,076
14,103
7,616
3,949
PLATINUM 1
Small Suite
230,000
31,045
16,764
8,693
41,427
22,273
11,549
32,597
17,602
9,127
43,308
23,386
12,126
PLATINUM 2
Open Pvt
230,000
26,568
14,347
7,439
35,199
19,007
9,856
27,896
15,064
7,811
36,958
19,957
10,348
PLATINUM 3
Open Pvt
185,000
26,028
14,055
7,288
34,469
18,613
9,651
27,332
14,759
7,653
36,193
19,544
10,134
PLATINUM 4
Lrg Pvt
185,000
25,292
13,658
7,082
33,474
18,076
9,373
26,556
14,340
7,436
35,147
18,979
9,841
GOLD 1
Reg Pvt
185,000
22,837
12,332
6,394
30,154
16,283
8,443
23,979
12,949
6,714
31,664
17,099
8,866
GOLD 2
Reg Pvt
130,000
22,298
12,041
6,243
29,424
15,889
8,239
23,410
12,641
6,555
30,894
16,683
8,650
GOLD 3
Reg Pvt
110,000
21,716
11,727
6,080
28,643
15,467
8,020
22,802
12,313
6,385
30,076
16,241
8,421
SILVER 1
Semi-Pvt
90,000
17,347
9,367
4,857
22,736
12,277
6,366
18,215
9,836
5,100
23,874
12,892
6,685
SILVER 2
Semi-Pvt
80,000
16,999
9,179
4,760
22,267
12,024
6,235
17,848
9,638
4,997
23,381
12,626
6,547
BRONZE
Ward
70,000
14,036
7,579
3,930
18,266
9,864
5,114
14,740
7,960
4,127
19,177
10,356
5,370
Ann
Semi
Qtr
OPTIONAL RIDERS FOR NATIONWIDE:

1. Annual Check up Routine (Clinic)
2. Annual Check Up Routine (Mobile)
3. Standard Dental (1 oral propahylaxis)
805
435
225
1,016
549
284
369
199
103
7
4. Life Insurance with AD&D - Php 25,000
51
28
14
448
242
125
6. Maternity Benefit
3,161
1,707
885
7. Semi Executive Check Up Outpatient MMC
5,781
3,122
1,619
8. Executive Check Up Outpatient MMC
17,523
9,462
4,906
9. Executive Check Up Inpatient MMC
32,516
17,559
9,104
10. Semi Executive Check Up Outpatient TMC
16,000
8,640
4,480
11. Executive Check Up Outpatient TMC
35,045
18,924
9,813
12. Executive Check Up Inpatient TMC
53,381
28,826
14,947
3,604
1,946
1,009
5. Cancer Benefit (Php200,000)
13. Executive Check Up OP MHC

14. Wellness Session
4,516
2,439
1,264
P450 Network Access
Fee & 13.5% claims fee
per availment
15. Fee for Service for Senior Citizens
PROVINCIAL
PLAN TYPES
ROOM
NORTH LUZON (10-99 Employees)

MBL
EMPLOYEES
STANDARD INDUSTRIES
SOUTH LUZON (10-99 Employees)
RATED INDUSTRIES
Ann
Semi
Qtr
Ann
Semi
Qtr
STANDARD INDUSTRIES
Ann
Semi
RATED INDUSTRIES
Qtr
Ann
Semi
Qtr
PLATINUM 1
230,000
12,548
6,777
3,514
16,952
9,154
4,747
15,134
8,172
4,237
18,585
10,036
5,204
PLATINUM 2
230,000
10,958
5,916
3,069
14,803
7,994
4,145
13,212
7,135
3,700
16,227
8,763
4,544
PLATINUM 3
185,000
10,651
5,752
2,982
14,388
7,770
4,029
12,842
6,935
3,596
15,771
8,516
4,416
PLATINUM 4
185,000
10,308
5,566
2,886
13,924
7,519
3,899
12,430
6,712
3,481
15,265
8,243
4,274
GOLD 1
185,000
9,323
5,034
2,610
12,593
6,800
3,526
11,243
6,071
3,149
13,805
7,455
3,865
GOLD 2
130,000
9,014
4,868
2,524
12,177
6,576
3,410
10,870
5,870
3,044
13,349
7,208
3,738
GOLD 3
110,000
8,681
4,688
2,431
11,727
6,333
3,284
10,469
5,654
2,931
12,857
6,943
3,600
SILVER 1
90,000
7,082
3,824
1,982
9,568
5,167
2,679
8,541
4,612
2,391
10,488
5,664
2,937
SILVER 2
80,000
6,883
3,717
1,927
9,298
5,021
2,603
8,298
4,481
2,323
10,191
5,503
2,853
70,000
5,692
3,073
1,593
7,688
4,152
2,153
6,864
3,707
1,922
8,429
4,552
2,360
230,000
17,457
9,427
4,888
23,583
12,735
6,603
21,050
11,367
5,894
25,851
13,960
7,238
BRONZE
DEPENDENTS
PLATINUM 1
Small
8
Suite
PLATINUM 2
Open Pvt
230,000
14,900
8,045
4,173
20,127
10,869
5,636
17,968
9,703
5,031
22,065
11,915
6,178
PLATINUM 3
Open Pvt
185,000
14,590
7,879
4,085
19,709
10,643
5,519
17,593
9,500
4,926
21,605
11,667
6,049
PLATINUM 4
Lrg Pvt
185,000
14,170
7,652
3,967
19,142
10,337
5,360
17,086
9,227
4,784
20,984
11,331
5,876
GOLD 1
Reg Pvt
185,000
12,766
6,894
3,575
17,247
9,313
4,829
15,394
8,313
4,310
18,905
10,209
5,293
GOLD 2
Reg Pvt
130,000
12,457
6,726
3,488
16,827
9,087
4,712
15,022
8,111
4,205
18,447
9,961
5,165
GOLD 3
Reg Pvt
110,000
12,125
6,548
3,396
16,380
8,845
4,586
14,623
7,897
4,095
17,957
9,697
5,028
SILVER 1
Semi-Pvt
90,000
9,628
5,200
2,696
13,006
7,023
3,642
11,611
6,270
3,251
14,259
7,700
3,993
SILVER 2
Semi-Pvt
80,000
9,429
5,092
2,640
12,738
6,879
3,567
11,368
6,139
3,184
13,962
7,539
3,909
70,000
7,738
4,178
2,167
10,453
5,645
2,927
9,331
5,039
2,613
11,459
6,188
3,209
Semi
Qtr
Ann
BRONZE
Ward
OPTIONAL RIDERS:
Ann
Annual Check-up (Basic 5) Clinic
Cancer Benefit (Php200,000)
PROVINCIAL
PLAN TYPES
ROOM
EMPLOYEES
Small
PLATINUM 1
Suite
PLATINUM 2
Semi
Qtr
Ann
STANDARD INDUSTRIES
199
103
369
199
103
1,334
720
374
1,877
1,014
526
51
28
14
51
28
14
448
242
125
448
242
125
MINDANAO (20-99 Employees)
RATED INDUSTRIES
Semi
Qtr
Ann
230,000
12,138
6,555
3,399
14,907
8,050
4,174
12,778
Open Pvt
230,000
10,599
5,724
2,968
13,017
7,029
3,645
PLATINUM 3
Open Pvt
185,000
10,301
5,562
2,884
12,650
6,831
PLATINUM 4
Lrg Pvt
185,000
9,972
5,384
2,792
12,246
GOLD 1
Reg Pvt
185,000
9,019
4,869
2,525
GOLD 2
Reg Pvt
130,000
8,719
4,708
GOLD 3
Reg Pvt
110,000
8,399
SILVER 1
Semi-Pvt
90,000
6,850
SILVER 2
Semi-Pvt
80,000
70,000
Ward
DEPENDENTS
Semi
Qtr
STANDARD INDUSTRIES
Ann
BRONZE
Qtr
369
VISAYAS (10-99 Employees)

