2017 Maxicare MaxiPlus SMEs

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For inquiries: contact us at (02)

6247010; (02) 2169252;
09178327044; 09178078814 or email
product.omg@gmail.com
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 3 employees can now enroll under Maxicare’s 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 Maxicare’s own Primary Care Centers located in major hospitals and other strategic locations
 Access to My Health Clinics
 Optional Access to Top Major Hospitals (Asian Hospital & Medical Center, The Medical City, St. Luke's Medical
Center QC, St. Lukes Medical Center Global City, Makati Medical Center, Cardinal Santos Medical Center,
Cebu Doctors Hospital, Chong Hua Hospital & Davao Doctors Hospital)
 Optional Access to Healthway Clinics
 Customized and lower pricing for regional accounts (North Luzon, South Luzon, Visayas & Mindanao)
 Coverage for Pre Existing Conditions subject to the package chosen:
1st Year 2nd Year onwards
Pre Existing Pre Existing Pre Existing Pre Existing
Access Size
Non Dreaded Dreaded Non Dreaded Dreaded
Conditions Conditions Conditions Conditions
3-9 Employees / Starter
Plan up to P5,000 up to P5,000 up to MBL up to P5,000
Nationwide 10-19 Employees /
Group Plan & 20-99 up to MBL
Employees / Small Plan
North Luzon
10-19 Employees / Platinum - Up to Php20,000; Gold up to MBL
Group Plan & 20-99 - Up to 15,000; Silver- Up to
South Luzon Employees / Small Plan 10,000; Bronze- Up to 5,000
Visayas
up to MBL
Mindanao
For inquiries you may contact us at: (02) 6247010; (02) 2169252; 09178327044; 09178078814; product.omg@gmail.com
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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) 635-9058.
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. Any gov’t issued ID of the signatory
4. KYC Requirements. See Pages 38-40 for the list of KYC Requirements. (to be submitted to us after we
prepare the conforme for your signature).
Note: The package attached is only applicable to companies with 3-99 employees. For companies with 100 employees
and up (or of the combined headcount of the employees and dependents exceeds 100), a separate proposal will be
drafted. Proposal is not applicable to accounts with previous experience with Maxicare. A separate proposal will be
drafted.
Should you have any other questions, you may call us at (02) 6247010; (02) 216-9252, Mobile 09178327044;
09178078814 or email product.omg@gmail.com
Thank you.
Office of Mark Gastardo

Accredited Agent License Code: A000494
6 years (2011-2016) Top 5 Performing AIA Nationwide
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TABLE OF CONTENTS
Introduction
Cover Letter 1-2
Table of Contents 3
Nationwide Access Rates
3-9 Employees Starter Plan Rates with Nationwide Access 4-5
10-19 Employees Group Plan Rates with Nationwide Access 6-7
20-99 Employees Small Plan Rates with Nationwide Access 8-10
Optional Riders Rates for Nationwide Access 10-11
Provincial Access Rates
10-99 Employees Provincial Access Rates (North Luzon, South Luzon, Visayas & Mindanao) 12-14
Provincial Access Directory 15
Benefits & Limitations
Summary of Benefits 16-25
Rider Benefits Description & Inclusions 25-32
Exclusions and Limitations Provisions 32-34
Notes & Special Reminders 34
Pre Existing Non Dreaded & Dreaded Conditions 35
List of Providers
List of Hospitals & Clinics 36
List of Doctors 36
List of Dentists thru Dental Hub 36
List of ACU Annual Check Up Providers 36
Other Industries & Companies with 100 employees & up
Rated & Ineligible Industries 36
Ineligible Industries with less than 100 employees Requirements for Quotation 37
All Companies & Industries with 100 employees & up Requirements for Quotation 37
Enrollment Guidelines
Plan Types for Employees 38
Plan Types for Dependents 38-39
KYC Requirements for Employers 39-41
KYC Requirements for Employees 41
Enrollment Process Step by Step 42
Enrollment Form
Company Info Sheet 43
Employees' Masterlist 44
Dependents' Masterlist 45
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Nationwide Access Rates

2017-OCT to 2018-SEPT STARTER (3-9 EMPLOYEES)
STANDARD INDUSTRIES
PLAN TYPES ROOM MBL NATIONWIDE WITHOUT NATIONWIDE WITH
HEALTHWAY HEALTHWAY
Without 9 Without 9
EMPLOYEES With 9 Major With 9 Major
Major Major
Ann Semi Ann Semi Ann Semi Ann Semi
PLATINUM 1 Small Suite 230,000 15,386 8,308 20,311 10,968 16,157 8,725 21,325 11,516
PLATINUM 2 Lrg Pvt 185,000 12,702 6,859 16,680 9,007 13,336 7,201 17,512 9,456
GOLD 1 Reg Pvt 160,000 11,379 6,145 14,942 8,069 11,955 6,456 15,696 8,476
GOLD 2 Reg Pvt 110,000 10,751 5,806 14,044 7,584 11,288 6,096 14,746 7,963
SILVER 1 Semi-Pvt 90,000 8,830 4,768 11,449 6,182 9,272 5,007 12,022 6,492
SILVER 2 Semi-Pvt 70,000 8,549 4,616 11,084 5,985 8,979 4,849 11,640 6,286
BRONZE Ward 60,000 7,146 3,859 9,179 4,957 7,504 4,052 9,640 5,206
DEPENDENTS
PLATINUM 2 Lrg Pvt 185,000 17,329 9,358 22,935 12,385 18,195 9,825 24,081 13,004
GOLD 1 Reg Pvt 160,000 15,508 8,374 20,524 11,083 16,290 8,797 21,554 11,639
GOLD 2 Reg Pvt 110,000 14,879 8,035 19,625 10,598 15,624 8,437 20,606 11,127
SILVER 1 Semi-Pvt 90,000 11,885 6,418 15,578 8,412 12,481 6,740 16,357 8,833
SILVER 2 Semi-Pvt 70,000 11,603 6,266 15,212 8,214 12,184 6,579 15,974 8,626
BRONZE Ward 60,000 9,596 5,182 12,492 6,746 10,075 5,441 13,116 7,083
NO 2018 OPTIONAL RIDERS FOR STARTER PLAN Ann Semi

1 Annual Check up Routine (Clinic) 805 435
2 Standard Dental (1 oral propahylaxis) 369 199
3 Life Insurance with AD&D (Php50,000) 142 77
4 Semi Executive Check Up Outpatient Makati Medical Center 5,781 3,122
5 Executive Check Up Outpatient Makati Medical Center 17,523 9,462
6 Executive Check Up Inpatient Makati Medical Center 32,516 17,559
7 Semi Executive Check Up Outpatient The Medical City 16,000 8,640
8 Executive Check Up Outpatient The Medical City 35,045 18,924
9 Executive Check Up Inpatient The Medical City 53,381 28,826
10 Executive Check Up OP My Health Clinic 3,604 1,946
Note: Starter Plan is valid until September 30, 2018
*Standard Industries are companies whose nature of business are NOT Construction (office based), Education (except pre schools,
tutorials & review centers), Law Firms, Media, Pharmaceuticals (Distributors), Sauna, Turkish bath, massage parlors (except spa,
salons), Construction (Field Based or combined), Drillers (oil/water/gas), Firemen, Full Time athletes, Government Institutions, Groups
involving special hazards, Logging or Forestry, Manufacturers of Ammunitions, Medical Groups or any healthcare related, Mining /
Underground mine workers, NGOs, Foundations, Cooperatives, Associations, Oil production, Pharmaceutical (manufacturing), Political
groups, Private households, Protection services (security guards), Previous accounts of Maxicare
** 9 Major Hospitals are: Asian Hospital & Medical Center, The Medical City, St. Luke's Medical Center QC, St. Lukes Medical Center
Global City, Makati Medical Center, Cardinal Santos Medical Center, Cebu Doctors Hospital, Chong Hua Hospital & Davao Doctors
Hospital
***Healthway Clinics are located in Alabang Town Center, Edsa Shangri-la Mall, Festival Mall, Greenbelt 5, Market! Market!, Adriatico
Tower Padre Faura & SM North
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2018 GROUP (10-19-Employees)
STANDARD INDUSTRIES
HEALTHWAY HEALTHWAY
Without 9 Without 9
Major Major
PLATINUM 1 Open Suite 500,000 29,984 16,191 39,579 21,373 31,483 17,001 41,558 22,441
PLATINUM 4 Open Pvt 250,000 18,504 9,992 24,341 13,144 19,428 10,491 25,558 13,801
PLATINUM 6 Lrg Pvt 200,000 17,435 9,415 22,896 12,364 18,306 9,885 24,040 12,982
GOLD 1 Reg Pvt 200,000 15,811 8,538 20,703 11,180 16,602 8,965 21,737 11,738
GOLD 2 Reg Pvt 150,000 15,304 8,264 20,016 10,809 16,066 8,676 21,017 11,349
GOLD 3 Reg Pvt 110,000 14,758 7,969 19,279 10,411 15,495 8,367 20,243 10,931
SILVER 1 Semi-Pvt 90,000 12,122 6,546 15,716 8,487 12,728 6,873 16,504 8,912
SILVER 2 Semi-Pvt 80,000 11,796 6,370 15,276 8,249 12,386 6,688 16,040 8,662
BRONZE Ward 70,000 9,841 5,314 12,632 6,821 10,331 5,579 13,265 7,163
DEPENDENTS
PLATINUM 6 Lrg Pvt 200,000 23,788 12,846 31,484 17,001 24,977 13,488 33,056 17,850
GOLD 1 Reg Pvt 200,000 21,480 11,599 28,364 15,317 22,553 12,179 29,779 16,081
GOLD 2 Reg Pvt 150,000 20,969 11,323 27,675 14,945 22,019 11,890 29,057 15,691
GOLD 3 Reg Pvt 110,000 20,425 11,030 26,940 14,548 21,447 11,581 28,286 15,274
SILVER 1 Semi-Pvt 90,000 16,316 8,811 21,384 11,547 17,133 9,252 22,453 12,125
SILVER 2 Semi-Pvt 80,000 15,988 8,634 20,943 11,309 16,786 9,064 21,990 11,875
BRONZE Ward 70,000 13,203 7,130 17,178 9,276 13,861 7,485 18,036 9,739
Note: Group Plan is valid until December 31, 2018 and based on a 12 - month coverage only
*Standard Industries are companies whose nature of business are NOT Construction (office based), Education (except pre schools,
tutorials & review centers), Law Firms, Media, Pharmaceuticals (Distributors), Sauna, Turkish bath, massage parlors (except spa,
salons), Construction (Field Based or combined), Drillers (oil/water/gas), Firemen, Full Time athletes, Government Institutions, Groups
involving special hazards, Logging or Forestry, Manufacturers of Ammunitions, Medical Groups or any healthcare related, Mining /
Underground mine workers, NGOs, Foundations, Cooperatives, Associations, Oil production, Pharmaceutical (manufacturing), Political
groups, Private households, Protection services (security guards)
Hospital
2018 GROUP (10-19-Employees)
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RATED INDUSTRIES
HEALTHWAY HEALTHWAY
Without 9 Without 9
Major Major
PLATINUM 6 Lrg Pvt 200,000 22,059 11,912 28,970 15,644 23,162 12,507 30,417 16,425
GOLD 1 Reg Pvt 200,000 20,005 10,803 26,194 14,145 21,003 11,342 27,503 14,852
GOLD 2 Reg Pvt 150,000 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
BRONZE Ward 70,000 12,451 6,724 15,982 8,630 13,071 7,058 16,784 9,063
DEPENDENTS
PLATINUM 6 Lrg Pvt 200,000 30,097 16,252 39,834 21,510 31,602 17,065 41,824 22,585
GOLD 1 Reg Pvt 200,000 27,179 14,677 35,886 19,378 28,535 15,409 37,678 20,346
GOLD 2 Reg Pvt 150,000 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
Note: Group Plan is valid until December 31, 2018 and based on a 12 - month coverage only
*Rated Industries are Construction (office based), Education (except pre schools, tutorials & review centers), Law Firms, Media,
Pharmaceuticals (Distributors), Sauna, Turkish bath, massage parlors (except spa, salons)
Hospital
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2018 SMALL (20-99 Employees)

