HMO Benefit Plan

Fees & Payment

(Effective Jan. 1, 2020)

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 HMO Benefit Plan - Fees & Payment
Effective Date: January 1, 2020

Annual Premium
This section provides information on the cost of premium for dependents and how such is computed. Read
through this section carefully for your information and guidance. Note that enrollment of dependents is
voluntary. No employee is required to do so especially for those who will bear the cost of their
dependent’s HMO Premium. For more information on the company’s health plan, refer to Sykes HMO Benefit
Plan available in Intellicare member site.

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 HMO Benefit Plan - Fees & Payment
Effective Date: January 1, 2020

I. Terms of Payment:

• The cost of employee paid premiums shall be paid within the year via salary deductions over a period
of up to eleven (11) months (22 payrolls for staff and 11 payrolls for managers). Deduction starts on
February 15 payroll.

• For employees hired in the middle of the 2020 benefit year, dependent/s premium is pro-rated based on
effective date of coverage and amortized over remaining months of the year. Deduction will commence
in the nearest applicable pay period from approval of dependent/s coverage.

• ***For employees hired starting January 1, 2012, premium for first two dependents of Single
Parents/Married employees is FREE but subject to compensation tax which will be shouldered by
employee. Corresponding tax is payable within the year.

• Sykes reserves the right to adjust the amount of amortization as necessary to complete the annual
premium payments by December 31 payroll.

• Pay slips will reflect the following description to identify the type of payment made for each dependent:

For Married/Single Parents (spouse/children/domestic partner as dependent):

o 2020 HMO Subsidy D1 – First dependent in hierarchy where the premium is free but is reflected
as earnings where taxes due shall be applied
o 2020 HMO Subsidy D2 – Second dependent in hierarchy where the premium is free but is
reflected as earnings where taxes due shall be applied
o 2020 HMO Premium D3 – Third dependent in hierarchy where the full premium is paid by the
employee
o 2020 HMO Premium D4 – Forth dependent in hierarchy where the full premium is paid by the
employee

For Single employees (parents/siblings/domestic partner as dependent):

o 2020 HMO Premium D1,D2 and where applicable D3,D4,D5 – Dependents where the full cost
of premium is paid by the employee
o The same description will apply for dependents of Comp2 employees on 50/50 cost sharing.

• To illustrate the computation of deduction, see samples below:

Example No 1
- Employee A, hired January 1, 2013, Married and successfully enrolled four (4) Dependents
- Membership Period: January 1 to December 31, 2020
- Referring to Annual premium matrix (page 2), the cost per dependent is PhP 11,897.00

Amortization
PAYSLIP DESCRIPTION Premium description Cost Per payday Full Year Total Period
2020 HMO SUBSIDY D1 HMO cost is free but subject to Tax PhP 540.77 PhP 11,897.00 Feb 15 to Dec 31, 2020
2020 HMO SUBSIDY D2 HMO cost is free but subject to Tax PhP 540.77 PhP 11,897.00 Feb 15 to Dec 31, 2020
2020 HMO PREMIUM D3 HMO cost fully paid by employee PhP 540.77 PhP 11,897.00 Feb 15 to Dec 31, 2020
2020 HMO PREMIUM D4 HMO cost fully paid by employee PhP 540.77 PhP 11,897.00 Feb 15 to Dec 31, 2020

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 HMO Benefit Plan - Fees & Payment
Effective Date: January 1, 2020

Example No 2
- Employee B, hired January 1, 2013, Single and successfully enrolled two (2) Dependents
- Membership Period: January 1 to December 31, 2020
- Referring to Annual premium matrix (page 2), the cost per dependent is PhP 19,203.00

Amortization
PAYSLIP DESCRIPTION Premium description Cost Per payday Full Year Total Period
2020 HMO PREMIUM D1 HMO cost fully paid by employee PhP 872.86 PhP 19,203.00 Feb 15 to Dec 31, 2020
2020 HMO PREMIUM D2 HMO cost fully paid by employee PhP 872.86 PhP 19,203.00 Feb 15 to Dec 31, 2020

Example No 3
- Employee C, hired April 25, 2020, Married and successfully enrolled three (3) Dependents
Example Nodate,
- Based on hire 3 the membership takes effect May 16, 2020
-- Referring
EmployeetoA,Annual
hired April 25, 2020,
premium Married
matrix (pageand successfully
2), the enrolled four
cost per dependent (4) Dependents
is PhP 11,897.00
- Based on hire date, the membership takes effect May 16, 2020

Dependent 1 Dependent 1 Dependent 2 Dependent 2

Dependent 3 Dependent 3
(A) Annual Premium(A) Annual Premium 11,897.00 11,897.00
11,897.00 11,897.00
11,897.00 11,897.00
(B) Effective date of coverage
(B) Effective date of coverage 16-May-19 16-May-19
16-May-19 16-May-1916-May-19 16-May-19
(C) No. of days from (B) to(C)
endNo. of days from (B) to end of year
of year 230.00 230.00
230.00 230.00
230.00 230.00
(D) Pro-ration: (C) divided by 365 days 63% 63% 63%
(D) Pro-ration: (C) divided by 365 days 63% 63% 63%
(E) Actual Premium for the year 7,496.74 7,496.74 7,496.74
(E) Actual Premium for the year 7,496.74 7,496.74 7,496.74
where (E) = (A) X (D)
where (E) = (A) X (D)