MBL
Semi
Ann
Semi
RATED INDUSTRIES
Qtr
Ann
6,900
3,577
15,692
8,474
4,394
11,157
6,025
3,123
13,701
7,399
3,836
3,542
10,842
5,854
3,035
13,314
7,190
3,728
6,613
3,429
10,499
5,669
2,940
12,892
6,962
3,610
11,075
5,981
3,101
9,493
5,126
2,658
11,657
6,295
3,264
2,442
10,708
5,782
2,998
9,177
4,955
2,570
11,270
6,086
3,156
4,536
2,351
10,314
5,570
2,888
8,840
4,774
2,475
10,857
5,863
3,040
3,699
1,918
8,412
4,542
2,355
7,209
3,893
2,019
8,854
4,781
2,479
6,657
3,595
1,864
8,176
4,415
2,289
7,007
3,784
1,962
8,606
4,647
2,410
5,507
2,974
1,542
6,764
3,653
1,894
5,798
3,131
1,623
7,120
3,845
1,994
Semi
Qtr
9
PLATINUM 1
Small
Suite
230,000
16,886
9,119
4,728
20,738
11,199
5,807
17,775
9,598
4,977
21,828
11,787
6,112
PLATINUM 2
Open Pvt
230,000
14,413
7,783
4,035
17,699
9,557
4,956
15,170
8,192
4,248
18,630
10,060
5,216
PLATINUM 3
Open Pvt
185,000
14,112
7,620
3,951
17,330
9,358
4,852
14,854
8,021
4,159
18,243
9,851
5,108
PLATINUM 4
Lrg Pvt
185,000
13,705
7,402
3,838
16,832
9,089
4,713
14,427
7,791
4,040
17,718
9,568
4,961
GOLD 1
Reg Pvt
185,000
12,348
6,668
3,457
15,164
8,189
4,246
13,000
7,019
3,641
15,964
8,621
4,470
GOLD 2
Reg Pvt
130,000
12,051
6,508
3,375
14,799
7,991
4,144
12,684
6,850
3,551
15,576
8,411
4,361
GOLD 3
Reg Pvt
110,000
11,730
6,334
3,284
14,406
7,779
4,034
12,347
6,667
3,457
15,163
8,188
4,246
SILVER 1
Semi-Pvt
90,000
9,314
5,030
2,608
11,439
6,177
3,203
9,804
5,295
2,746
12,040
6,502
3,371
SILVER 2
Semi-Pvt
80,000
9,123
4,926
2,554
11,204
6,050
3,137
9,603
5,186
2,690
11,794
6,369
3,302
BRONZE
Ward
70,000
7,482
4,041
2,095
9,190
4,963
2,573
7,878
4,254
2,206
9,675
5,225
2,709
OPTIONAL RIDERS:
Ann

Annual Check-up (Basic 5)
Cancer Benefit (Php200,000)
Executive Check Up OP - Cebu Doctors Hospital
Executive Check Up Ip - Cebu Doctors Hospital
Executive Check Up Ip - Davao Doctor's Hospital
Semi
Qtr
Ann
Semi
Qtr
369
199
103
369
199
103
1,166
630
326
1,166
639
326
448
242
125
448
242
125
51
28
14
51
28
14
3,604
1,946
1,009
n/a
n/a
n/a
31,495
17,007
8,819
n/a
n/a
n/a
n/a
n/a
n/a
30,529
16,486
8,548
10
SUMMARY OF BENEFITS
MAXIPLUS
HEALTHCARE BENEFITS
A.
OUT-PATIENT CARE
1
Consultations during regular clinic hours,

except prescribed medicines
Subject to MBL
Pre and Post Natal consultations
Subject to MBL
4
5
1
0
1
1
B.
MAXICARE'S COVERAGE
Eye, ear, nose and throat (EENT)

treatment prescribed by an Accredited
Physician/Specialist
Treatment for minor injuries such as
lacerations, mild burns, sprains and the
like
Dressings, conventional casts (plaster of
Paris) and sutures.
X-Ray, laboratory examinations, routine,
diagnostic and therapeutic procedures
prescribed
by
an
Accredited
Physician/Specialist, provided however
that the cost of diagnostic and therapeutic
procedures covered shall be limited to a
specific amount.
Minor surgery not requiring confinement
prescribed by an Accredited Physician /
Specialist
Eye laser therapy only for retinal tear,
retinal hole, retinal detachment and
glaucoma prescribed by an Accredited
Physician/Specialist. Eye correction such
as Lasik, PRK and the like are not
covered.
Electrocauterization of skin lesions such
as plantar warts, flat warts, periungual
warts, filiform warts and molluscum
contagiosum, in any part of the body,
except genital warts and condyloma
acuminata, prescribed by an Accredited
Physician/Specialist.
Sclerotherapy for varicose veins (except
medicines and for cosmetic purposes) as
prescribed by an Accredited Physician, to
be availed through accredited vascular
surgeons.
Allergy Testing/ allergy screening and
other related examinations prescribed by
an Accredited Physician
1
2
Speech therapy (for stroke patients only)
1
3
Tuberculin test
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
Up to Php 10,000 /eye /member /year
Up to Php 1,000 /member /year
Up to Php 5,000 / leg / member / year
Up to Php 2,500 / member / year

Covered as charged up to Php 10,000 / member / year
(reimbursement basis)
Note: Consultations shall be part of the limit and
treated as sessions
Up to Php 600 / member / year
IN-PATIENT CARE
1
Room and Board Accommodation
Subject to the Member's Room and Board limit
11
2
4
5
6
7
8
9
1
0
1
1
1
2
C.
D.
Use of operating room, Intensive Care Unit