STANDARD INDUSTRIES
PLAN TYPES ROOM MBL
NATIONWIDE WITHOUT HEALTHWAY NATIONWIDE WITH HEALTHWAY
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
Open
PLATINUM 1 500,000 27,944 15,090 7,824 36,885 19,918 10,328
Suite 26,612 14,370 7,451 35,129 18,970 9,836
Small
PLATINUM 2 350,000 19,256 10,398 5,392 25,417 13,725 7,117
Suite 18,339 9,903 5,135 24,207 13,072 6,778
Small
PLATINUM 3 250,000 18,638 10,065 5,219 24,602 13,285 6,889
Suite 17,749 9,584 4,970 23,429 12,652 6,560
PLATINUM 4 Open Pvt 250,000 15,548 8,396 4,353 20,455 11,046 5,727 16,324 8,815 4,571 21,476 11,597 6,013
PLATINUM 6 Lrg Pvt 200,000 14,652 7,912 4,103 19,241 10,390 5,387 15,383 8,307 4,307 20,204 10,910 5,657
GOLD 1 Reg Pvt 200,000 13,286 7,174 3,720 17,397 9,394 4,871 13,950 7,533 3,906 18,267 9,864 5,115
GOLD 2 Reg Pvt 150,000 12,859 6,944 3,601 16,820 9,083 4,710 13,502 7,291 3,781 17,660 9,536 4,945
GOLD 3 Reg Pvt 110,000 12,401 6,697 3,472 16,203 8,750 4,537 13,021 7,031 3,646 17,010 9,185 4,763
SILVER 1 Semi-Pvt 90,000 10,188 5,502 2,853 13,209 7,133 3,699 10,697 5,776 2,995 13,871 7,490 3,884
SILVER 2 Semi-Pvt 80,000 9,914 5,354 2,776 12,837 6,932 3,594 10,409 5,621 2,915 13,480 7,279 3,774
BRONZE Ward 70,000 8,267 4,464 2,315 10,616 5,733 2,972 8,682 4,688 2,431 11,146 6,019 3,121
DEPENDENTS
Open
PLATINUM 1 500,000 35,070 18,938 9,820 46,292 24,998 12,962
Suite 33,399 18,035 9,352 44,088 23,808 12,345
Small
PLATINUM 2 350,000 26,382 14,246 7,387 34,824 18,805 9,751
Suite 25,127 13,569 7,036 33,166 17,910 9,286
Small
PLATINUM 3 250,000 25,764 13,913 7,214 34,229 18,484 9,584
Suite 24,537 13,250 6,870 32,599 17,603 9,128
PLATINUM 6 Lrg Pvt 200,000 19,989 10,794 5,597 26,458 14,287 7,408 20,988 11,334 5,877 27,778 15,000 7,778
GOLD 1 Reg Pvt 200,000 18,050 9,747 5,054 23,834 12,870 6,674 18,951 10,234 5,306 25,025 13,514 7,007
GOLD 2 Reg Pvt 150,000 17,623 9,516 4,934 23,255 12,558 6,511 18,504 9,992 5,181 24,418 13,186 6,837
GOLD 3 Reg Pvt 110,000 17,163 9,268 4,806 22,638 12,225 6,339 18,023 9,732 5,046 23,771 12,836 6,656
SILVER 1 Semi-Pvt 90,000 13,711 7,404 3,839 17,970 9,704 5,032 14,397 7,774 4,031 18,869 10,189 5,283
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SILVER 2 Semi-Pvt 80,000 13,436 7,255 3,762 17,599 9,503 4,928 14,106 7,617 3,950 18,479 9,979 5,174
BRONZE Ward 70,000 11,093 5,990 3,106 14,436 7,795 4,042 11,650 6,291 3,262 15,158 8,185 4,244
Note: Small Plan is valid until December 31, 2018 and based on a 12 - month coverage only
*Standard Industries are companies whose nature of business are NOT Construction (office based), Education (except pre schools, tutorials & review centers), Law Firms, Media,
Pharmaceuticals (Distributors), Sauna, Turkish bath, massage parlors (except spa, salons), Construction (Field Based or combined), Drillers (oil/water/gas), Firemen, Full Time athletes,
Government Institutions, Groups involving special hazards, Logging or Forestry, Manufacturers of Ammunitions, Medical Groups or any healthcare related, Mining / Underground mine
workers, NGOs, Foundations, Cooperatives, Associations, Oil production, Pharmaceutical (manufacturing), Political groups, Private households, Protection services (security guards)
** 9 Major Hospitals are: Asian Hospital & Medical Center, The Medical City, St. Luke's Medical Center QC, St. Lukes Medical Center Global City, Makati Medical Center, Cardinal Santos
Medical Center, Cebu Doctors Hospital, Chong Hua Hospital & Davao Doctors Hospital
***Healthway Clinics are located in Alabang Town Center, Edsa Shangri-la Mall, Festival Mall, Greenbelt 5, Market! Market!, Adriatico Tower Padre Faura & SM North
2018 SMALL (20-99 Employees)

RATED INDUSTRIES
PLAN TYPES ROOM MBL
NATIONWIDE WITHOUT HEALTHWAY NATIONWIDE WITH HEALTHWAY
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
Open
PLATINUM 1 500,000
Suite 31,971 17,264 8,952 42,202 22,789 11,817 33,570 18,128 9,400 44,312 23,928 12,407
Small
PLATINUM 2 350,000
Suite 23,051 12,448 6,454 30,427 16,431 8,520 24,204 13,070 6,777 31,948 17,252 8,945
Small
PLATINUM 3 250,000
Suite 22,458 12,127 6,288 29,644 16,008 8,300 23,582 12,734 6,603 31,128 16,809 8,716
PLATINUM 6 Lrg Pvt 200,000 18,538 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 200,000 16,810 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 150,000 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 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
DEPENDENTS
Open
PLATINUM 1 500,000
Suite 40,558 21,901 11,356 53,537 28,910 14,990 42,586 22,996 11,924 56,214 30,356 15,740
Small
PLATINUM 2 350,000
Suite 31,638 17,085 8,859 41,762 22,551 11,693 33,220 17,939 9,302 43,850 23,679 12,278
PLATINUM 3 Small 250,000 31,045 16,764 8,693 41,247 22,273 11,549 32,597 17,602 9,127 43,308 23,386 12,126
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Suite
PLATINUM 6 Lrg Pvt 200,000 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 200,000 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 150,000 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
Note: Small Plan is valid until December 31, 2018 and based on a 12 - month coverage only
*Rated Industries are Construction (office based), Education (except pre schools, tutorials & review centers), Law Firms, Media, Pharmaceuticals (Distributors), Sauna, Turkish bath,
massage parlors (except spa, salons)
** 9 Major Hospitals are: Asian Hospital & Medical Center, The Medical City, St. Luke's Medical Center QC, St. Lukes Medical Center Global City, Makati Medical Center, Cardinal Santos
Medical Center, Cebu Doctors Hospital, Chong Hua Hospital & Davao Doctors Hospital
***Healthway Clinics are located in Alabang Town Center, Edsa Shangri-la Mall, Festival Mall, Greenbelt 5, Market! Market!, Adriatico Tower Padre Faura & SM North
NO 2018 OPTIONAL RIDERS FOR NATIONWIDE: Ann Semi Qtr

1 Annual Check up Routine (Clinic) 805 435 225
2 Annual Check Up Routine (Mobile) 1,016 549 284
3 Standard Dental (1 oral propahylaxis) 369 199 103
4 Life Insurance with AD&D (Php50,000) 142 77 40
13 Maternity Benefit 4,516 2,439 1,264
14 International Assistance 475 257 133
Semi Executive Check Up Outpatient Makati Medical
15
Center 5,781 3,122 1,619
16 Executive Check Up Outpatient Makati Medical Center 17,523 9,462 4,906
10
17 Executive Check Up Inpatient Makati Medical Center 32,516 17,559 9,104

18 Semi Executive Check Up Outpatient The Medical City 16,000 8,640 4,480
19 Executive Check Up Outpatient The Medical City 35,045 18,924 9,813
20 Executive Check Up Inpatient The Medical City 53,381 28,826 14,947
21 Executive Check Up OP My Health Clinic 3,604 1,946 1,009
22 Wellness Session 4,516 2,439 1,264
SPECIAL ACCOMMODATION FOR NON PHILHEALTH MEMBERS

