BATCH UPLOAD TEMPLATE - ENROLLMENT (CORPORATE)

Scope: Use of this template is required in processing below listed transactions:

a. New Business
b. Renewal
c. Additional Enrollees
d. Transfer of Dependent(s) under New Principal (Married Employees employed in the same company)

Legend:
Mandatory Fields to be filled out by Account / Authorized Repsentative (s) - Existing on Batch Upload Template
Mandatory Fields to be filled out by Account / Authorized Representative(s) - Additional Columns on the Batch Upload Temp
Optional Fields to be filled out by Account / Authorized Representative(s) if applicable

Reminders:
1. Refer to comments on the template for specific instructions per column.
2. Completeness and accuracy of data provided on the template is required to facilitate prompt processing.
3. Discrepancies in provided data will be confirmed with Account Handler(s)/ Authorized Representative(s) prior processing.

Required File Name:

Account Name_Enrollment_Batch, Date_No. of Enrollees/Members
Maxicare Healthcare Corp_Enrollment_Batch031816_1000

List of Applicable Documentary Requirements:

Skipping of Heirarchy - refers to the non-enrollment of dependents based on the specified priority of Maxicare.
1. HMO ID Card with Validity Date or Certificate of Coverage for dependents with other HMO coverage.
2. Copy of Employment Contract or Certificate of Employment for dependents working abroad.
3. Copy of Passport with Visa or proof of residency for dependents who migrated/ will migrate overseas.

Note: Other documentary requirements may be requested as necessary.

d Template
the Batch Upload Template

s) prior processing.