(ICU), isolation room (if prescribed by
attending Accredited Physician) and
recovery room.
Professional fees in accordance with
Maxicare Schedule of Rates.
a. Attending Physicians
Subject to MBL
Subject to MBL
b. Surgeons
c. Anesthesiologists
d. Cardio-pulmonary clearance before
surgery and cardiac monitoring during
surgery.
Standard Nursing Services
Subject to MBL
Subject to MBL
Medicines for in-patient use

Blood
products
transfusions
and
intravenous
fluids,
including
blood
screening and cross matching.
X-Ray, laboratory examinations, routine,
diagnostic
tests
and
therapeutic
procedures incidental to confinement
Dressings, conventional casts (plaster of
Paris) and sutures
Anesthesia and its administration
Subject to MBL
Oxygen and its administration
Subject to MBL
Standard Admission kit
Subject to MBL
All other items directly related in the

medical management of the patient, as
deemed medically necessary by the
attending Accredited Physician
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
Subject to MBL
ROUTINE PROCEDURES (whether IP or OP)

1
2
Blood Chemistries
Chest X-Ray
100% of Actual Cost subject to MBL

Complete Blood Count (CBC)
Fecalysis
Urinalysis
DIAGNOSTIC PROCEDURES
1
2
3
4
5
6
7
8
9
1
0
1
1
12-Lead Electrocardiogram (ECG)

24-Hour Electroencephalogram
Monitoring
24-hour Holter Monitoring

(EEG)

Adrenocortical Function
Anti-Nuclear Antibody, C-Reactive Protein,
Lupus Cell Exam
Arterial Blood Gas
Arthroscospic Procedures, Orthopedic
Arthroscopy
Audiograms and Tympanograms
Bone Densitometry Scan (Dexascan)
Bone Mineral Density Studies
Cardiac Stress Tests (Thalium

Dipyridamole Stress Tests)
and

12
1
2
1
3
Computed Tomography Scans

Diagnostic Radiographs:
a. Biliary tract: Cholecystogram and
Cholangiogram
b. Chest, ribs, sternum and clavicle
c. Digestive: Plain film of the abdomen,
Barium Enema, Upper GI Series, Lower GI
Series, Small Bowel series
d. Face (including sinuses), Head and
Neck
e. Urinary: Kidney, Ureter, Bladder (KUB),
Pyelograms and Cystograms
f. X-ray of the extremities and pelvis
g. X-ray of the spine (cervical, thoracic,
lumbo-sacral)
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
2
2
2
3
2
4
2
5
2
6
2
7
2
8
2
9
3
0

Diagnostic Ultrasounds:
a. 2D-Echo with Doppler
b. Abdomen
c. Duplex Scan

d. Digestive and Urinary Systems

e. Ultrasound of the Lungs

Electroencephalogram (EEG) Monitoring
Electromyelography
Conduction Studies
and
Nerve
Endoscopic Procedures
Fluorescein Angiography
Impedance Plethysmography
Magnetic Resonance Angiography (MRA)
Magnetic Resonance Imaging (MRI)
Mammography and Sonomammogram
Myelogram
Nuclear Radioactive Isotope Scan
Pap's Smear
Perfusion Scan
Plasma
Urinary
Aldosterone
Cortisol,
Plasma
Polysomnograms (Sleep Recording)
Pulmonary Function Tests
Radioisotope
Studies:
a. Cardiac
Scans
and
Function
b. Gastrointestinal
c. Liver
d.
Parathyroid
Bone,
Pulmonary
13
(Perfusion/ Ventilation Lung Scans)
3
1
3
2
3
3
3
4
E.
f. Thyroid Scans
g. Total Body Scans
Radionuclide Ventriculography
Surface Electromyography (SEMG)
Thallium Scintigraphy
Treadmill Stress Test (TMST)
THERAPEUTIC PROCEDURES
Up to six (6) sessions subject to MBL for OP; Up to
MBL for IP
Up to MBL shared limit for OP and IP
Arthrocentesis
Dialysis
Intravenous Chemotherapy
Phlebotomy
Physical therapy / Occupational therapy

excluding subspecialties such as cardiac
rehabilitation, pulmonary rehabilitation and
the like.
Thoracentesis
Therapeutic Radiology:
8
9
F.
e. Renal
Shared limit of up to twelve (12) sessions/member/year

subject to MBL for OP; Up to MBL for IP.
Note: Therapy of one (1) body area shall be considered
as one (1) session.
MBL for IP
a. Brachytherapy
b. Cobalt
c. Linear Accelerator Therapy

d. Radioactive Cesium

e. Radioactive Iodine
Continuous Positive
(CPAP)
Oral Chemotherapy

Airway
Pressure
Up to Php 60,000 shared limit for OP and IP

Up to Php 60,000 shared limit for OP and IP
ANNUAL CHECK-UP
Optional
The following Routine ACU program shall be conducted at a designated Maxicare Accredited Clinic once
*
a year:
1 Routine (clinic) which includes:
Physical Examination
Complete Blood Count
Urinalysis
Fecalysis
Chest X-ray
ECG
Pap Smear
2
G.

MBL for IP
Pre-employment in lieu of ACU
Applicable for members 35 years old and above

Applicable for members (women) 35 years old and
above
Can be availed under Fee for Service. Billing shall be
based on actual cost plus 13.5% Claims Handling Fee
PREVENTIVE CARE
14
1
2
3
4
H.
Covered up to Php 40,000 / member / year

Covered
Covered
Covered
ADDITIONAL PROCEDURES AND MODALITIES (shared limit for OP and IP; Professional Fees,
Hospital Bills and other incidental expenses relative to the procedure shall form part of the limit)
3
4
Angiography
(gastrointestinal,
brain,
retinal and peripheral vascular)
Coronary
Angiogram
and/or
Angioplasty/Coronary Artery Bypass Graft
Cryosurgery
Gamma Knife Surgery
5
6
Hysterescopic Myoma Resection

Hysteroscopically-guided D&C

7
8
Laparoscopy
Lithotripsy

9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0
2
1
Percutaneous Ultrasonic Nephrolithotomy
Stereotactic Brain Biopsy
Conventional Hemorrhoidectomy
Scalpel Hemorrhoidectomy
Stapled Hemorrhoidectomy
Covered up to Php 5,000 /member /year
Mammotome
4D Ultrasound except for maternity-related

cases
Esophageal Manometry
Intensified Modulated Radiotheraphy
Botox which is not cosmetic in nature nor

for beautification purpose
Positron Emission Tomography
CT Pulmonary Angiography
Photodynamic Therapy
1
2
2
2
2
3
I.
Passive and active vaccines for treatment

of tetanus and animal bites
Periodic monitoring of health problems
Health-education and counselling on diets
or exercise
Health habits and Family Planning
counseling
Other medically necessary modalities not

mentioned above and those for which
there are no comparable, conventional or
traditional counterparts
Transurethral Microwave Therapy of
Prostate