NO 2018 FOREIGN NATIONALS WITHOUT PHILHEALTH MEMBERSHIP AND FOR
SENIOR CITIZEN EMPLOYEES
Non Philhealth Members Expats Foreign Nationals to waive P2,400 on top of the
1
filing of Philhealth premium
P415 initial processing fee
2 Fee for Service for Senior Citizens and then actual costs +
13.5% claims handlng fee
Premium Based Program for Senior Citizen Employees x 3 of the premium. Riders
3
aged 66-70 yrs old. Dependents not entitled to this option. not included
Premium Based Program for Senior Citizen Employees x 4 of the premium. Riders
4
aged 71-75 yrs old. Dependents not entitled to this option. not included
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Provincial Access Rates
PROVINCIAL NORTH LUZON (10-99 Employees) SOUTH LUZON (10-99 Employees)

PLAN TYPES ROOM MBL 2018 STANDARD 2018 RATED 2018 STANDARD 2018 RATED
EMPLOYEES Ann Semi Qtr Ann Semi Qtr Ann Semi Qtr Ann Semi Qtr
PLATINUM 1 Open Suite 500,000 22,643 12,227 6,340 26,465 14,291 7,410 25,482 13,760 7,135 28,098 15,173 7,867
PLATINUM 2 Small Suite 350,000 14,369 7,759 4,023 17,545 9,474 4,913 17,210 9,293 4,819 19,178 10,356 5,370
PLATINUM 6 Lrg Pvt 200,000 11,320 6,113 3,170 13,924 7,519 3,899 13,650 7,371 3,822 15,265 8,243 4,274
GOLD 1 Reg Pvt 200,000 10,239 5,529 2,867 12,593 6,800 3,526 12,347 6,667 3,457 13,805 7,455 3,865
GOLD 2 Reg Pvt 150,000 9,899 5,345 2,772 12,177 6,576 3,410 11,937 6,446 3,342 13,349 7,208 3,738
GOLD 3 Reg Pvt 110,000 9,534 5,148 2,670 11,727 6,333 3,284 11,496 6,208 3,219 12,857 6,943 3,600
SILVER 1 Semi-Pvt 90,000 7,778 4,200 2,178 9,568 5,167 2,679 9,380 5,065 2,626 10,488 5,664 2,937
SILVER 2 Semi-Pvt 80,000 7,558 4,081 2,116 9,298 5,021 2,603 9,113 4,921 2,552 10,191 5,503 2,853
BRONZE Ward 70,000 6,251 3,376 1,750 7,688 4,152 2,153 7,538 4,071 2,111 8,429 4,552 2,360
DEPENDENTS
PLATINUM 6 Lrg Pvt 200,000 15,562 8,403 4,357 19,142 10,337 5,360 18,765 10,133 5,254 20,984 11,331 5,876
GOLD 1 Reg Pvt 200,000 14,020 7,571 3,926 17,247 9,313 4,829 16,905 9,129 4,733 18,905 10,209 5,293
GOLD 2 Reg Pvt 150,000 13,679 7,387 3,830 16,827 9,087 4,712 16,497 8,908 4,619 18,447 9,961 5,165
GOLD 3 Reg Pvt 110,000 13,315 7,190 3,728 16,380 8,845 4,586 16,059 8,672 4,497 17,957 9,697 5,028
SILVER 1 Semi-Pvt 90,000 10,574 5,710 2,961 13,006 7,023 3,642 12,751 6,886 3,570 14,259 7,700 3,993
SILVER 2 Semi-Pvt 80,000 10,355 5,592 2,899 12,738 6,879 3,567 12,485 6,742 3,496 13,962 7,539 3,909
BRONZE Ward 70,000 8,498 4,589 2,379 10,453 5,645 2,927 10,247 5,533 2,869 11,459 6,188 3,209
NO OPTIONAL RIDERS: Ann Semi Qtr Ann Semi Qtr
1 Standard Dental (1 prophylaxis and 2 Lightcure) 369 199 103 369 199 103
2 Annual Check-up (Basic 5) Clinic 1,334 720 374 1,877 1,014 526
12
3 Life AD&D (Php25,000) 71 38 20 71 38 20

4 Maternity Benefit 4,516 2,439 1,264 4,516 2,439 1,264
5 International Assistance 475 257 133 475 257 133
6 Wellness Program 4,516 2,439 1,264 4,516 2,439 1,264
7 Fee for Service for Senior Citizens P415 initial processing fee and then actual costs + 13.5% claims handlng fee
2018 PROVINCIAL VISAYAS (10-99 Employees) MINDANAO (20-99 Employees)

PLAN TYPES ROOM MBL STANDARD INDUSTRIES RATED INDUSTRIES STANDARD INDUSTRIES RATED INDUSTRIES
EMPLOYEES Ann Semi Qtr Ann Semi Qtr Ann Semi Qtr Ann Semi Qtr
PLATINUM 6 Lrg Pvt 200,000 10,952 5,914 3,067 12,246 6,613 3,429 10,952 5,914 3,067 12,892 6,962 3,610
GOLD 1 Reg Pvt 200,000 9,905 5,349 2,773 11,075 5,981 3,101 9,905 5,349 2,773 11,657 6,295 3,264
GOLD 2 Reg Pvt 150,000 9,575 5,171 2,681 10,708 5,782 2,998 9,575 5,171 2,681 11,270 6,086 3,156
GOLD 3 Reg Pvt 110,000 9,223 4,980 2,582 10,314 5,570 2,888 9,223 4,980 2,582 10,857 5,863 3,040
SILVER 1 Semi-Pvt 90,000 7,522 4,062 2,106 8,412 4,542 2,355 7,522 4,062 2,106 8,854 4,781 2,479
SILVER 2 Semi-Pvt 80,000 7,311 3,948 2,047 8,176 4,415 2,289 7,311 3,948 2,047 8,606 4,647 2,410
BRONZE Ward 70,000 6,048 3,266 1,693 6,764 3,653 1,894 6,048 3,266 1,693 7,120 3,845 1,994
DEPENDENTS
PLATINUM 6 Lrg Pvt 200,000 15,051 8,128 4,214 16,832 9,089 4,713 15,051 8,128 4,214 17,718 9,568 4,961
GOLD 1 Reg Pvt 200,000 13,561 7,323 3,797 15,164 8,189 4,246 13,561 7,323 3,797 15,964 8,621 4,470
GOLD 2 Reg Pvt 150,000 13,234 7,146 3,706 14,799 7,991 4,144 13,234 7,146 3,706 15,576 8,411 4,361
GOLD 3 Reg Pvt 110,000 12,882 6,956 3,607 14,406 7,779 4,034 12,882 6,956 3,607 15,163 8,188 4,246
SILVER 1 Semi-Pvt 90,000 10,228 5,523 2,864 11,439 6,177 3,203 10,228 5,523 2,864 12,040 6,502 3,371
SILVER 2 Semi-Pvt 80,000 10,018 5,410 2,805 11,204 6,050 3,137 10,018 5,410 2,805 11,794 6,369 3,302
13
BRONZE Ward 70,000 8,217 4,437 2,301 9,190 4,963 2,573 8,217 4,437 2,301 9,675 5,225 2,709
NO OPTIONAL RIDERS: Ann Semi Qtr Ann Semi Qtr
1 Standard Dental (1 prophylaxis and 2 Lightcure) 369 199 103 369 199 103
2 Annual Check-up (Basic 5) Clinic 1,166 630 326 1,166 630 326
Executive Check Up Outpatient Cebu Doctors
3,604 1,946 1,009 n/a n/a n/a
3 Hospital
Executive Check Up Intpatient Cebu Doctors
31,495 17,007 8,819 n/a n/a n/a
4 Hospital
Executive Check Up Intpatient Davao Doctors
n/a n/a n/a 30,529 16,486 8,548
5 Hospital
6 Life AD&D (Php25,000) 71 38 20 71 38 20
7 Maternity Benefit 4,516 2,439 1,264 4,516 2,439 1,264
8 International Assistance 475 257 133 475 257 133
9 Wellness Program 4,516 2,439 1,264 4,516 2,439 1,264
10 Fee for Service for Senior Citizens
*Standard Industries are companies whose nature of business are NOT Construction (office based), Education (except pre schools, tutorials & review centers), Law Firms, Media,
Pharmaceuticals (Distributors), Sauna, Turkish bath, massage parlors (except spa, salons), Construction (Field Based or combined), Drillers (oil/water/gas), Firemen, Full Time athletes,
Government Institutions, Groups involving special hazards, Logging or Forestry, Manufacturers of Ammunitions, Medical Groups or any healthcare related, Mining / Underground mine
workers, NGOs, Foundations, Cooperatives, Associations, Oil production, Pharmaceutical (manufacturing), Political groups, Private households, Protection services (security guards)
**Rated Industries are Construction (office based), Education (except pre schools, tutorials & review centers), Law Firms, Media, Pharmaceuticals (Distributors), Sauna, Turkish bath,
massage parlors (except spa, salons)
***Visayas access has access to Cebu Doctors Hospitals and Chong Hua Hospital
***Mindanao access has access to Davao Doctors Hospital
PROVINCIAL ACCESS DIRECTORY
NORTHERN LUZON WITHOUT NCR & BAGUIO

● Members may avail to any accredited hospital/clinics within the following provinces:
a) CAR: Abra, Apayao, Benguet (except Baguio), Ifugao, Kalinga, Mountain Province
b) Region 1: Ilocos Norte, Ilocos Sur, La Union, Pangasinan
c) Region 2: Batanes, Cagayan, Isabela, Nueva Vizcaya, Quirino
d) Region 3: Aurora, Bataan, Bulacan, Nueva Ecija, Pampanga, Tarlac, Zambales
Note: Accounts requesting for Baguio access should enroll under our Nationwide Program
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
14
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.
15
Benefits & Limitations
SUMMARY OF BENEFITS
MAXIPLUS
HEALTHCARE BENEFITS MAXICARE'S COVERAGE

