7TH/ F FELIZA Building VA Rufino Street Legaspi Village, Makati City Trunkline: 894-5901 Fax No.

: 894-4642

09162011

ITPPL SERVICES, INC.

I. SCHEDULE OF BENEFITS A. ANNUAL PHYSICAL EXAM (principal members) can be availed only after a minimum of six (6) months of continuous
coverage. This shall be conducted at any IntelliCare Multi-Specialty Clinics or at the company site through a mobile medical team on a scheduled basis for a minimum of one hundred (100) members eight hour shift. This includes: Complete blood count Physical Examination Urinalysis Fecalysis Chest x-ray Electrocardiogram (for members ages thirty-five (35) years and above, or if indicated) Pap smear (for female members ages thirty-five (35) years and above, or if prescribed)

A-1. PREVENTIVE CARE

Periodic medical check-up Management of health problems Counseling on health habits (family planning, diet prescriptions) Record-keeping of medical history Routine immunization (except cost of vaccines) Pre-employment examination shall be covered through reimbursement at any IntelliCare Multi-Specialty Clinics. Applicant will initially pay cost of exam and will be reimbursed (up to Php 400.00) upon inclusion. Exam will be considered as the Annual Physical Exam of the member for the contract period

B. OUT-PATIENT
Medical consultation during regular clinic hours, excluding prescribed medicines Emergency room care Referral to accredited specialist/s Eye, Ear, Nose, and Throat (EENT) consultations Treatment of minor injuries and/or illnesses Laboratory tests, x-rays, and other diagnostic exams prescribed by an IntelliCare physician Minor surgery not requiring confinement Speech and Physical therapy, up to a maximum of twelve (12) sessions Pre-natal and post-natal consultations (14 sessions in a year)

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C. IN-PATIENT / CONFINEMENT
No deposit upon admission Room and board benefits specified in schedule per category Use of operating room and recovery room facilities Standard admission kit (e.g. ID bracelet, thermometer, etc.) Professional services of all attending accredited specialists/anesthesiologists Anesthesia and medications Blood transfusions and intravenous fluids Laboratory tests, x-rays, and other diagnostic examinations Administered medicines Dressings, plaster casts, sutures and other items directly related to the medical management of the patient ICU confinement/ dialysis CT scan and ultrasound (except for maternity cases) Ambulance service is covered up to PHP 2,500.00/member/year, hospital to hospital Assistance in administrative requirements through the liaison officer All other hospital charges deemed necessary by IntelliCare Accredited Physician in the treatment of the patient

C-1. Special Diagnostic Procedures (PEC Pre-existing Condition):

Heart Surgery/Angiography/Angiogram Transurethral Microwave Therapy of Prostate Percutaneous Ultrasonic Nephrolithotomy Lithotripsy Laparoscopic Procedure Arthroscopic Procedure Hysteroscopic Procedure Dialysis Chemotherapy / Radiotherapy Gamma Knife Surgery (based on cobalt/ radiotherapy) CT Scan Ultrasound (except for maternity cases) Thallium Scintigraphy Benign Prostatic Hypertrophy 2D-Echo with Doppler 24-Hour Holter Monitoring Herniorraphy Electromyography Treadmill Stress Test Myelogram Video Gastroscopy Mammography / Sonomammogram Bone Densitometry Scan (Dexascan) Magnetic Resonance Imaging Nuclear Radioactive Isotope Scan Neuroscan Perfusion Scan - up to PEC Limit, not to exceed PHP50,000.00 - up to PEC Limit, not to exceed PHP35,000.00 - up to PEC Limit, not to exceed PHP35,000.00 - up to PEC Limit, not to exceed PHP30,000.00 - up to PEC Limit, not to exceed PHP30,000.00 - up to PEC Limit, not to exceed PHP30,000.00 - up to PEC Limit, not to exceed PHP30,000.00 - up to PEC Limit - up to PEC Limit - up to PEC Limit - up to PEC Limit - up to PEC Limit - up to PEC Limit - up to PEC Limit - up to PEC Limit - up to PEC Limit - up to PEC Limit - up to PEC Limit - up to PEC Limit - up to PEC Limit - up to PEC Limit - up to PEC Limit - up to PEC Limit - maximum PHP6,000.00 - maximum PHP5,000.00 - maximum PHP7,000.00 - maximum PHP5,000.00