Covered up to Php 5,000/ procedure /member /year
EMERGENCY CARE
1
In Accredited Hospitals
a. Doctors services
b. Emergency Room Fees
Subject to MBL
Subject to MBL
c. Medicines used for immediate relief
Subject to MBL
15
during treatment
d. Oxygen, Intravenous fluids and blood
products.
e. Dressings, conventional casts (plaster
of Paris) and sutures.
f. X-Rays, laboratory and diagnostic
examinations, and other medical services
related to the emergency treatment of the
patient.
g. Room Upgrade in case of room
unavailability
Subject to MBL
up to 24 hours
Reimbursable up to 80% of hospital bills &
professional fees based on Maxicare rates incurred
during the first 24 hrs. of treatment up to Php 30,000 /
availment / member /year
In Non-Accredited Hospitals
Outside the Philippines
100% based on Maxicare rates up to MBL

Areas without Accredited Hospital
Ambulance
Service
(Accredited
Up to MBL
Hospital/Clinic
to
Accredited
Hospital/Clinic)
Ambulance
Service
(Non-accredited
Reimbusable up to Php 2,500 per conduction
Hospital/Clinic
to
Accredited
Hospital/Clinic)
Note: The ambulance service provided herein shall be available regardless of the location within the
Philippines
Covered for the first 24 hrs. from the time of bite
Initial Treatment of Animal Bites
subject to MBL
K.
Subject to MBL
J.
Subject to MBL
Reimbursable up to 100% of actual cost up to

Php30,000 / availment / member / year
PRE-EXISTING CONDITIONS
1
Dreaded Conditions
Covered depending on the type of Product
Non-Dreaded Conditions
Covered depending on the type of Product
DENTAL CARE
Optional
Dental examination/consultation only
Covered
Oral prophylaxis
Uncomplicated tooth extraction (anterior
tooth, posterior tooth, )
Temporary Fillings
Desensitization of hypersensitive teeth
(limited to the application of necessary
medicament to the affected teeth)
Simple denture adjustment and repair
Recementation of loose jacket crowns,
bridges, inlays and onlays
Palliative treatment for simple mouth sores
and blisters
Open incision and drainage (intraoral)
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
Covered - Once a year

Covered
Covered, as advised by Dentist
Up to 2 teeth
Covered
Covered
Covered
Covered
Dental Nutrition and Dietary Counseling
Covered
Dental Health Education
Covered
Pre-natal consultation on teeth and gums
Covered
Temporo Mandibular Joint Consultation
Initial Consultation -Covered
16
1
4
L.
Permanent Fillings
2 teeth per year
GROUP LIFE INSURANCE WITH

ACCIDENTAL DEATH AND DISABLEMENT
(AD&D) BENEFITS
1
2
3
Optional
The Philippine American Life & General Insurance

Company
Death (amount of insurance)
up to Php 25,000 /member
Corporate Personal Accidental Death & Dismemberment (AD&D)
Insurance Provider
A. Schedule of Losses for AD&D Coverage

i.) Loss of Life
100% of amount of insurance
ii.) Accidental Death, Dismemberment & Disablement or Loss of Use of Limbs

Both Hands
Both Feet
One hand and One foot

One hand
Arm between elbow and wrist

Arm at or above elbow

Leg below knee

Leg at or above knee

iii.) Loss of sight

Both eyes
One eye
iv.) Loss of speech

v.) Loss of hearing
Both ears
One ear
vi.) Accidental Dismemberment or Loss of
Use of Fingers
All of one hand
Exclusions

Any loss or expense caused by or resulting from the following will not be paid:
i.) Suicide during the first year
ii.) War, Invasion or Act of Foreign Enemy

iii.) Service in the Armed Forces of any country or international authority whether in peace or war.
General Guidelines
A. Eligibility Age
Benefits:
Life
Principals, Spouse / Parent: 18 to 69 years old;

Children / Sibling: 14 days to 26 years old
AD&D
Principals, Spouse / Parent: 18 to 65 years old;

Children / Sibling: 14 days to 26 years old
i.) Dependents of Married employees
ii.) Dependents of Single Employees
B. Eligible Dependents
Legal spouse who are actively performing the daily
normal chores of life
Children who are single, unemployed and fully
dependent on the principal for support
Parents who are actively performing the daily normal
chores of life
17
iii.) Dependents of Single Parent

Employees
M.
CONDITIONS WITH SPECIFIC LIMITATIONS

Work Related Conditions based on
1
conditions covered by ECC
2
Motor Vehicular Accidents

Provoked and Unprovoked Assault,
including domestic violence, whether
initiated by the Member or by a known or
unknown third party
Scoliosis, including necessary procedures,
except physical therapy sessions, whether
congenital, pre-existing, developmental or
acquired
Congenital Conditions except physical
therapy sessions and developmental
disorders
Congenital Hernia
N.
Chronic Dermatoses
7
8
Scabies
Exclusion #25
Hepatitis B
Siblings who are single, unemployed and fully

Parents who are actively performing the daily normal
chores of life
Children who are single, unemployed and fully
Up to MBL (Principal only)

Covered subject to MBL and Exclusions and
Limitations Provisions
Up to MBL
Up to Php 60,000 /member /year (shared limit for OP
and IP)
Note: Physical Therapy sessions shall form part of the
Physical therapy /Occupational therapy limits.
up to Php 60,000 /member /year (shared limit for OP
and IP)
Note: Physical Therapy
sessions shall form part of the Physical therapy
/Occupational therapy limits.
Covered up to MBL
Consultations only
Consultations and treatments
Covered up to MBL
Covered up to MBL (if acquired)
ADDED PROGRAM FEATURES

1
2
3
24-Hour/7 Days a Week Customer Care

Hotline
Roving Customer Care Representative
Manner of Access:
a. Hospitals
b. Clinics
more than 1,000 Hospitals (65% are tertiary hospitals)

and Clinics
4
5
PayorLink System
Orientation
Maxicare Primary Care Centers at Makati Medical