A. OUT-PATIENT CARE
Consultations during regular clinic hours,
1 Subject to MBL
except prescribed medicines
2 Pre and Post Natal consultations Subject to MBL
Eye, ear, nose and throat (EENT)
3 treatment prescribed by an Accredited Subject to MBL
Physician/Specialist
Treatment for minor injuries such as
4 lacerations, mild burns, sprains and the Subject to MBL
like
Dressings, conventional casts (plaster of
5 Subject to MBL
Paris) and sutures.
X-Ray, laboratory examinations, routine,
diagnostic and therapeutic procedures
prescribed by an Accredited
6 Physician/Specialist, provided however Subject to MBL
that the cost of diagnostic and therapeutic
procedures covered shall be limited to a
specific amount.
Minor surgery not requiring confinement
7 prescribed by an Accredited Physician / Subject to MBL
Specialist
Eye laser therapy only for retinal tear,
retinal hole, retinal detachment and
glaucoma prescribed by an Accredited
8 Up to Php 10,000 /eye /member /year
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
9 contagiosum, in any part of the body, Up to Php 1,000 /member /year
except genital warts and condyloma
acuminata, prescribed by an Accredited
Physician/Specialist.
Sclerotherapy for varicose veins (except
medicines and for cosmetic purposes) as
1
prescribed by an Accredited Physician, to Up to Php 5,000 / leg / member / year
0
be availed through accredited vascular
surgeons.
Allergy Testing/ allergy screening and
11 other related examinations prescribed by Up to Php 2,500 / member / year
an Accredited Physician
Covered as charged up to Php 10,000 / member / year
1 (reimbursement basis)
Speech therapy (for stroke patients only)
2 Note: Consultations shall be part of the limit and
treated as sessions
1
Tuberculin test Up to Php 600 / member / year
3
B. IN-PATIENT CARE
1 Room and Board Accommodation Subject to the Member's Room and Board limit
16
Use of operating room, Intensive Care Unit
(ICU), isolation room (if prescribed by
2 Subject to MBL
attending Accredited Physician) and
recovery room.
Professional fees in accordance with
3
Maxicare Schedule of Rates.
a. Attending Physicians Subject to MBL
b. Surgeons Subject to MBL
c. Anesthesiologists Subject to MBL
d. Cardio-pulmonary clearance before
surgery and cardiac monitoring during Subject to MBL
surgery.
4 Standard Nursing Services Subject to MBL
5 Medicines for in-patient use Subject to MBL
Blood products transfusions and
6 intravenous fluids, including blood Subject to MBL
screening and cross matching.
X-Ray, laboratory examinations, routine,
7 diagnostic tests and therapeutic Subject to MBL
procedures incidental to confinement
Dressings, conventional casts (plaster of
8 Subject to MBL
Paris) and sutures
9 Anesthesia and its administration Subject to MBL
1
Oxygen and its administration Subject to MBL
0
11 Standard Admission kit Subject to MBL
All other items directly related in the
1 medical management of the patient, as
Subject to MBL
2 deemed medically necessary by the
attending Accredited Physician
C. ROUTINE PROCEDURES (whether IP or OP)

1 Blood Chemistries 100% of Actual Cost subject to MBL
2 Chest X-Ray 100% of Actual Cost subject to MBL
3 Complete Blood Count (CBC) 100% of Actual Cost subject to MBL
4 Fecalysis 100% of Actual Cost subject to MBL
5 Urinalysis 100% of Actual Cost subject to MBL
D. DIAGNOSTIC PROCEDURES
1 12-Lead Electrocardiogram (ECG) 100% of Actual Cost subject to MBL
24-Hour Electroencephalogram (EEG)
2 100% of Actual Cost subject to MBL
Monitoring
3 24-hour Holter Monitoring 100% of Actual Cost subject to MBL
4 Adrenocortical Function 100% of Actual Cost subject to MBL
Anti-Nuclear Antibody, C-Reactive Protein,
Lupus Cell Exam
6 Arterial Blood Gas 100% of Actual Cost subject to MBL
Arthroscospic Procedures, Orthopedic
Arthroscopy
8 Audiograms and Tympanograms 100% of Actual Cost subject to MBL
9 Bone Densitometry Scan (Dexascan) 100% of Actual Cost subject to MBL
1
Bone Mineral Density Studies 100% of Actual Cost subject to MBL
0
Cardiac Stress Tests (Thalium and
Dipyridamole Stress Tests)
1
Computed Tomography Scans 100% of Actual Cost subject to MBL
2
17
1
Diagnostic Radiographs:
3
a. Biliary tract: Cholecystogram and
100% of Actual Cost subject to MBL
Cholangiogram
b. Chest, ribs, sternum and clavicle 100% of Actual Cost subject to MBL
c. Digestive: Plain film of the abdomen,
Barium Enema, Upper GI Series, Lower GI 100% of Actual Cost subject to MBL
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 100% of Actual Cost subject to MBL
g. X-ray of the spine (cervical, thoracic,
lumbo-sacral)
1
Diagnostic Ultrasounds:
4
a. 2D-Echo with Doppler 100% of Actual Cost subject to MBL
b. Abdomen 100% of Actual Cost subject to MBL
c. Duplex Scan 100% of Actual Cost subject to MBL
d. Digestive and Urinary Systems 100% of Actual Cost subject to MBL
e. Ultrasound of the Lungs 100% of Actual Cost subject to MBL
1
Electroencephalogram (EEG) Monitoring 100% of Actual Cost subject to MBL
5
1 Electromyelography and Nerve
6 Conduction Studies
1
Endoscopic Procedures 100% of Actual Cost subject to MBL
7
1
Fluorescein Angiography 100% of Actual Cost subject to MBL
8
1
Impedance Plethysmography 100% of Actual Cost subject to MBL
9
2
Magnetic Resonance Angiography (MRA) 100% of Actual Cost subject to MBL
0
2
Magnetic Resonance Imaging (MRI) 100% of Actual Cost subject to MBL
1
2
Mammography and Sonomammogram 100% of Actual Cost subject to MBL
2
2
Myelogram 100% of Actual Cost subject to MBL
3
2
Nuclear Radioactive Isotope Scan 100% of Actual Cost subject to MBL
4
2
Pap's Smear 100% of Actual Cost subject to MBL
5
2
Perfusion Scan 100% of Actual Cost subject to MBL
6
2 Plasma Urinary Cortisol, Plasma
7 Aldosterone
2
Polysomnograms (Sleep Recording) 100% of Actual Cost subject to MBL
8
2
Pulmonary Function Tests 100% of Actual Cost subject to MBL
9
3 Radioisotope Scans and Function
0 Studies:
a. Cardiac 100% of Actual Cost subject to MBL
b. Gastrointestinal 100% of Actual Cost subject to MBL
c. Liver 100% of Actual Cost subject to MBL
d. Parathyroid Bone, Pulmonary
(Perfusion/ Ventilation Lung Scans)
e. Renal 100% of Actual Cost subject to MBL
18
f. Thyroid Scans 100% of Actual Cost subject to MBL
g. Total Body Scans 100% of Actual Cost subject to MBL
3
Radionuclide Ventriculography 100% of Actual Cost subject to MBL
1
3
Surface Electromyography (SEMG) 100% of Actual Cost subject to MBL
2
3
Thallium Scintigraphy 100% of Actual Cost subject to MBL
3
3
Treadmill Stress Test (TMST) 100% of Actual Cost subject to MBL
4
E. THERAPEUTIC PROCEDURES
Up to six (6) sessions subject to MBL for OP; Up to
1 Arthrocentesis
MBL for IP
2 Dialysis Up to MBL shared limit for OP and IP
3 Intravenous Chemotherapy Up to MBL shared limit for OP and IP
4 Phlebotomy
MBL for IP
Shared limit of up to twelve (12) sessions/member/year
Physical therapy / Occupational therapy
subject to MBL for OP; Up to MBL for IP.
excluding subspecialties such as cardiac
5
rehabilitation, pulmonary rehabilitation and
Note: Therapy of one (1) body area shall be considered
the like.
as one (1) session.
6 Thoracentesis
MBL for IP
7 Therapeutic Radiology:
a. Brachytherapy Up to MBL shared limit for OP and IP
b. Cobalt Up to MBL shared limit for OP and IP
c. Linear Accelerator Therapy Up to MBL shared limit for OP and IP
d. Radioactive Cesium Up to MBL shared limit for OP and IP
e. Radioactive Iodine Up to MBL shared limit for OP and IP
Continuous Positive Airway Pressure
8 Up to Php 60,000 shared limit for OP and IP
(CPAP)
9 Oral Chemotherapy Up to Php 60,000 shared limit for OP and IP
F. 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 Applicable for members 35 years old and above
Applicable for members (women) 35 years old and
Pap Smear
above
Can be availed under Fee for Service. Billing shall be
2 Pre-employment in lieu of ACU
based on actual cost plus 13.5% Claims Handling Fee
G. PREVENTIVE CARE
Passive and active vaccines for treatment
1 Covered up to Php 40,000 / member / year
of tetanus and animal bites
2 Periodic monitoring of health problems Covered
19
Health-education and counselling on diets
3 Covered
or exercise
Health habits and Family Planning
4 Covered
counseling
ADDITIONAL PROCEDURES AND MODALITIES (shared limit for OP and IP; Professional Fees, Hospital
H.
Bills and other incidental expenses relative to the procedure shall form part of the limit)
Angiography (gastrointestinal, brain,
retinal and peripheral vascular)
Coronary Angiogram and/or
Angioplasty/Coronary Artery Bypass Graft
3 Cryosurgery 100% of Actual Cost subject to MBL
4 Gamma Knife Surgery 100% of Actual Cost subject to MBL
5 Hysterescopic Myoma Resection 100% of Actual Cost subject to MBL
6 Hysteroscopically-guided D&C 100% of Actual Cost subject to MBL
7 Laparoscopy 100% of Actual Cost subject to MBL
8 Lithotripsy 100% of Actual Cost subject to MBL
9 Percutaneous Ultrasonic Nephrolithotomy 100% of Actual Cost subject to MBL
1
Stereotactic Brain Biopsy 100% of Actual Cost subject to MBL
0
11 Conventional Hemorrhoidectomy 100% of Actual Cost subject to MBL
1
Scalpel Hemorrhoidectomy 100% of Actual Cost subject to MBL
2
1
Stapled Hemorrhoidectomy Covered up to Php 5,000 /member /year
3
1
Mammotome Covered up to Php 5,000 /member /year
4
1 4D Ultrasound except for maternity-related
Covered up to Php 5,000 /member /year
5 cases
1
Esophageal Manometry Covered up to Php 5,000 /member /year
6
1
Intensified Modulated Radiotheraphy Covered up to Php 5,000 /member /year
7
1 Botox which is not cosmetic in nature nor
8 for beautification purpose
1
Positron Emission Tomography Covered up to Php 5,000 /member /year
9
2
CT Pulmonary Angiography Covered up to Php 5,000 /member /year
0
2
Photodynamic Therapy Covered up to Php 5,000 /member /year
1
Other medically necessary modalities not
2 mentioned above and those for which
Covered up to Php 5,000/ procedure /member /year
2 there are no comparable, conventional or
traditional counterparts
2 Transurethral Microwave Therapy of
3 Prostate
I. EMERGENCY CARE
1 In Accredited Hospitals
a. Doctor’s services Subject to MBL
b. Emergency Room Fees Subject to MBL
c. Medicines used for immediate relief
Subject to MBL
during treatment
d. Oxygen, Intravenous fluids and blood
Subject to MBL
products.
e. Dressings, conventional casts (plaster
Subject to MBL
of Paris) and sutures.
20
f. X-Rays, laboratory and diagnostic
examinations, and other medical services
Subject to MBL
related to the emergency treatment of the
patient.
g. Room Upgrade in case of room
up to 24 hours
unavailability
Reimbursable up to 80% of hospital bills & professional
fees based on Maxicare rates incurred during the first
2 In Non-Accredited Hospitals
24 hrs. of treatment up to Php 30,000 / availment /
member /year
Reimbursable up to 100% of actual cost up to
3 Outside the Philippines
Php30,000 / availment / member / year
4 Areas without Accredited Hospital 100% based on Maxicare rates up to MBL
Ambulance Service (Accredited
5 Hospital/Clinic to Accredited Up to MBL
Hospital/Clinic)
Ambulance Service (Non-accredited
6 Hospital/Clinic to Accredited Reimbusable up to Php 2,500 per conduction
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
7 Initial Treatment of Animal Bites
subject to MBL
J. PRE-EXISTING CONDITIONS
1 Dreaded Conditions Covered depending on the type of Product
2 Non-Dreaded Conditions Covered depending on the type of Product
K. DENTAL CARE Optional