NOTE: All new modalities of treatment and/or diagnosis, for which there are no comparable conventional or traditional equivalents/counterparts, will have a maximum limit of PHP5,000.00 subject to the exclusions and limitations of the contract.
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C-2. Room and Board Accommodation:

Involuntary Room Upgrading = Member will be charged with the room and board difference only if he has to occupy a room one category higher than what he is entitled to because of non-availability of the category room. Member should transfer to their category room should it become available. Voluntary Room Upgrading = Member will be charged with the room & board difference including the incremental cost if he chooses and occupies a room one category higher than what they are entitled to.

D. EMERGENCY CARE D-1. IN ACCREDITED HOSPITALS

Doctors services Medicines used Oxygen and intravenous fluids Dressings, casts and sutures Laboratory, x-ray and other diagnostic examinations directly related to the emergency management of the patient IntelliCare agrees to reimburse up to eighty percent (80%) of the total hospital bills including professional fees using IntelliCare Relative Values Scale (RVS) but not exceeding Php30,000.00.

D-2. IN NON-ACCREDITED HOSPITALS

D-3. IN FOREIGN COUNTRIES

Confinement in foreign territory shall be treated as if the member had been confined in a non-accredited hospital facility using IntelliCare Relative Values Scale (RVS) but not exceeding Php30,000.00.

D-4. IN AREAS WITHOUT ACCREDITED HOSPITALS IntelliCare agrees to reimburse up to one hundred percent (100%) of the total hospital bills including professional fees using IntelliCare Relative Values Scale (RVS) but not exceeding Php30,000.00. E. Dental Services:
Dental Examination Annual oral prophylaxis Oral health education through chairside instruction Orthodontic consultation (braces and malposition of teeth) Pre-natal check of teeth and gums Temporo Mandibular Joint (TMJ) consultation (clicking of jaws) Conduct activities on dental health education (e.g. regarding AIDS) Emergency dental treatment for the relief of pain Gum treatment for cases like inflammation or bleeding Temporary fillings Simple extraction of unsavable tooth Recementation of fixed bridges, crowns, jackets, inlays/outlays

ACCOUNT NAME/MGM/SALESREF

II. PRE-EXISTING CONDITION (PEC)

A disability which is diagnosed before enrollment or during the first year of members cover; that which presented signs and symptoms of which the member was aware of; and illnesses whose pathogenesis had started PRIOR TO ENROLLMENT or during the first year of cover even if the member was not aware thereof. The following are automatically considered as pre-existing conditions: Dreaded Diseases Hypertension Thyroid disease, Goiter Cataracts/Glaucoma/ Pterigium Ear nose and/or throat conditions requiring surgery Asthma Tuberculosis Chronic cholecystitis/cholelithiasis and other forms of calcification Hernia Prostate disorders Hemorrhoids and fistulae Tumors Uterine myoma, ovarian cysts endometriosis Buergers disease Varicose veins Scoliosis Arthritis Chronic Allergies Gastric and duodenal ulcers

Principal Members
Pre-existing shall be covered up to the Maximum Benefit Limit (per illness/member).

Dependent Members To have equal waiver of PEC with principals, at least 80% of the total population of principals must enroll their dependents. If the 80% rule is not met, pre-existing condition for dependents shall not be covered. III. MEMBERSHIP ELIGIBILITY
1. 2.

3. 4. 5.