Center, Filomena Bldg., St. Luke's Medical Center Quezon City, The Medical City, Chinese General
Hospital, Asian Hospital, My Health Clinic - Festival
Mall, My Health Clinic - EDSA Shangri-La Plaza,
MyHealth Clinic Walter-mart Calamba, MyHealth Clinic
Robinson's Cybergate Cebu
Pampanga, Baguio, Batangas, Cebu, Bacolod, Iloilo,
General Santos & Davao
Clinica Manila, Manila Doctors Hospital, Capitol
Medical Cnter, Mary Mediatrix Medical Center, Calamba
Medical Center. Soon to open: UST Hospital and De La
Salle Hospital
over 30,000 accredited doctors (composed of Fellows,
Diplomates)
6
7
VAT Charges
ID Processing Fee
Inclusive of 12% VAT

at no additional cost
c. Primary Care Centers
d. Maxicare Centers
e. Maxicare Helpdesks
e. Accredited Doctors
18
8
O.
1 per principal member
Booklets & Summary of Coverage (SOC)
MEMBERSHIP GUIDELINES
1
Age Eligibility
18 up to 65 years old
18 up to 65 years old
Principals
Adult Dependents
*
*
*
Dependents should be the same plan or lower than the Principals, on a per level basis.
No coverage for extended dependents.
Hierarchy of Enrollment to be followed:

Married Employees
*
3
P.
15 days old up to 21 years old
Minor Dependents
Enrollees age 66 years old & above shall not be covered
Legal spouse must be enrolled first, followed by the

eldest to the youngest child.
Single Employees
Both parents (anyone ahead of the other) and then the

siblings (eldest to the youngest)
Single Parent Employees
Children (eldest to youngest) and/or Parents (anyone

ahead of the other) and siblings (eldest to 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.
Participation Requirement
a. Non-contributory accounts
100% of all eligible employees should enroll all the

eligible dependents under the program or the number
of dependents should reach 75% of the total number of
principals.
b. Contributory accounts
At least 75% of all eligible employees should enroll all

the eligible dependents under the program or the
number of dependents should reach 75% of the total
number of principals.
Philhealth Integration
Additional Philhealth fee on the onset

of enrollment: Php 1,800 per NonPhilhealth member per year (applicable
for expatriate enrollees only)
MBL on top of Philhealth. Philhealth portion not

deductible to the member's MBL. Required to file
Philhealth
ESCALATION CLAUSE:
1
at least 75%
standard rates
2
3
60% - 74.9%
40% - 59.9%
+ 10% to standard rates

Below 40%
Above escalation clause shall apply and subject to change to the following cases:
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 dependent's 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.
19
Q.
ENROLLMENT GUIDELINES
Waived
Application Forms
Masterlist of Enrollees
Medical Requirements* (at the applicant's
account)
Other medical requirements if deemed
necessary
3
4
Maxicare Format
Waived
Waived
NOTES:
The coverage for the Special Diagnostic Procedures are subject to the recommendation of the accredited
1 physician if medically necessary and the provisions of the dreaded and non dreaded pre-existing
conditions.
2
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, diagnostic and therapeutic procedures and hospitalization. All
procedures or benefits are subject to the limitations on pre-existing conditions as stated in this proposal.
EXCLUSIONS AND LIMITATIONS PROVISIONS
Notwithstanding any provisions to the contrary, the following shall not be covered except otherwise specified in
Maxicare Benefits
1
Services obtained for non-emergency conditions from Physicians and Hospitals in any of the following
circumstances
a. non-Accredited Physicians in non-Accredited Hospitals
b. non-Accredited Physicians in Accredited Hospitals
c. Accredited Physicians in non-Accredited Hospitals or other non accredited healthcare facility.
2
Additional hospital charges and physician's professional fees resulting from:
a. room-upgrading beyond Member's allowable time during emergency care
b. extension of hospital stay despite release of discharge order from Member's attending physician
c. fees of the assistant surgeons / resident doctors who assisteed the Attending Physician in the process of
rendering the above mentioned 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 or extra bed, TV, electric fan, DVD/VCD, and other similar items unless such appliances and items are
necessarily and ordinarily medical services brought about by obtaining a room accommodation higher than the Member's
Room and Board Accommodation limit
e. extra food
f. toilet articles like face towel, soap, toothbrush and the like
g. difference in room and board, the incremental rate differences for professional fees, diagnostic and laboratory
examinations, and other ancillary medical services brought about by obtaining a room accommodation higher than the
Member's Room and Board Accommodation limit;
h. services of a private or a special nurse;
i. all other items not medically necessary in the medical management of the patient.
3
Custodial, domiciliary, convalescent and intermediate care.
4
Long-term rehabilitation and psychiatric and/or psychological illnesses and conditions including neurotic and
psychotic behavior disorders; anxiety disorders/
5
Treatment for injury and its complications resulting from self-inflicted injuries including infections as a result of
tattoos, piercing of the ear or in any body part, whether self-inflicted or done by a third party or attempted suicide or selfdestruction, whether sane or insane.
6
Developmental disorders including functional disorders of the mind, such as but not limited to Attention-Deficit
Disorder (ADD)/Attention-Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorders, Bipolar Disorders, Central
Auditory Processing Disorder (CAPD), Cerebral Palsy, Down Syndrome, Neural Tube Defects, and Mental Retardation.
7
Treatment of any injury received when there is negligence, unauthorized use of prohibited drugs or regulated
drugs, alcoholic liquor intake, direct or indirect participation in the commission of a crime whether consummated or not,
violation of a law or ordinance or unnecessary exposure to imminent danger, knowingly or unknowingly or hazard to
health, by the Member. Maxicare may rely on the Police or Doctor's report to evaluate such claim.
20
8
Aesthetic, cosmetic and reconstructive surgery or any consultation or treatment for any beautification purposes
except if necessary to treat a functional defect due to accidental injury within the initial confinement.
9
Oral surgery following accidental injury to teeth for purposes of beautification. Dental examinations, extractions,
fillings, other dental treatment and their complications except to the extent that are medically necessary for repair or
alleviation of damage to the Member caused solely by an accident. Medical care resulting from any dental related
conditions.
10
Maternity care and all other conditions (except pre and post natal consultations) related to and/or resulting from
pregnancy and/or delivery which affect the conditions of the Member and the unborn child.
11
Circumcision (except for treatment of urological conditions), sex transformation, diagnosis, treatment and
procedures related to fertility or infertility, artificial insemination, sterilization or reversal of such and their complications.
12
Experimental medical procedures and its complications.
13
Acupuncture, chirotherapy and other forms of therapies and its complications.
14
All expenses incurred in the process of organ donation and transplantation if the Member is the donor of such
donation or transplantation, and its complications.
15
Routine physical examinations required for obtaining or continuing employment, requirement in school,
insurance/travel or government licensing, health permit and other similar purposes.
16
Purchase or lease of durable medical equipment, oxygen dispensing equipment, and oxygen except during
covered in-patient care.
17
Corrective appliances, prosthetics and orthotics such as but not limited to eye glasses and contact lenses,
hearing aids, pacemaker, artificial limbs, valves, knee-tibial insert for total knee arthroplasty, vascular grafts, titanium
thread, myringotomy tube, intravascular catheters, vascular stents, bone screws/plates, pins, wires, balloons,
orthopedic internal fixator/fixation systems, orthopedic external fixator/fixation systems, intraocular lens, braces,
crutches.
18
Take-home medicine and out-patient medicine except:
a. chemotherapy medicine
b. medicine administered during an emergency treatment
19
Congenital, genetic and hereditary diseases and their complications (except for hernias) affecting functions of
individuals.
20
All physical deformities prior to enrollment.
21
Treatment of injuries/illnesses caused directly or indirectly by engaging in any professional sport or hazardous
activity such as but not limited to scuba diving, surfing, water skiing, mountain climbing, rock climbing, mountaineering,
parachuting, airsoft, drag racing, paintballing, wakeboarding and bungee jumping, except for activities under companysponsored sports activities.
22
Injuries resulting from direct participation in riots, strikes, and other civil disturbances.
23
Treatment of injuries or illnesses resulting from war or any combat-related activities while in military service.
24
Sexually transmitted diseases, genital warts, AIDS and AIDS related diseases.
25
Valvular heart disease (congenital and/or acquired) including Cardiomyopathies, Chronic Glomerulonephritis,
previous craniotomy sequelae/hearing impairment/ Neurologic disease and Spinal Stenosis (if preexisting)/Poliomyelitis/Slipped disc (if pre-existing) and Guillain-Barre Syndrome, Diabetes and its complications (if preexisting), Complicated Hypertension (e.g. those with history of stroke, myocardial ischemia or infarction and poor kidney
function), and all malignant tumors (if pre-existing).
26
Treatment for chronic dermatoses.
27
Infectious diseases (i.e. Avian Flu, Meningococcemia, etc.) that are declared epidemic or pandemic by the
Department of Health, World Health Organization or any recognized health authority.
28
Pre-existing Hepatitis B and screening and vaccines for all types of Hepatitis.
29
Animal bite/scratch/lick or snake bite including its complications.
30
Benefits covered by Philhealth and all other government funded healthcare entitlements as provided for by law.
31
Laser procedures/treatments.
32
Speech therapy for developmental and congenital diseases.
33
Weight reduction programs, surgical operation or procedure for treatment of obesity, including gastric stapling or
balloon procedures and liposuction.
34
Routine, diagnostic, therapeutic and other procedures of the same or similar nature not otherwise specified in
this Agreement.
35
Cost of vaccines for immunization including its administration.
36
Cost of medico-legal cases.
38
Intravenous Immunoglobulin (IVIG).
39
Treatment of work-related injuries of high-risk occupations such as but not limited to construction workers,
miners, loggers and drillers.
40
Cost of the medical services and professional fees in excess of the MBL/ABL.
21
Notes & Special Reminders:
Rates are only applicable for virgin accounts or those with no previous enrollment with Maxicare.
Rates and benefits are valid until December 31, 2016 and based on a 12-month coverage only. Rates for
Starter Plan are valid until September 30, 2017
Rates presented are inclusive of 12% VAT. For VAT Exempt companies, they must present a PEZA Certicate to
be exempted for VAT
Effectivity date, id number and ID card issuance shall be 5 days after OR date including subsequent addition
Bronze Plan has no access to Makati Medical Center for Inpatient
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.
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.
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, accroding 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.
All terms not mentioned are assumed to be based on Maxicare standard provisions.
LIST OF PROVIDERS
You may download the lists of providers at these links
DOCUMENT
TINYURL LINK
List of Hospitals & Clinics
http://tinyurl.com/maxicarehospitalsclinics
List of Doctors
http://tinyurl.com/maxicaredoctors
List of Dentists thru Dental Hub
http://tinyurl.com/maxicaredentalhub
List of ACU Annual Check Up Providers
http://tinyurl.com/maxicareacuproviders
PLAN TYPES FOR DEPENDENTS