1 Dental examination/consultation only Covered
2 Oral prophylaxis Covered - Once a year
Uncomplicated tooth extraction (anterior
3 Covered
tooth, posterior tooth, )
4 Temporary Fillings Covered, as advised by Dentist
Desensitization of hypersensitive teeth
5 (limited to the application of necessary Up to 2 teeth
medicament to the affected teeth)
6 Simple denture adjustment and repair Covered
Recementation of loose jacket crowns,
7 Covered
bridges, inlays and onlays
Palliative treatment for simple mouth sores
8 Covered
and blisters
9 Open incision and drainage (intraoral) Covered
1
Dental Nutrition and Dietary Counseling Covered
0
11 Dental Health Education Covered
1
Pre-natal consultation on teeth and gums Covered
2
1
Temporo Mandibular Joint Consultation Initial Consultation -Covered
3
1
Permanent Fillings 2 teeth per year
4
GROUP LIFE INSURANCE WITH

L. ACCIDENTAL DEATH AND DISABLEMENT Optional
(AD&D) BENEFITS
21
The Philippine American Life & General Insurance
1 Insurance Provider
Company
2 Death (amount of insurance) P50,000 and up depending on the rider chosen
3 Corporate Personal Accidental Death & Dismemberment (AD&D)
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 100% of amount of insurance

Both Feet 100% of amount of insurance
One hand and One foot 100% of amount of insurance
One hand 50% of amount of insurance
Arm between elbow and wrist 60% of amount of insurance
Arm at or above elbow 70% of amount of insurance
Leg below knee 60% of amount of insurance
Leg at or above knee 70% of amount of insurance
iii.) Loss of sight
Both eyes 100% of amount of insurance
One eye 50% of amount of insurance
iv.) Loss of speech 100% of amount of insurance
v.) Loss of hearing
Both ears 100% of amount of insurance
One ear 50% of amount of insurance
vi.) Accidental Dismemberment or Loss of
Use of Fingers
All of one hand 50% of amount of insurance
4 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.
5 General Guidelines
A. Eligibility Age
Benefits:
Principals, Spouse / Parent: 18 to 69 years old;
Life
Children / Sibling: 14 days to 26 years old
Principals, Spouse / Parent: 18 to 65 years old;
AD&D
Children / Sibling: 14 days to 26 years old
B. Eligible Dependents
Legal spouse who are actively performing the daily
normal chores of life
i.) Dependents of Married employees
Children who are single, unemployed and fully
dependent on the principal for support
Parents who are actively performing the daily normal
chores of life
ii.) Dependents of Single Employees
Siblings who are single, unemployed and fully
Parents who are actively performing the daily normal
iii.) Dependents of Single Parent chores of life
Employees Children who are single, unemployed and fully
22
M. CONDITIONS WITH SPECIFIC LIMITATIONS
Work Related Conditions based on
1 Up to MBL (Principal only)
conditions covered by ECC
Covered subject to MBL and Exclusions and
2 Motor Vehicular Accidents
Limitations Provisions
Provoked and Unprovoked Assault,
including domestic violence, whether
3 Up to MBL
initiated by the Member or by a known or
unknown third party
Scoliosis, including necessary procedures, Up to Php 60,000 /member /year (shared limit for OP
except physical therapy sessions, whether and IP)
4 Note: Physical Therapy sessions shall form part of the
congenital, pre-existing, developmental or
acquired Physical therapy /Occupational therapy limits.
up to Php 60,000 /member /year (shared limit for OP
Congenital Conditions except physical
and IP) Note: Physical Therapy
5 therapy sessions and developmental
sessions shall form part of the Physical therapy
disorders
/Occupational therapy limits.
Congenital Hernia Covered up to MBL
6 Chronic Dermatoses Consultations only
7 Scabies Consultations and treatments
8 Exclusion #25 Covered up to MBL
9 Hepatitis B Covered up to MBL (if acquired)
N. ADDED PROGRAM FEATURES

24-Hour/7 Days a Week Customer Care
1 √
Hotline
2 Roving Customer Care Representative √
3 Manner of Access:
a. Hospitals more than 1,000 Hospitals (65% are tertiary hospitals)
b. Clinics and Clinics
Maxicare Primary Care Centers at Makati Medical
Center, Filomena Bldg., St. Luke's Medical Center -
Quezon City, The Medical City, Chinese General
c. Primary Care Centers 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,
d. Maxicare Centers
General Santos & Davao
Clinica Manila, Manila Doctors Hospital, Capitol
Medical Cnter, Mary Mediatrix Medical Center, Calamba
e. Maxicare Helpdesks
Medical Center. Soon to open: UST Hospital and De La
Salle Hospital
over 30,000 accredited doctors (composed of Fellows,
e. Accredited Doctors
Diplomates)
4 PayorLink System √
5 Orientation √
6 VAT Charges Inclusive of 12% VAT
7 ID Processing Fee at no additional cost
8 Booklets & Summary of Coverage (SOC) 1 per principal member
O. MEMBERSHIP GUIDELINES
1 Age Eligibility
Principals 18 up to 65 years old
Adult Dependents 18 up to 65 years old
Minor Dependents 15 days old up to 21 years old
23
* Enrollees age 66 years old & above shall not be covered
* Dependents should be the same plan or lower than the Principals, on a per level basis.
* No coverage for extended dependents.
2 Hierarchy of Enrollment to be followed:
Legal spouse must be enrolled first, followed by the
Married Employees
eldest to the youngest child.
Both parents (anyone ahead of the other) and then the
Single Employees
siblings (eldest to the youngest)
Children (eldest to youngest) and/or Parents (anyone
Single Parent Employees
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.
3 Participation Requirement
100% of all eligible employees should enroll all the
eligible dependents under the program or the number
a. Non-contributory accounts
of dependents should reach 75% of the total number of
principals.
At least 75% of all eligible employees should enroll all

the eligible dependents under the program or the
b. Contributory accounts
number of dependents should reach 75% of the total
number of principals.
MBL on top of Philhealth. Philhealth portion not
4 Philhealth Integration deductible to the member's MBL. Required to file
Philhealth
Additional Philhealth fee on the onset
of enrollment: Php 1,800 per Non-
*
Philhealth member per year (applicable
for expatriate enrollees only)
P. ESCALATION CLAUSE:
1 at least 75% standard rates
2 60% - 74.9% + 10% to standard rates
3 40% - 59.9% + 20% to standard rates
4 Below 40% + 35% to standard rates
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.
Q. ENROLLMENT GUIDELINES
1 Application Forms Waived
2 Masterlist of Enrollees Maxicare Format
Medical Requirements* (at the applicant's
3 Waived
account)
Other medical requirements if deemed
4 Waived
necessary
24
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.
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
2
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.
RIDER BENEFIT DESCRIPTION & INCLUSIONS