Principal members should be at least eighteen (18) to sixty-five (65) years old. Enrollment of dependents should strictly follow the HIERARCHY RULE (No Substitution shall be allowed): a) Married principals must enroll their spouse first, aged sixty-five (65) and below, followed by the eldest to the youngest child at thirty (30) days old to twenty-one (21) years old b) Single/unmarried members must be acknowledged natural children first, parents aged sixty-five (65) and below, then the siblings, eldest brother/sister to the youngest child at least thirty (30) days old to twenty-one (21) years old Over-aged and Extended dependents (acknowledged natural children, parents and siblings of married principals, nephews, nieces, cousins, in-laws, grandchildren, housemaids, drivers, etc.) are NOT eligible to enroll. Enrollment of dependents must be within thirty (30) days from effectivity date of membership. Newly regularized/hired may enroll their dependents within (30) days from date of regularization/hiring. Maximum limit per illness per year for dependent members enrolled after six (6) months from effective date of coverage shall be availed on a pro-rated basis.

ACCOUNT NAME/MGM/SALESREF

IV. ADDITIONAL BENEFITS

1. Financial Assistance including AD&D (For principals only): Natural death Accidental death Loss of both hands Loss of both feet Loss of sight of both eyes Loss of one hand and one foot Loss of one hand and sight of one eye Loss of one foot and sight of one eye Loss of one hand or one foot Loss of sight of one eye PHP 10,000.00 20,000.00 10,000.00 10,000.00 10,000.00 10,000.00 10,000.00 10,000.00 5,000.00 5,000.00

V. OTHER BENEFITS
1. Most extensive network of affiliated facilities and medical specialists nationwide Accredited Hospitals 406 Accredited Clinics 391 Accredited Doctors 11,929 Accredited Dentist 518 2. Hospital-based members can proceed directly to any of the accredited facilities for emergencies and ordinary consults without being required to proceed first to specific clinics (Open-Door Policy) 3. Widest line-up of Medical Liaison Officers nationwide to assure personalized assistance to the members while they are confined 60 Liaison Officers Nationwide

4. Members are privileged to avail of medical treatments from the mall-based multi-specialty clinics such as Casa Medica, Fortmed, M-Tech, Clinica Manila, etc. 5. Widest In-House Customer Service from Monday to Sunday, 24 hours/7 days a week 62 Call center representative 6. IntelliCare Membership Cards are delivered within 15 working days with the complete membership kit. Membership cards with picture at the option of the client 7. Claims reimbursement turn-around time: 20 working days 8. Generation of Comprehensive Utilization Report 9. Tailor Fitted billing statements segregated billings per cost center 10. IntelliCare Accounts Management team will handle/oversee the day-to-day concerns of the client. An Account Officer will be assigned to coordinate with the client regarding all aspects of servicing. 11. Feedback Forum open access to IntelliCare Management Team 12. Uses Swipe Card Technology
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VI. EXCLUSIONS
INTELLICARE will not pay for any costs or losses arising directly or indirectly from: 1. Services rendered by Non- INTELLICARE doctors, except with the prior written authorization of an INTELLICARE coordinator, or in emergency cases; 2. Hospital charges for special or private nursing services, supplemental foods and medicines like vitamins and minerals (unless prescribed), extra accommodation and non-medical personal appliances such as radio, television, telephone, computer; 3. Health/Annual/Pre-employment check-ups for other companies, Government requirements, insurance purposes, or travel abroad; 4. Recuperation such as confinement in a sanitarium or convalescent home, rehabilitation medicines (including work-ups), custodial, domiciliary care, Government imposed quarantines; 5. Medical certificates; 6. Professional fees in medico-legal cases; 7. Refusal to undergo recommended treatment or demanding treatment for which INTELLICARE doctors believe a professionally acceptable alternative exists; 8. Blood screening; 9. Vaccines for immunization, anti-rabies, anti-venom, steroid injections; 10. Organ transplants or acquisition of an organ; 11. Procurement or use of eyeglasses, special braces, steel implants, buckles for retinal detachment, wheelchairs or prosthetic appliances including but not limited to items such as artificial limbs, hearing aids, crutches, intra-ocular lens, contact lenses, artificial hips or joints, pacemakers, mesh (for hernia), stents and ventilating tubes; 12. Determining/ruling out of PEC during the first 12 months of membership if result is positive; 13. Determining /ruling out of hepatitis or tuberculosis if result is negative.