a) The dependents plan could be uniform with respect to the categories or ranks within the company.
Level
Employees Plan Type
Dependents Plan Type
Comments
Executives
Platinum 1
Platinum 1
Same plan with employee
Managers
Gold 1
Gold 1
Staff
Silver 1
Silver 1
b) The dependents plan can be 1 plan lower (only) but must be uniform across all levels
Level
Executives
Managers
Staff
Employees Plan Type

Platinum 1
Gold 1
Silver 1
Dependents Plan Type

Platinum 2
Gold 2
Silver 2
Comments
1 plan lower from Platinum 1
1 plan lower from Gold 1
1 plan lower from Silver 2
c) The dependents plan for all dependents can be the same plan with that of the lowest plan assigned to the employees
Level
Employees Plan
Type
Dependents Plan
Type
Comments
22
Executives
Managers
Platinum 1
Gold 1
Silver 1
Silver 1
Staff
Silver 1
Silver 1
Silver 1 is the lowest plan assigned to the

employees
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
Level
Employees Plan
Type
Platinum 1
Dependents Plan
Type
Silver 2
Managers
Gold 1
Silver 2
Staff
Silver 1
Silver 2
Executives
Comments
Silver 2 is 1 plan lower from the lowest plan of the
employee
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:
at least 75%
standard rates
60% - 74.9%
40% - 59.9%
Below 40%
PROVINCIAL ACCESS
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
SOUTHERN LUZON WITHOUT NCR & BAGUIO
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
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.
INDUSTRIES
CATEGORY
INDUSTRIES
Construction (Office Based)
Education (except pre schools, tutorials & review centers)
Rated
Law Firms
Media
Pharmaceuticals (Distributors)
Sauna, Turkish bath, massage parlors (except spa, salons)
23
"Ineligible" Groups
Construction (Field Based or combined)
Drillers (oil/water/gas)
Firemen
Full Time athletes
Government Institutions
Groups involving special hazards
Logging or Forestry
Ineligible
Manufacturers of Ammunitions
Medical Groups or any healthcare related
Mining / Underground mine workers
NGO, Foundations, Cooperatives, Associations (if enrolling with members, if
employees only yes)
Oil production
Pharmaceutical (manufacturing)
Political groups
Private households
Protection services (security guards)
PRE EXISTING NON DREADED & DREADED CONDITIONS
Non-dreaded conditions are as follows, but not limited to:

a. All benign tumors
b. Anal Fistulae
c. Cervical Polyps (if benign biopsy)
d. Conjunctivitis (except chemical, complicated)
e. Endometrioses/Controlled Dysfunctional Uterine Bleeding (except if caused by uterine malignancies)
f. Hemorrhoids
g. Hepatitis A
h. Gastritis, Duodenitis or Uncomplicated Gastric / Duodenal Ulcer
i. Inactive Pulmonary Tuberculosis
j. Migraine
k. 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.
l. Non-Toxic Goiter (if uncomplicated)
m. Ovarian cysts Uncomplicated Cholecystitis, Cholelithiasis
n. Uncomplicated Hernias (Congenital Hernia will have coverage as listed in the Congenital Clause)
o. Uncomplicated Hypertension
p. Uncomplicated Urinary Tract Infection, Stones/Calculi
q. Urinary Incontinence
Dreaded conditions are as follows, but not limited to:
a. All malignancies (including indicated chemotheraphy or radiotheraphy)
b. Arthritis
c. Blood Dyscrasias such as but not limited to Leukemia, Idiopathic Thrombocytopenic Purpura
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, Aortic Dissection, Abdominal Aortic Aneurysm and Peripheral Vascular Disease and its complications such as
but not limited to Buergers Disease
e. Cataract and Glaucoma
24
f. Cerebrovascular Diseases such as but not limited to Stroke, Cerebral, Cerebellar, Thrombosis, Embolism and
Ruptured aneurysm and all Intracranial Hemorrhage and related conditions
g. Cholecystolithiasis and Choledocholithiasis
h. Chronic Endocrine Disorders and its complications such as but not limited to Dyslipidemia, Obesity, Diabetes Mellitus,
Hormonal Dysfunctions excluding surgical treatment/procedures for obesity
i. Chronic Gastrointestinal Diseases such as but not limited to Irritable Bowel Syndrome, Crohns disease
j. Chronic Genito-urinary Disorders
k. Chronic Kidney Disease/Failure & its complications
l. Chronic Liver Parenchymal Diseases such as but not limited to Liver Cirrhosis, Chronic hepatitis, Non-alcoholic Fatty
Liver Disease/Steatohepatisis (NASH)
m. Chronic Pulmonary Diseases such as but not limited to Bronchial Asthma, Chronic Obstructive Pulmonary Disease
(COPD), emphysema, and other chronic lung disease
n. Collagen Vascular/Connective Tissue/Immunologic Disorders such as but not limited to Systemic Lupus
Erythematosus and its complications
o. Complications of immuno-compromised clinical conditions except HIV/AIDS
p. Extrapulmonary Tuberculosis including Potts disease and Multi-Drug Resistance Case (MDR) case
q. Multiple Organ Failure
r. Muscular Dystrophies such as but not limited to Duchenne, Becker, limb girdle, facioscapulohumeral, myotonic,
oculopharyngeal, distal, and Emery-Dreifuss
s. 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 System Disorders/Diseases
t. Thyroid Dysfunctions due to disease of thyroid such as but not limited to Hypothyroidism and Hyperthyroidism
u. Any illness other than above which would require Critical Care/Intensive Care Unit (ICU) Confinement
v. All complications resulting from above list of conditions
KYC REQUIREMENTS FOR EMPLOYERS

1. Mayor's Permit
2. SEC Certificate
3. Articles of Incorporation
4. General Information Sheet
5. Photocopy of Company ID of Signatory
CORPORATIONS
AND ORGANIZED
UNDER FOREIGN
LAWS
6. Photocopy of at least one (1) valid Government issued ID of owner/authorized signatory. Any
of the ff:
i. Driver's
ii. GSIS-E Card
iii. Passport
iv. Philhealth
v. PRC
vi. SSS
vii. TIN
viiii. UMID
ix. Voter's
7. Signed Maxicare Masterlist (to be provided by the agent upon submission of final masterlist)
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:
i. Board Resolution duly certified by the Corporate Secretary
ii. Notarized Appointment Letter
iii. Special Power of Attorney or similar document
B. For entities registered outside of the Philippines:
25
i. similar documents and/or information shall be obtained duly authenticated by the Philippine
Consulate where said entities are registered
C. For companies with 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)

1. Mayor's Permit
2. SEC Certificate
3. Articles of Partnership
5. 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)
PARTNERSHIPS
C. For companes with that are VAT Exempt or Zero Rated
1. Mayor's Permit
2. SEC Certificate or Certificate of Registration issued by Cooperative Development Authority
(CDA)
4. Articles of Incorporation
4. Latest General Information Sheet
NON GOVERNMENT
ORGANIZATIONS /
COOPERATIVES
SOLE
PROPRIETORSHIP

C. For companes with that are VAT Exempt or Zero Rated:
1. Mayor's Permit
2. DTI Certificate
26
A. If Signatory is not the President / CEO or the highest ranking officer, proof of authority to sign
in behalf of the entity
i. Notarized appointment letter
ii. Special Power of Attorney or similar document
B. For companies that are VAT-Exempt or Zero-Rated
1. Chartered Document
3. Maxicare Questionnaire for Rated Accounts
GOVERNMENT
AGENCIES / LOCAL
GOVERNMENT
EMBASSY

A. If signatory is not the procurement head, head of the agency or head of the local Government,
proof of authority of the signatory
i. Resolution duly certified by the managing body, or
ii. Notarized appointment letter
1. Letter credence for their representative stating
KYC REQUIREMENTS FOR EMPLOYEES & SUBSEQUENT ADDITIONS
a. BIR Form 2316 duly signed by the authorized signatories of Employer
Employees
b. BIR 1604 / Alphabetical List (latest with stamped received by the BIR), or
c. Philhealth ER2
d. SSS R5 and R3 Contribution List
Board Members
a. General Information Sheet

a. BIR Form 2316 duly signed by the authorized signatories of Employer
b. BIR 1604 / Alphabetical List (latest with stamped received by the BIR), or
Consultants
c. Philhealth Members Data Form (MDR), or

d. SSS Contribution List or General Information Sheet
e. Notarized Sworn Certification signed by the authorized signatory
Foreign Nationals
(Expats)
a. Alien Employment Permit issued by the Department of Labor and Employment

b. Photocopy of Alien Certificate of Registration Identity I-card issued by the Bureayu of Immigration
INELIGIBLE INDUSTRIES WITH LESS THAN 100 EMPLOYEES

Requirements for Quotation:
NGOs, Foundations, Churches, Associations, Cooperatives,
All Ineligible Industries mentioned
Associations
1. minimum of 10 employees enrolling
1. minimum of 10 employees enrolling
2. Signed Maxicare Prospective Account Form. You may download
2. Signed Maxicare Prospective Account
the form at http://tinyurl.com/maxicarepcaf
Form. You may download the form at
3. SEC Registration Certificate and/or Cooperative Developing
http://tinyurl.com/maxicarepcaf
Authority Certificate of Registration (for Cooperatives)
27
3. BIR 2303
4. Signed Questionnaire for Rated Accounts. You may download the

form here http://tinyurl.com/maxicarequestionnaire
4. Filled out Corporate Enrollment Sheet