The following riders are exclusive and optional. Kindly refer to the Optional Riders Rates for Nationwide Access Page for
the fees applicable for each rider. Some riders can be assigned selectively to some employees and some have to be
assigned to everyone, either all employees and dependents, or for all employees only
Can be assigned to selected employees only Semi Executive Check Up, Executive Check Up
Outpatient, Executive Check Up Overnight, Fee for
Service, Maternity
Can be assigned to either all employees and All the riders
dependents (combined) or for all employees only
N
RIDER INCLUSIONS & DESCRIPTIONS
O
・to be availed at an Maxicare accredited ACU provider
・lab inclusions are Physical, Chest Xray, Urinalysis, Urinalysis, Fecalysis, Complete Blood
Annual Count, ECG (for 35 & above) & Papmsmear (for female 35 & above)
Check up
1 ・can be availed after settling the 1st SOA for accounts under Annual & Semi Annual mode and 2
Routine
(Clinic) quarters for accounts under Quarterly mode
・to be scheduled at least 2 weeks in advance by filling out the ACU Request Form
・results are for pick up or delivery
Annual ・similar with ACU Routine Clinic except that this is done in the
Check Up premises of the account
2
Routine ・there must be a minimum of 50 confirmed members that will avail the Mobile ACU
(Mobile)
・through Dental Hub. Availent is done through individual appointment by calling the dentist
directly
・Annual Dental examination and consultation
・Emergency out-patient dental treatment - to be availed at accredited dental clinics only
・Oral Prophylaxis once a year
・Simple tooth extractions
・Restorative and prosthodontic treatment planning
・Temporary fillings
Standard
Dental (1 ・Desensitization of hypersensitive teeth up to 2 teeth
3 oral ・Simple adjustment and repair of dentures.
propahylaxis ・Re-cementation of loose crowns, bridges, inlays and onlays.
) ・Dental nutrition and dietary counseling.
・Dental health education.
・Permanent fillings (not applicable for basic dental package)
・Palliative treatment for simple mouth sores and blisters
・Open incision and drainage (intraoral)
・Pre-natal check of teeth and gums
・Temporo Mandibular Joint Consultation (Initial consult only, referral to specialist not covered)
・Gum Treatment for cases like inflammation or bleeding
4 Life The Manufacturers Life
Insurance Insurance Provider Insurance Co. (Phils.), Inc.
with AD&D (Manulife)
Death (Amount of Insurance) Php25,000/member
25
Manulife will pay an insured member’s designated beneficiary/ies an amount equal to his/her
Basic Life Insurance coverage in lumpsum upon the death of the covered member from ANY
CAUSE WHATSOEVER, except suicide on the first year of coverage.
Accidental Death & Dismemberment (ADD&D)
Should an insured member suffer a loss directly and independently of all other causes, any bodily
injury affected solely through external, violent and accidental means, within one hundred eighty
(180) days from the said accident, Manulife will pay such member, if living, otherwise to his/her
designated beneficiary/ies an amount equal to the benefits stated in the Schedule of Losses:
A. Schedule of Losses for ADD&D Coverage
100% of amount of
i.) Loss of Life
insurance
100% of amount of
ii.) Both hands or both feet
insurance
100% of amount of
iii.) One hand and one foot
insurance
50% of Amount of
iv.) One hand or one foot
Insurance
100% of Amount of
v.) Sight of both eyes
Insurance
50% of Amount of
vi.) Sight of one eye
Insurance
100% of Amount of
vii.) One hand and sight of one eye
Insurance
100% of Amount of
viii.) One foot and sight of one eye
Insurance
100% of Amount of
ix.) Hearing of both ears
Insurance
50% of Amount of
x.) Hearing of one ear
Insurance
100% of Amount of
xi.) Speech
Insurance
40% of Amount of
xii.) All four fingers and thumb of either hand
Insurance
60% of Amount of
xiii.) Whole arm
Insurance
50% of Amount of
xiv.) Lower arm
Insurance
50% of Amount of
xv.) Whole leg
Insurance
40% of Amount of
xvi.) Lower leg
Insurance
20% of Amount of
xvii.) Thumb
Insurance
xviii.) Fingers of one hand
10% of Amount of
- Index finger
Insurance
- Middle finger 5% of Amount of Insurance
- Ring finger 3% of Amount of Insurance
- Little finger 2% of Amount of Insurance
xix.) Toes of one foot
10% of Amount of
- All
Insurance
- Big toe 5% of Amount of Insurance
- Any toe other than big, each 1% of Amount of Insurance
Note: Loss of hands and feet shall mean dismemberment by severance at or above the wrist or
ankle joints respectively; loss of eyesight should be total and irrecoverable.
Conversion privilege
26
A member whose insurance coverage terminates due to separation from employment, has the
privilege of converting his/her individual Group Term coverage to an Individual Permanent plan
without having to submit any evidence of insurability subject to the following conditions:
The written application for the individual policy and the first premium payment for such were made
within thirty-one (31) days from date of separation.
The individual policy selected shall be any plan customarily issued by Manulife Philippines except
term and other supplemental plans.
The sum assured on the individual policy must not be more than the amount on the member’s life
insurance that was terminated and must not be less than the minimum required by Manulife for the
plan selected.
The premium rate on the individual policy applied for shall be based on the company’s rate
applicable to both the class of risk to which the member belongs and his/her then attained age.
The policy will become effective at the end of 31 days after the date of termination of the
member’s employment.
Free Insurance Coverage
A member whose coverage terminates is covered for an additional thirty-one (31) days from date
of termination of membership, free of charge, whether or not he/she avails of the conversion
privilege.
Termination
This benefit will automatically terminate on the first of the following events:
The date of termination of the group master policy.

Non-payment of premiums beyond the grace period.
The policy anniversary immediately following the 66th birthday of the employee/spouse/parent and
22nd birthday of the child/sibling.
The date a member becomes ineligible.
Exclusions
No benefit shall be made for any loss resulting from or caused by:
· Suicide or intentionally self-inflicted injury or any similar attempt whether sane or insane,
or
· Any drug, poison, gas or fumes, voluntarily or otherwise taken, administered, absorbed
or inhaled other than or as a result of an accident arising from a hazard incident to the member’s
occupation, or
· War or any act incident to war, whether declared or undeclared, or
· Riot, civil commotion or insurrection, or
· Travel or flight in or descent from any aircraft, if the insured person is a member of the
crew or a pilot of the aircraft, or if the flight is made for instructional or training purposes, or
· Travel or flight in or descent from any aircraft of military, naval or air force, or
· Murder, or
· Provoked assault or participation in an assault or brawl, or
· Any violation or attempt of violation of the law or resistance to arrest.
General Guidelines
A. Eligibility Age
Life with AD&D
Principals 18-65 years old
All active, regular and full time employees, and are in good health at the inception of the policy,
shall be eligible for coverage under the plan. Future full time employees shall be enrolled upon
eligibility
If an enrolled person is an employee, and if, on account of injury or disease, the enrolled person is
not actively working in full-time employment on the date his insurance would otherwise become
effective as provided above, the insurance shall not become effective until the date such person
returns to full-time active work for a continuous period of 30 days.
“Full-time employment” means employment on a regular schedule of at least thirty hours per
week, at his employer’s regular place of business or other location where his employer’s business
specifically requires him to be in performance of such work.
27
Delete if dependents are not to be enrolled
Spouse/Parent 18-65 years old
Children/Sibling Not more than 21 years old
B. Eligible Dependents
Legal spouse and Children
i.) Dependents of Married employees who are in good health at
the inception of the policy.
Parents and siblings who