TREATMENT / PROCEDURES
1. Circumcision, infertility or fertility and virility/potency (erectile dysfunctions), artificial insemination, sex change; 2. Laser eye surgery for myopia or error of refraction; 3. Acupuncture, chiropractic treatment, iridology, chelation; cell implant therapy; 4. Speech or physical therapy in excess of twelve (12) sessions; 5. Sleep Study, unless directly related to an organic illness and the maximum limit is PHP5,000.00; 6. Reconstructive surgery except to treat a functional defect directly caused by accident or illness covered herein, cautery of warts, milia, xyringoma, facial moles, aesthetic, cosmetic or beautification alterations, sclerotherapy;
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7. Out-patient medicines and medical supplies except in emergency cases; 8. All other treatments, laboratory examinations, diagnostic procedures and surgical procedures not specifically defined in this Agreement are considered not covered (Example but not limited to the following: Dental Surgery, Dental X-Ray, etc.).

EXTERNAL FORCES / ACTIVITIES

1. War-like or combat operations, Government declared acts of rebellion, active participation in riots or demonstrations, strikes or labor disputes, terrorism, provoked criminal acts, violation of a law or ordinance, commission of a crime whether consummated or not, serving in military, naval, or air forces of any country or international authority, unnecessary exposure to imminent danger or hazard, active participation in setting off and/or handling pyrotechnic materials, attempted suicide, self inflicted injuries; 2. Participation in hazardous activities such as skydiving, motor sports, judo, karate, taekwondo, boxing, wrestling, bungee jumping, scuba diving, snorkeling, horseback riding, polo, hunting, mountain climbing, rock climbing, hang gliding, spelunking, ballooning, gymnastics, or partaking as a paid professional or semi-professional in any sport; 3. Government declared epidemics; complete or partial destruction of hospital by fire; flood, or other perils; earthquake, tsunami, volcanic eruption; acts or order of Government, brownouts; 4. Aviation or aeronautics or sea travel other than as a fare-paying passenger on a licensed aircraft/vessel operated by a recognized airline/operator; 5. Computer hardware or software affected by date/time based functionality or the use of any date format.

ILLNESSES / CONDITIONS
1. Congenital abnormalities such as neonatal hernia, indirect hernia, hemangioma, phimosis, harelip, clubfoot, cerebral palsy, renal diseases such as medullary sponge kidney, pediatric cardiovascular work-up and the like; 2. Developmental delay; 3. Neuro-developmental disorders such as ADHD Attention Deficit Hyperactive Disorder, Autism; Genetic Disorder which may result to Mental Retardation (e.g. Down Syndrome); and other condition which may require speech/ physical and other related therapies; 4. Sexually transmitted diseases, AIDS and AIDS-related complex or condition; 5. Substance addiction or reaction to use of prohibited drugs, alcoholism, alcohol intake, anxiety reaction, psychiatric and psychological illnesses, neurotic and psychiatric behavior disorders, or accidents arising from these conditions; 6. Guillaine-Barre Syndrome; 7. PEC during the first twelve (12) months of cover; 8. Hypersensitivity tests to check for allergies and desensitization; 9. Any disability which may have affected a Dependent prior to the thirtieth (30th) day after birth; 10. Pregnancy, complications due to abnormal pregnancies such as but not limited to ectopic pregnancy, tube pregnancy, hmole, abruptio placenta, placenta previa etc., childbirth, miscarriage, abortion.
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