(found at the last 3 pages of this initial
proposal)
5. 2 Year Audited Financial Statements

6. Detailed Master list with Rank Classification, Job Designation and
Description, Birthdays / Age, Gender. You may download the
template here http://tinyurl.com/maxicaredetailed
HOW TO SUBMIT THE REQUIREMENTS:

Option 1: (Via Email) You may scan the document and email it back to us.
Option 2: (Via Fax) You may also fax it to us at (02) 819-9899
ALL COMPANIES & INDUSTRIES WITH 100 EMPLOYEES & UP (OR EMPLOYEES AND DEPENDENTS IF
COMBINED REACHES 100)
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 http://tinyurl.com/maxicarepcaf
2. Excel Softcopy of Company Masterlist (with birthdates or

age, gender, ranks/classification)
3. Filled out Maxicare Product Mix Survey Form. You may

download the form here
http://tinyurl.com/maxicareproductmix
NGOs/Foundations/Cooperatives/Associations with
100 employees and up
1. Signed Maxicare Prospective Account Form. You
may download the form at
http://tinyurl.com/maxicarepcaf
2. SEC Registration Certificate and/or Cooperative
Developing Authority Certificate of Registration (for
Cooperatives)
3. Signed Questionnaire for Rated Accounts. You may
download the form here
http://tinyurl.com/maxicarequestionnaire
4. 2 Year Audited Financial Statements
5. Detailed Master list with Rank Classification, Job
Designation and Description, Birthdays / Age, Gender
6. Filled out Maxicare Product Mix Survey Form. You
may download the form here
http://tinyurl.com/maxicareproductmix
HOW TO SUBMIT THE REQUIREMENTS:

Option 1: (Via Email) You may scan the document and email it back to us.
Option 2: (Via Fax) You may also fax it to us at (02) 819-9899
28
COMPANY INFO SHEET
Company Name:
Nature of Business:
Address:
Telephone Number/s:
Company TIN:
Company Signatory (Name and

Designation)
Contact Person (Name and
Designation)
Contact Person Email Address:
Contact Person Mobile Number:

Term of Payment
(Annual/Semi/Quarterly)
Note: Quarterly option is not available for
Starter & Group Plans and for Provincial
companies with less than 20 employees
Provider Access (With 9 Major) (Yes or

No)
Note: Not Available for Provincial Plans
With Healthway Access (Yes or No)

Note: Not Available for Provincial Plans
Optional Riders (pls enumerate)

Note: Riders cannot be selectively
assigned but must be applied to all
employees or all dependents or both
except for Executive Check Ups which can
be assigned to Executives / Officers only
29
EMPLOYEES
Last Name
First Name
MI Extension
Employee no.
Position Date of Birth Sex Civil Status
Legend:
1
2
3
4
5
6
7
8
9
10
First Name
Middle Name
Last Name
Extension Name
Employee No
Position
Date of Birth
Sex
Civil Status
Plan
Jr. / Sr. / I, II, III, IV etc.
mm/dd/yyyy format
Either F for female or M for male
Single / Married / Separated / Widowed / Divorced
Platinum1, Gold2, Silver2 , Bronze
Plan
30
DEPENDENTS
First Name Middle Initial /Name
Last
Name
Extension
Relationship
Principal/Employee
Legend:
1
2
3
4
5
6
7
8
9
10
First Name
Middle Name
Last Name
Extension Name
Relationship
Principal
Date of Birth
Sex
Civil Status
Plan
Jr. / Sr. / I, II, III, IV etc.

Either as spouse, child, siblings or parent
Name of the employee
mm/dd/yyyy format
Either F for female or M for male
Single / Married / Separated / Widowed / Divorced
Platinum1, Gold2, Silver2 , Bronze
Date of
Birth
Sex
Civil
Status
Plan

2016 Maxicare MaxiPlus Healthcare Program For 5-99 Heads

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2016 Maxicare MaxiPlus Healthcare Program For 5-99 Heads

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Доступные форматы

1

Access to Maxicares own Primary Care Centers located in major hospitals

Access to My Health Clinics

Optional Access to Healthway Clinics

Coverage for Pre Existing Conditions subject to the package chosen:

Covered up to Maximum Benefit Limit

Pre Existing Non Dreaded Conditions up to P5,000

Pre Existing Dreaded up to P5,000

2nd Year onwards

Pre Existing Non Dreaded Conditions up to Maximum Benefit Limit

Pre Existing Dreaded up to P5,000

Outpatient Care and Consultations

In Patient Care and Confinement

Cover Letter & Requirements for Enrollment

Starter Plan Rates for 5-9 Employees

Group Plan Rates for 10-19 Employees

Small Plan Rates for 20-99 Employees

Optional Riders for Nationwide

Provincial Rates (North Luzon, South Luzon, Visayas & Mindanao)

Exclusions and Limitations Provisions

Notes & Special Reminders

Plan Types for Dependents

Provincial Access Directory

Rated & Ineligible Industries

Pre Existing Non Dreaded & Dreaded Conditions

KYC Requirements for Employers

KYC Requirements for Employees

Company Info Sheet

STARTER (5-9 EMPLOYEES)

OPTIONAL RIDERS FOR STARTER PLAN:

Standard Dental (1 prophylaxis and 2 Lightcure)

Annual Check Up Routine Clinic

Life AD&D (Php25,000)

NATIONWIDE WITHOUT HEALTHWAY

NATIONWIDE WITH HEALTHWAY

NATIONWIDE WITHOUT HEALTHWAY

NATIONWIDE WITH HEALTHWAY

SMALL (20-99 Employees)

NATIONWIDE WITHOUT HEALTHWAY

NATIONWIDE WITH HEALTHWAY

NATIONWIDE WITHOUT HEALTHWAY

NATIONWIDE WITH HEALTHWAY

OPTIONAL RIDERS FOR NATIONWIDE:

7. Semi Executive Check Up Outpatient MMC

8. Executive Check Up Outpatient MMC

9. Executive Check Up Inpatient MMC

10. Semi Executive Check Up Outpatient TMC

11. Executive Check Up Outpatient TMC

12. Executive Check Up Inpatient TMC

5. Cancer Benefit (Php200,000)

13. Executive Check Up OP MHC

15. Fee for Service for Senior Citizens

NORTH LUZON (10-99 Employees)

SOUTH LUZON (10-99 Employees)

MINDANAO (20-99 Employees)

VISAYAS (10-99 Employees)

Standard Dental (1 prophylaxis and 2 Lightcure)

Consultations during regular clinic hours,

Pre and Post Natal consultations

Eye, ear, nose and throat (EENT)

Speech therapy (for stroke patients only)

Up to Php 10,000 /eye /member /year

Up to Php 1,000 /member /year