ii.) Dependents of Single Employees are in good health at the
inception of the policy.
Children and
Parent/Siblings who are in
iii.) Dependents of Single Parent Employees
good health at the
inception of the policy.
Note: Coverage and exclusions shall still subject to the terms and conditions of the Insurance
provider.
5 Cancer The Philippine American
Benefit Insurance Provider Life & General Insurance
(Php200,000) Company (Philam Life)
Cancer Benefit Php200,000/member
Death Benefit
i.) If not diagnosed as terminally ill Php20,000/member
ii.) If diagnosed as terminally ill Php10,000/member
Terminal Illness Benefit Php10,000/member
Definition of Terms
Cancer - the occurrence of a histologically confirmed invasive malignant tumor involving the
spread of malignant cells. Spread of malignant cells means spread of malignant cells to lymph
nodes or distant parts of the body which is also known as metastatic stage. This criterion must be
satisfied if cancer is diagnosed within the 7th to 24th month of coverage; but this criteria is not
required if the cancer is first diagnosed after the Contract has been in force for two (2) years from
the Effective Date or the latest date of any Reinstatement, whichever is the latest. Any stage of
cancer is qualified for coverage on the 25th month and onwards.
Cancer Benefit – the lump sum amount to be paid to the Member if the Member is diagnosed by
an accredited physician to have contracted a cancer illness after the waiting period.
Death Benefit - the amount to be paid to the beneficiaries of the Member if the Member dies while
still a member of Maxicare.
Terminal Illness Benefit – portion of Death Benefit that will be advanced in lump sum to the
Member if the Member is medically diagnosed as terminally ill with a life expectancy of twelve (12)
months or less.
Waiting Period – refers to the length of time after the member’s effective date within which Cancer
Benefit is not payable to the Member.
No Evidence Limit (NEL) – is the limit within which no evidence of insurability will be required. If
coverage is beyond this limit, then a health statement will be required and from the declarations on
this health statement, shall assess if medical examinations will be required.
Waiting Period
Cancer illness diagnosed after member’s effective date shall be payable in accordance to the
following waiting period:
i.) Cancer is diagnosed to be in metastatic stage after one hundred eighty (180) days from
member’s effective date; or
ii.) Cancer is diagnosed in any stage after two (2) years from member’s effective date or latest
reinstatement date.
No Evidence Limit (NEL) is Php1,000,000
For any amount of insurance in excess of NEL, proof of good health must be submitted (i.e.
accomplished Health Statement, Medical exam).
Eligible Members
Principals 18-65 years old
28
(regular, full time and actively at work)
Actively performing daily normal chores with standard occupational risk up to Class B medical
rating.
Spouse/Parent 18-65 years old
Children/Sibling 15 days - 21 years old
Eligible Dependents
Legal spouse who are
actively performing the
i.) Dependents of Married employees daily normal chores of life
and fully dependent on the
principal for support
Children who are
unmarried, actively
performing the daily normal
chores of life and fully
dependent on the principal
for support
Parents who are actively
ii.) Dependents of Single Employees chores of life and and fully
for support
Siblings who are
unmarried, actively
for support
Children who are
unmarried, actively
iii.) Dependents of Single Parent Employees for support and/or Parents
who are actively
for support
Siblings who are
unmarried, actively
for support
Exclusions
Cancer Benefit shall not be payable under the following circumstances:
i.) Diagnosed cancer/tumor is of the following nature:
a. Tumors treated by endoscopic procedures alone;
b. Tumors classified as carcinoma in situ;
c. Prostate tumors classified as T1 (TNM classification system);
d. Malignant melanomas other than those greater than 1.5 mm in depth;
e. Other skin cancers;
f. Tumors that are a recurrence or metastases of a tumor that first manifested within the
Waiting Period;
g. Kaposi’s Sarcoma;
h. Other tumors associated with Human Immuno-Deficiency Virus (HIV) infection; and
i. Tumors that pose no threat to life and for which no treatment is required.
29
ii.) Pre-existing conditions are excluded within the first twelve (12) months of a Member’s
coverage. Pre-existing conditions are conditions for which the Member received treatment,
diagnosis, consultation or prescribed drugs in the six (6) months preceding Member’s effective
date.
iii.) Any illness or surgery, other than a diagnosis of, or surgery for cancer.
iv.) Cancer was diagnosed prior to, or within one hundred eighty (180) days following the Effective
Date or the latest date of any reinstatement of the respective Member whichever is later.
v.) If the Member seeks medical advice or treatment for any signs or symptoms for such illness
which, based on the findings of Philam, first manifested or occurred prior to, or within one hundred
eighty (180) days following the Effective Date of Coverage or the latest date of reinstatement of
the respective Member whichever is later.
vi.) Cancer which was diagnosed due, directly or indirectly, to a congenital defect or disease
which has manifested or was diagnosed before the Member reached seventeen (17) years of age.
vii.) Cancer caused directly or indirectly, wholly or partly, by
a. self-inflicted injury; or
b. addiction to alcohol or drugs not prescribed by a medical doctor; or
c. while under the influence of alcohol or unprescribed drugs; or
d. atomic or nuclear radiation; or
e. Acquired Immunodeficiency Syndrome (AIDS) or Human Immunodeficiency Virus(HIV); or
f. pregnancy and resulting childbirth, miscarriage or abortion; or
g. cosmetic or plastic surgery, except as a result of injury; or
h. war or any acts thereof; or acts of terrorism; or
i. homicide, frustrated homicide or any attempt thereof, or physical injuries; or
j. automobile and motorcycle racing, judo, karate and similar martial arts, scuba diving,
hang-gliding and sky gliding.
Note: Coverage and exclusions shall still subject to the terms and conditions of the Insurance
provider.
Female Employees
(Married or Single/Married
Covered Members
only) and Spouse of Male
Employees
Maxicare shall cover the hospital bills and professional fees incurred by covered Member for
maternity services/procedures, up to the following limit:
Normal Delivery Php5,000
Caesarian Php10,000
Miscarriage and Abortion Php5,000
LOA-facilitated if availed
Maternity within the network; and
6
Benefit shall be on reimbursement
Type of Availment basis based on actual
amount and subject to
above mentioned limits if
availed outside the network
Philhealth benefits On top of Maternity Limit
280 days Waiting Period Not Applicable
Laboratory procedures/work-ups Not Covered
For availments in Accredited Hospitals but with Non-Accredited Physicians, Maxicare shall provide
outright coverage for the hospitals bills and the professional fees of Non-Accredited Physicians
shall be on a reimbursement.
7 International Insurance Company of
Assistance North America (A Chubb
Insurance Provider Company)
Worldwide Travel Assistance Covered
Medical Necessary Expenses (Sickness and Accident) Php1,000,000
Emergency Medical Evacuation and Repatriation of Mortal Remains Php1,000,000
30
Personal Accident Php250,000
・can only be availed at the chosen ACU Provider at the onset of the agreement
・member has to choose a specific date at least 2 weeks in advance by filling out the ACU
Request Form
・Lab tests may include the following. Actual lab tests at the time of availment may vary
depending on the provider:
Physical Examination
Semi
Executive Urinalysis
8
Check Up Fecalysis
Outpatient
Chest X-ray
CBC (Complete Blood Count)
Blood Chemistry (FBS, SGPT, Cholesterol, Creatinine, Uric Acid)
12-Lead ECG
Papsmear
・can only be availed at the chosen ACU Provider at the onset of the agreement
・member has to choose a specific date at least 2 weeks in advance by filling out the ACU
Request Form
・Lab tests may include the following. Actual lab tests at the time of availment may vary
depending on the provider:
Physical Examination
Routine Urinalysis
RoutineFecalysis
Executive
9 Check Up Chest X-ray
Outpatient CBC (Complete Blood Count)
Blood Chemistry (Fasting Blood Sugar, Potassium,
Creatinine, SGOT/AST, Alkaline Phosphatase, Total Protein, Albumin, Calcium, uric Acid, BUN,
Total Bilirubin, Sodium, Chloride/CO2 and Cholesterol)
Ultrasound of Kidney: Renal Sonogram
Cardiac Work-up: 12 Lead ECG, Treadmill Stress Test
Abdominal Work-up: Ultrasound of Liver, Gallbladder and Pancreas
Pap Smear (slides) for female members regardless of age
CBC (Complete Blood Count)
Blood Chemistry (Fasting Blood Sugar, Potassium,
Total Cholesterol HDL, LDL, VLDL Cholesterol, Triglycerides, Urea, Creatinine, SGOT (AST),
SGPT (ALT), Alkaline Phosphatase, Total Bilirubin, Total Protein, Albumin, Globulin, Calcium, Uric
Acid)
Thyroid Function: TSH-IRMA
Hepatitis Screening: HBsAG, Anti-HBs
Routine Urinalysis
Executive
Routine Fecalysis
10 Check Up
Inpatient Cardiac Work-up: 12 Lead ECG; Treadmill Stress Test
Chest X-Ray
Abdominal Work-up: Upper Gastrointestinal series or
Barium Enema, Ultrasound of Liver, Gallbladder &
Pancreas, Proctosigmoidoscopy_
Pap’s Smear for female members regardless of age
Prostate Ultrasound for male members regardless of age
Consultations to a Gastroenterologist,Gynecologist/Urologist and Cardiologist
15 Wellness 30-45 min lecture
Session
Conducted at the premises of the account by a Maxicare accredited doctor
31
Topic to be chosen by the account
・The member is part of the active enrolled members but will be under a Fee for Service
Arrangement or Bill Back Arrangement
・Member will be issued a card and plan type will be based on the choice selected by the
company
・P450 Network Access Fee to be collected at the beginning and cannot be prorated
・Company will be charged 13.5% Claims Handling Fee Per Availment of the member on top of
Fee for the pre negotiated / discounted rates being charged to us by our affiliated providers
Service for ・Billing is on the next month after availment and does not follow the billing cycle of the account
16
Senior
Citizens ・Member is not entitled to Senior Citizen discount. If Client wishes to avail of the Senior Citizen
discount, client must settle the bill on his own. Senior Citizen discount is not on top of pre
negotiated rates being given to us by our affiliated providers
・The senior citizen is not counted in the employee headcount with a minimum of 5, 10 or 20
enrollees
・Fee for Service is only available under our Corporate Program and not available in the
Individual or Family Program.
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 self-
destruction, 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,
32
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.
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 company-
sponsored 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 pre-
existing)/Poliomyelitis/Slipped disc (if pre-existing) and Guillain-Barre Syndrome, Diabetes and its complications (if pre-
existing), 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.
33
40 Cost of the medical services and professional fees in excess of the MBL/ABL.
Notes & Special Reminders:

 Rates are only applicable for virgin accounts or those with no previous enrollment with Maxicare. A separate
proposal will be drafted upon submission of requirements for quotation.
 Rates and benefits are valid until December 31, 2017 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. If the account did not enroll dependents at the onset, account will not be allowed to
enroll dependents in the middle of the coverage. Enrollment of dependents will only be accommodated upon
renewal.
 Rated rates will apply to companies whose nature of business falls under Rated Industries. Companies whose
nature of business falls under Ineligible will not be allowed to enroll under this program. A separate proposal will
be drafted upon submission of requirements for quotation.
 In case an extraordinary inflation or deflation of the Philippine Peso should supervene during the term of this
agreement, Maxicare shall be authorized to adjust the Membership fees accordingly or shall be released in
whole or in part, from performance of its obligation, when such has become so difficult on its part as to be
manifestly beyond that contemplated in this Agreement. Extraordinary inflation or deflation shall be conclusively
presumed to have supervened if the exchange rate of the Philippine Peso to the U.S. Dollar should change by
more than twenty-five percent (25%) during any twelve (12) month period.
 In case accredited hospitals increase their rates by more than thirty percent (30%), Maxicare shall be authorized
to adjust the membership fees accordingly or exclude such accredited hospital where a Member can seek
medical services from, 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.
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
34
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 Buerger’s Disease
e. Cataract and Glaucoma
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, Crohn’s 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 Pott’s 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
List of Providers
You may download the lists of providers at these links or request these from us.
DOCUMENT TINYURL LINK

List of Hospitals & Clinics 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
Other Industries & Companies with 100 employees & up

RATED & INELIGIBLE INDUSTRIES
Industries not listed as either Rated and Ineligible will fall under Standard Industries and will enjoy the Standard rates
presented in this proposal. Rated Industries will enjoy Rated Rates while Ineligible Industries will have to submit some
requirements for quotation before a proposal can be submitted.
CATEGORY INDUSTRIES
Rated Construction (Office Based)
35
Education (except pre schools, tutorials & review centers)

Law Firms
Media
Pharmaceuticals (Distributors)
Sauna, Turkish bath, massage parlors (except spa, salons)
Construction (Field Based or combined)
Drillers (oil/water/gas)
Firemen
Full Time athletes
Government Institutions
Groups involving special hazards
Logging or Forestry
Manufacturers of Ammunitions
Medical Groups or any healthcare related
Ineligible 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)
Existing Maxicare Plus Accounts
Lapsed / Suspended/ Cancelled Maxicare Plus accounts w/ a high loss ratio (>120%)
Previous blacklisted accounts (fraudulent / bad payment habit)
INELIGIBLE INDUSTRIES
This proposal is not applicable to companies who fall under the list of Ineligible Industries. Requirements must be
submitted for quotation before a proposal can be submitted.
INELIGIBLE INDUSTRIES WITH LESS THAN 100 EMPLOYEES

Requirements for Quotation:
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
http://tinyurl.com/maxicarepcaf 3. SEC Registration Certificate and/or Cooperative Developing
Authority Certificate of Registration (for Cooperatives)
4. Signed Questionnaire for Rated Accounts. You may download the

3. BIR 2303
form here http://tinyurl.com/maxicarequestionnaire
5. 2 Year Audited Financial Statements

4. Filled out Corporate Enrollment Sheet
(found at the last 3 pages of this initial 6. Detailed Master list with Rank Classification, Job Designation and
proposal) Description, Birthdays / Age, Gender. You may download the template
here http://tinyurl.com/maxicaredetailed
HOW TO SUBMIT THE REQUIREMENTS:
36
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) 635-9058
COMPANIES & INDUSTRIES WITH 100 EMPLOYEES & UP