- Deductions will take effect in the nearest applicable pay period

Amortization
PAYSLIP DESCRIPTION Premium description Cost Per payday Full Year Total Period
2020 HMO SUBSIDY D1 HMO cost is free but subject to Tax PHP 535.48 PHP 7,496.74 Jun 15 to Dec 31, 2020
2020 HMO SUBSIDY D2 HMO cost is free but subject to Tax PHP 535.48 PHP 7,496.74 Jun 15 to Dec 31, 2020
2020 HMO PREMIUM D3 HMO cost fully paid by employee PHP 535.48 PHP 7,496.74 Jun 15 to Dec 31, 2020

II. Cancellation of Enrolled Dependents and/or Separation from employment

• Dependents coverage is co-terminus with the employee. Once enrolled, cancellation of dependents is
allowed only on the following instances:
o Change of marital status from Single to Married/Single parent. Existing dependent’s parent
coverage will be automatically revoked.
o Death of a dependent
o Dependent/s migrated abroad or an OFW
For reasons not mentioned above, employee will be only be allowed to cancel on the next renewal
period.

• Once cancellation is approved, coverage shall be revoked. When the dependent’s premium is paid by
the employee, re-computation shall be made. This will be completed after two (2) months from approved
cancellation date. Any existing deduction in employee’s payroll will continue until the cost of
accountability is determined, finalized and paid in full.

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 HMO Benefit Plan - Fees & Payment
Effective Date: January 1, 2020

• Cancellation/Separation Rules on Employee-Paid Premiums

In the event of employee separation, regardless of nature and reason, employee shall remain liable for
the premium of his/her dependent/s. This amount will form part of employee’s final pay deduction.

▪ For employee separations or cancellation made from January – June, pro-rated amount shall
be computed based on employee coverage and utilization (see example 4).
▪ For employee separations or cancellations made July onwards, Full amount of membership
premium shall be collected from the employee (see example 5).
▪ All utilizations (or the actual cost of clinic and hospitalization services used) shall always be
added in the total payment due. If total utilization is more than the Annual Premium, employee
is required to pay the full amount of the computed Premium regardless of the date of separation
or cancellation (see example 6).
▪ Any payment due shall be compared against the total amount deducted from employee’s payroll.
If the result is greater than what has been deducted, the amount will be refunded to employee.
However, if the amount deducted from employee’s payroll is insufficient, additional deductions
from payroll shall be performed.
a) For active employees, remaining balance will be amortized until Dec. 31 of the current
year
b) For separated employees, deducted from final pay

Example 4
- Employee D, hired November 23, 2015, Single and successfully enrolled two (2) Dependents
- Membership Period: January 1 to December 31, 2020
- Separation Date: May 8, 2020
- Referring to Annual premium matrix (page 2), the cost per dependent is PhP 19,203.00

Dependent 1 Dependent 2
Annual Premium 19,203.00 19,203.00
(A) No. of months stayed/covered 5.00 5.00
(B) Membership Period in Months 12.00 12.00
(C) Membership tenure in %: 42% 42%
where (C) = (A) divided by (B)

Computation
(D) Admin Cost OF 15% (A) x 15% 2,880.45 2,880.45
(E) Annual Premium X 85% 16,322.55 16,322.55
(F) Actual cost of premium (C) X (D) 6,801.06 6,801.06
(G) Member Utilization 300.00 1,000.00
FINAL PAY DEDUCTION PER MEMBER (D+F+G) 9,981.51 10,681.51

TOTAL DEDUCTION 20,663.03

Example 5
- Employee E, hired December 7, 2014, Single and successfully enrolled two (2) Dependents
- Membership Period: January 1 to December 31, 2020
- Separation Date: July 7, 2010
- Referring to Annual premium matrix (page 2), the cost per dependent is PhP 19,203.00

Dependent 1 Dependent 2
Annual Premium 19,203.00 19,203.00

TOTAL DEDUCTION 38,406.00

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 HMO Benefit Plan - Fees & Payment
Effective Date: January 1, 2020

Example 6
- Employee F, hired September 7, 2016, Single and successfully enrolled two (2) Dependents
- Membership Period: January 1 to December 31, 2020
- Separation Date: May 8, 2020
- Referring to Annual premium matrix (page 2), the cost per dependent is PhP 19,203.00

Dependent 1 Dependent 2
Annual Premium 19,203.00 19,203.00
(A) No. of months stayed/covered 5.00 5.00
(B) Membership Period in Months 12.00 12.00
(C) Membership tenure in %: 42% 42%
where (C) = (A) divided by (B)

Computation
(D) Admin Cost OF 15% (A) x 15% 2,880.45 2,880.45
(E) Annual Premium X 85% 16,322.55 16,322.55
(F) Actual cost of premium (C) X (D) 6,801.06 6,801.06
(G) Member Utilization 90,000.00 75,000.00
FINAL PAY DEDUCTION PER MEMBER 19,203.00 19,203.00
Total utilization is more than the Annual Premium

TOTAL DEDUCTION 38,406.00

Notice: This document contains information on HMO Policies of Sykes Asia applicable at the time of publishing. Amendments to or
updating of the information in this material may be done from time to time. The reader is kindly requested, at all times, to verify the
correctness of the published information with the Sykes Human Resources.

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