Maxicare.
 EmpNo LastName FirstName MiddleName Extension Gender Email MobileNo
1168 0110 4712 8817 Anam Eden Aldea F 09954598810
1168 0110 4054 2923 Alberto Kathlene Abuy F 09202847245
1168 0110 2525 9956 Alvaro Ernesto Diala Jr M 09954598854
1168 0110 3494 5215 Ambuyoc Daniel De Jesus Sr. M 09954723404
1168 0110 2741 6182 Arcon Janice Angela NMN F 09219635050
1168 0110 5716 2789 Arevalo Melvin Asaytono M 09175848233
1168 0110 2741 6158 Austria Grace Labio F 09954598809
1168 0110 2741 6240 Basobas Einstein Abadam M 09984598845
1168 0110 5628 2802 Bual John Dexter Rosario M 09397649131
1168 0110 4889 7477 Montero Angelyn Bulanadi F 09770166779
1168 0110 6804 0404 Ceralde Christopher Gelisanga M 09218101030
1168 0110 6009 0530 Dahilig Jennifer Zaila F 09171426801
1168 0110 2741 6174 Danan Penelope Amemita F 09770813089
1168 0110 2932 2719 Dedicatoria Athela Elamparo F 09473776326
1168 0110 4889 7493 Rellora Sharon Ducot F 09094008215
1168 0110 3494 5199 Elbambo Ethel Joy Tandiaman F 09954598811
1168 0110 2741 6166 Enriquez Maria Socorro Burlaza F 09192442463
1168 0110 6009 0548 Lindayag Manuel Garcia Jr. M 09453328591
1168 0110 6007 3593 Lintag Jose Gatdula M 09950171808
1168 0110 4889 7444 Mamaril Jelly Anne Legaspi F 09293373358
1168 0110 4889 7402 Martin Michael John Sagadal M 09462193984
1168 0110 2932 2701 Millana Sheena Mancio F 09954598814
1168 0110 2919 3078 Oribello Lalaine Garcia F 09086303930
1168 0110 4053 4821 Santiago Erwin Del Rosario M 09232686156
1168 0110 6009 0522 Pizarro Aubrey Resolme F 09567845452
1168 0110 2919 3086 Quindara Rjay Ramos M 09954598847
Santos Brenda Castro F 09194649379
Malana Renea Bayle F 09957561411
Talosig Raquel Reyes F 09155608689
Lugtu Mark Anthony Plattao M 09369889687
Alipan Marven Amaro M 09120127153
Bacunawa Anthony NMN M 09175442708
Casinillo Sarah Jane NMN F 09069723120
Pescante Raniel Rescuerdo M 09276230878
MemberType BirthDate RelationshipID CivilStat EffectiveDate DateHired RegDate PHIC
P 11/15/1961 Married 11/02/1987 05/01/1988 R
P 1/24/1984 Single 03/12/2018 09/11/2018 R
P 10/26/1979 Married 11/11/2002 05/10/2003 R
P 9/28/1970 Married 04/06/2017 10/05/2017 R
P 2/10/1981 Single 06/21/2012 12/20/2012 R
P 10/29/1979 Single 09/13/2017 03/12/2018 R
P 2/22/1969 Married 05/29/2006 11/28/2006 R
P 2/17/1975 Married 03/01/2010 09/30/2010 R
P 11/30/1981 Single 05/30/2016 11/29/2016 R
P 10/23/1988 Married 04/08/2013 10/07/2013 R
P 12/9/1981 Single 09/13/2017 03/12/2018 R
P 1/29/1984 Single 11/22/2017 05/22/2018 R
P 8/27/1985 Single 09/17/2012 03/16/2013 R
P 1/12/1978 Single 09/06/2013 03/05/2014 R
P 6/24/1982 Married 07/25/2008 01/24/2009 R
P 12/20/1977 Married 07/02/2008 01/01/2009 R
P 12/26/1960 Married 11/19/1985 05/18/1986 R
P 10/2/1989 Single 10/10/2017 04/09/2018 R
P 3/19/1954 Married 10/10/2018 04/09/2019 R
P 9/3/1993 Single 11/06/2016 05/05/2017 R
P 4/16/1987 Single 11/06/2016 05/05/2017 R
P 4/12/1984 Married 02/04/2014 08/03/2014 R
P 1/30/1966 Married 08/03/1989 02/02/1990 R
P 7/29/1988 Single 07/27/2017 01/26/2018 R
P 11/17/1974 Married 01/22/2018 07/21/2018 R
P 9/11/1986 Single 08/26/2009 02/25/2010 R
P 01/07/1990 Single 11/06/2019 05/05/2020 R
P 04/13/1974 Married 09/11/2019 03/10/2020 R
P 04/11/1982 Single 03/27/2019 09/26/2019 R
P 01/04/1996 Single 10/25/2019 04/24/2020 R
P 08/31/1973 Married 02/14/1996 08/13/1996 R
P 04/20/1978 Single 11/07/2018 05/06/2019 R
P 07/18/1993 Single 10/11/2017 04/10/2018 R
P 05/30/1990 Single 02/15/2018 08/14/2018 R
 Form Template Control: Underwriting and Enrollment Fulfillment/May 27, 2019/FO-UEF-0.037/Rev.00
SENIOR CITIZEN ID.
POSITION PLAN TYPE BRANCH NAME PHILHEALTH NO. NO.
Commisary Manager Gold 07-050182695-0
Executive Secretary Silver 07-050506919-4
Asst. Manager-Rooms Silver 07-050448473-2
Division Office
Night Duty Supervisor Silver 07-050353375-6
Restaurant Manager Silver 07-050251195-3
Comptroller Silver 10-050049657-0
Accounting Manager Silver 07-050143657-5
Business Development Silver 07-050146339-4
Manager
Sales Supervisor Silver 07-025208954-1
Asst. Manager Silver 07-050667495-4
Supervisor Silver 07-050421038-1
Managemnet Trainee Silver 03-050395239-0
Asst. Business Silver 07-050602028-8
Development
Senior Manager
Supervisor-Rooms Silver 07-025434995-8
Division Office
Supervisor Silver 07-200786801-5
Purchasing Officer Silver 07-050217333-0
Treasury Officer Silver 07-050143672-9
Sales Officer Silver 07-025612988-2
General Manager Silver 03-050008053-8
Store Supervisor Silver 07-050764872-8
Head Line Cook Silver 07-050495785-1
Area Manager Silver 07-025360775-9
Head Cashier Silver 07-050143731-8
OIC Silver 21-050009263-1
Operations Manager Silver 19-089755030-3
Accounting Head Silver 07-050538968-7
Accounting Officer Silver 07-050832075-0
CHRD Consultant Silver 01-050029865-6
Marketing Manager Silver 07-050468732-3
Accounting Officer Silver 07-251821843-4
Head Production Cook Silver 07-050182693-4
Senior Area Manager Silver 07-050310237-2
Management Trainee Silver 08-025471688-3
Marketing Officer Silver 02-050915447-4
rol: Underwriting and Enrollment Fulfillment/May 27, 2019/FO-UEF-0.037/Rev.00

Client Remarks

Enrolment upon renewal

Enrolment upon renewal
Enrolment upon renewal
Enrolment upon renewal
Enrolment upon renewal

Enrolment upon renewal

Enrolment upon renewal