This proposal is not applicable to companies who have more than 100 employees. Requirements must be submitted for
quotation before a proposal can be submitted.
ALL COMPANIES & INDUSTRIES WITH 100 EMPLOYEES & UP (OR EMPLOYEES AND DEPENDENTS IF
COMBINED REACHES 100)
Mandatory Requirements to Generate a Pricing Proposal:
NGOs/Foundations/Cooperatives/Associations with
All companies with 100 employees & up
100 employees and up
1. Signed Maxicare Prospective Account Form. You may
download the form at http://tinyurl.com/maxicarepcaf
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
2. Excel Softcopy of Company Masterlist (with birthdates or download the form here
age, gender, ranks/classification) http://tinyurl.com/maxicarequestionnaire
4. 2 Year Audited Financial Statements
5. Detailed Master list with Rank Classification, Job
3. Filled out Maxicare Product Mix Survey Form. You may Designation and Description, Birthdays / Age, Gender
download the form here 6. Filled out Maxicare Product Mix Survey Form. You
http://tinyurl.com/maxicareproductmix 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) 635-9058
Enrollment Guidelines
PLAN TYPES FOR EMPLOYEES
The following enrollment set up can be applied when choosing a plan type for all the employees. Note that the enrollment
set up cannot be modified in the middle of the coverage. Creation of additional plan types not chosen at the onset is not
allowed.
1.) Same Plan for all Employees regardless of rank classification (eg. Everyone under Gold 3 Plan)
Example:
Level Employees Plan Type Comments
Executives Gold 3
Managers Gold 3 Uniform plan for all employees
Staff Gold 3
2.) Different Plan Types. Higher Positions must have higher plans. Lower Positions must have lower plans. Employees
with the same position must have the same plan type.
Example:
Level Employees Plan Type Comments
Executives Platinum 1
Managers Gold 1 Choosing different plan types must be
Staff Silver 1 consistent with respect to the rank/level.
37
PLAN TYPES FOR DEPENDENTS

Dependents’ enrollment is optional. If the client did not enroll any dependents at the onset, enrollment of dependents will
only be entertained during renewal.
a) Same Plan for the dependents and employees

Level Employees Plan Type Dependents Plan Type Comments
Executives Platinum 1 Platinum 1 Same plan with employee
Managers Gold 1 Gold 1 Same plan with employee
Staff Silver 1 Silver 1 Same plan with employee
b) 1 plan lower based from the plan type assigned to each rank classification

Executives Platinum 1 Platinum 2 1 plan lower from Platinum 1
Managers Gold 1 Gold 2 1 plan lower from Gold 1
Staff Silver 1 Silver 2 1 plan lower from Silver 2
c) The dependents’ plan for all dependents can be the same plan with that of the lowest plan assigned to the employees

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

Executives Platinum 1 Silver 2 Silver 2 is 1 plan lower from the lowest plan of the
Managers Gold 1 Silver 2 employee
Staff Silver 1 Silver 2
Escalation Clause: Should there be a significant decrease in the number of enrollees per membership type and/ or did
not meet the existing participation requirement in enrolling of eligible dependents, the following adjustment clause shall
apply:
at least 75% standard rates
60% - 74.9% + 10% to standard rates
40% - 59.9% + 20% to standard rates
Below 40% + 35% to standard rates
KYC REQUIREMENTS
The following KYC requirements are required and will be submitted upon submission of the signed conforme
KYC REQUIREMENTS FOR EMPLOYERS

CORPORATIONS 1. Mayor's Permit
AND ORGANIZED 2. SEC Certificate
UNDER FOREIGN 3. Articles of Incorporation
LAWS 4. General Information Sheet
5. Photocopy of Company ID of Signatory

6. Photocopy of at least one (1) valid Government issued ID of owner/authorized
signatory. Any of the ff:
i. Driver's
38
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:
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

signatory (Drivers, GSIS-E Card, Passport, Philhealth, PRC, SSS, TIN, UMID,
Voter's)
masterlist)

PARTNERSHIPS
C. For companes with that are VAT Exempt or Zero Rated
certificate
NON 1. Mayor's Permit
GOVERNMENT 2. SEC Certificate or Certificate of Registration issued by Cooperative Development
ORGANIZATIONS / Authority (CDA)
COOPERATIVES 4. Articles of Incorporation
4. Latest General Information Sheet
39
Voter's)
masterlist)

C. For companes with that are VAT Exempt or Zero Rated:
certificate
1. Mayor's Permit
2. DTI Certificate

Voter's)
masterlist)
SOLE
PROPRIETORSHIP ADDITIONAL REQUIREMENTS FOR SPECIAL CASES:
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
certificate
1. Chartered Document
Voter's)
3. Maxicare Questionnaire for Rated Accounts
GOVERNMENT
AGENCIES / LOCAL
GOVERNMENT
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
EMBASSY 2. Photocopy of at least one (1) valid Government issued ID of owner/authorized
signatory
40
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
(any of the
following) 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
Consultants b. BIR 1604 / Alphabetical List (latest with stamped received by the BIR), or
(any of the c. Philhealth Members Data Form (MDR), or
following) d. SSS Contribution List or General Information Sheet
e. Contract with the Employer
Foreign a. Alien Employment Permit issued by the Department of Labor and Employment
Nationals b. Photocopy of Alien Certificate of Registration Identity I-card issued by the
(Expats) Bureayu of Immigration
ENROLLMENT PROCESS STEP BY STEP
41
Enrollment Form
COMPANY INFO SHEET
Company Name:
Nature of Business:
Address with Zip Code:

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
42
Provider Access (With 9 Major) (Yes or No)
Note: Can be assigned to selected ranks like
the Executoves only. Not Available for
Provincial Plans
With Healthway Access (Yes or No)
Note: Can be assigned to selected ranks like
the Executoves only. Not Available for
Provincial Plans
Plan Assignments according to Rank.
Ex.
EMPLOYEES
Executives - Platinum 1
Managers - Gold 1
Staff - Silver 1
DEPENDENTS
Executives' Dependents - Platinum 2
Managers' Dependents - Gold 2
Staff's Dependents - Silver2
Optional Riders (pls enumerate)
43
EMPLOYEES
Last Name First Name MI Extension Employee no. Position Date of Birth Sex Civil Status Plan
Legend:
1 First Name
2 Middle Name
3 Last Name
4 Extension Name Jr. / Sr. / I, II, III, IV etc.
5 Employee No
6 Position
7 Date of Birth mm/dd/yyyy format
8 Sex Either F for female or M for male
9 Civil Status Single / Married / Separated / Widowed / Divorced
10 Plan Platinum1, Gold2, Silver2 , Bronze
44
DEPENDENTS
Last First Name of Date of

Middle Initial /Name Extension Relationship Sex Civil Status Plan
Name Name Principal/Employee Birth
Legend:
1 First Name
2 Middle Name
3 Last Name
4 Extension Name Jr. / Sr. / I, II, III, IV etc.
5 Relationship Either as spouse, child, siblings or parent
6 Principal Name of the employee
7 Date of Birth mm/dd/yyyy format
8 Sex Either F for female or M for male
9 Civil Status Single / Married / Separated / Widowed / Divorced
10 Plan Platinum1, Gold2, Silver2 , Bronze

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For inquiries: contact us at (02)

We hope this proposal finds you in good health!

Comprehensive Medical Care Features

Requirements for Enrollment:

Office of Mark Gastardo

Nationwide Access Rates

NO 2018 OPTIONAL RIDERS FOR STARTER PLAN Ann Semi

2018 GROUP (10-19-Employees)

2018 SMALL (20-99 Employees)

2018 SMALL (20-99 Employees)

NO 2018 OPTIONAL RIDERS FOR NATIONWIDE: Ann Semi Qtr

17 Executive Check Up Inpatient Makati Medical Center 32,516 17,559 9,104

SPECIAL ACCOMMODATION FOR NON PHILHEALTH MEMBERS

Provincial Access Rates

PROVINCIAL NORTH LUZON (10-99 Employees) SOUTH LUZON (10-99 Employees)

3 Life AD&D (Php25,000) 71 38 20 71 38 20

2018 PROVINCIAL VISAYAS (10-99 Employees) MINDANAO (20-99 Employees)

PROVINCIAL ACCESS DIRECTORY

NORTHERN LUZON WITHOUT NCR & BAGUIO

SOUTHERN LUZON WITHOUT NCR & BAGUIO

c) Region V: Albay, Camarines Norte, Camarines Sur, Catanduanes, Masbate, Sorsogon

HEALTHCARE BENEFITS MAXICARE'S COVERAGE

C. ROUTINE PROCEDURES (whether IP or OP)

F. ANNUAL CHECK-UP Optional

2 Non-Dreaded Conditions Covered depending on the type of Product

K. DENTAL CARE Optional

GROUP LIFE INSURANCE WITH

ii.) Accidental Death, Dismemberment & Disablement or Loss of Use of Limbs

Both Hands 100% of amount of insurance

i.) Suicide during the first year

N. ADDED PROGRAM FEATURES

At least 75% of all eligible employees should enroll all

RIDER BENEFIT DESCRIPTION & INCLUSIONS

The date of termination of the group master policy.

Parents and siblings who

EXCLUSIONS AND LIMITATIONS PROVISIONS

Notes & Special Reminders:

PRE EXISTING NON DREADED & DREADED CONDITIONS

Non-dreaded conditions are as follows, but not limited to:

Dreaded conditions are as follows, but not limited to:

DOCUMENT TINYURL LINK

Other Industries & Companies with 100 employees & up

Education (except pre schools, tutorials & review centers)

INELIGIBLE INDUSTRIES WITH LESS THAN 100 EMPLOYEES

4. Signed Questionnaire for Rated Accounts. You may download the

5. 2 Year Audited Financial Statements

COMPANIES & INDUSTRIES WITH 100 EMPLOYEES & UP

PLAN TYPES FOR DEPENDENTS

a) Same Plan for the dependents and employees

Level Employees Plan Type Dependents Plan Type Comments

Level Employees Plan Type Dependents Plan Type Comments

Level Employees Plan Type Dependents Plan Type Comments

KYC REQUIREMENTS FOR EMPLOYERS

5. Photocopy of Company ID of Signatory

ADDITIONAL REQUIREMENTS FOR SPECIAL CASES:

ii. BIR Certificate of Registration (BIR 2303)

4. Photocopy of Company ID of Signatory

ADDITIONAL REQUIREMENTS FOR SPECIAL CASES:

ADDITIONAL REQUIREMENTS FOR SPECIAL CASES:

5. Photocopy of at least one (1) valid Government issued ID of owner/authorized

ENROLLMENT PROCESS STEP BY STEP

COMPANY INFO SHEET

Address with Zip Code: