Dear Ma’am/Sir:

We are pleased to submit our offer for the Comprehensive Health Care MediCard Select Package for your family/______/______.

The accompanying proposal includes in depth information on:

 Hospitalization / In-patient  Emergency Care  Out-patient Care  Dental Health Care  Preventive Health Care

MediCard has over 30 years of experience in providing quality healthcare across a range of industries and have helped many of its customers manage their healthcare. As the only HMO founded and run by doctors, you are assured that the plan we offer you is recommended and approved by our industry experts on board.

MediCard stands tall – it has more than 43,000 accredited medical professionals in more than 1,000 accredited hospitals and clinics that serve its more than 700,000 members across the archipelago. Add to that the prestige of being the first HMO in the country that is ISO-certified and has taken steps to advance its Quality Management Systems so you are gu aranteed of quality healthcare.

MediCard continues to play a role as an innovator and a leader in providing solutions to your needs so you can channel your a dministrative’ s time and efforts to other more productive areas.

 MediCard is the first to introduce the E-corporate portal that lets you check your employees’ membership information, enroll new members, view utilization and more.  MediCard is also the first to introduce MyPocket Doctor, a telemedicine facility offered to its members that allows cons ultation with a doctor via video or phone call anytime, anywhere  MediCard is the first to offer occupational health services and corporate staffing for onsite clinics  MediCard has its own network of free -standing clinics and pharmacies for total managed he althcare

On top of these, MediCard has a high renewal persistency rate among its satisfied clients.

We hope that you will find our proposal convincing and that the package meets your requirements. Should you need further cla rification, please call the undersigned at 8864-0907.

Thank you for allowing us the opportunity to present our offer.

We look forward to the pleasure of servicing the health care needs of your family.

Sincerely, Noted by:

JOSEPHER M. GILVERO RANDY V. VERDE Membership Consultant – MediCard Select Senior Assistant Sales Director- Sales and Business Development II MediCard , Inc.

MediCard Select Program – Individual/Family/SME

A. Membership Eligibility

a. Principal Member

For Individual Account: Any person at least 18 years old up to 99 years of age For Family Unit/SME Account: Any person at least 18 years old up to 60 years of age

b. Qualified Dependent Members for Family Unit/SME Account

Legal Spouse up to age 60 For Married Principal Members

Legitimate and/or legally adopted children, 30 days old up to 60 years of age who are not gainfully employed and unmarried

Parents up to age 60, unemployed and dependent on the Principal Member For Single Principal Members Brothers and sisters, 30 days old up to 60 years of age, who are not gainfully employed and unmarried Children, 30 days old up to 60 years of age, who are not gainfully employed For Single Parent Principal Members and unmarried

Notes:  All members must be below 60 years and 6 months old and younger upon enrollment  No hierarchy to follow

B. Preventive Healthcare Services The Preventive Health Care Services will be provided to MEMBERS by designated MediCard Medical Service Units Health Care Benefits Coverage/Limit

1. Annual Physical Examination (APE) to include* Covered

Covered a. Complete Blood Count

b. Urinalysis (urine examination) Covered

c. Fecalysis (stool examination) Covered

d. Chest X-Ray Covered

e. Electrocardiogram (for ______) Covered

f. Pap Smear (for ______) Covered g. Eight Blood Chemistries: Fasting Blood Sugar, Total Cholesterol, Uric Acid, Covered under APE; for members 30 years old and above Creatinine, BUN, HDL, LDL and Triglycerides

h. Anti-flu vaccines Covered under APE; for members below 30 years old

2. Management of Health Problems Covered

3. Routine Immunization (______cost of vaccines) Covered

4. Counseling on Health habits, diets and Family Planning Covered

5. Record keeping of medical history Covered *APE may be conducted at any MediCard-free standing clini MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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List of MediCard Free Standing Clinics:

1. MediCard Lifestyle Center - – 51 Avenue corner Senator , Makati City 2. MediCard Philippines, Inc. - Makati – 2129 G/F King's Court Bldg. II, Don , Makati City 3. MediCard Philippines, Inc. – Ortigas Clinic – Unit 105, Parc Royale Condominium, Julia Vargas Avenue, Ortigas Centre, Pasig City 4. MediCard Philippines, Inc. – Sta. Rosa - 2nd Floor Humana Wellness Center, Tagaytay Highway, Brgy. Don Jose, Sta. Rosa, Laguna 5. MediCard Philippines, Inc. – Centris - Unit E, F, G Two Cyberpod Centris, Eton Centris, EDSA corner Quezon Avenue, Quezon City 6. MediCard Philippines, Inc. - Cavite Clinic - G/F MediCard, Anabu Kostal, Anabu II D, Aguinaldo Highway, Imus, Cavite 7. MediCard Philippines, Inc. – Alabang Filinvest Clinic – 3/L Festival Supermall, Corporate Avenue, Filinvest, Alabang, Muntinlupa City 8. MediCard Philippines, Inc. – Calamba Clinic – Unit 1 G/F, Adenson Building, Brgy. Parian, National Hi-way Calamba, Laguna 9. MediCard Philippines, Inc. – Fairview Clinic – Unit 31 E & F LF Building, Commonwealth Avenue corner Camaro Street, Fairview, Quezon City 10. MediCard Philippines, Inc. – Clark - 2nd Floor, SM City Clark, Manuel A. Roxas Highway, Clark Freeport, Pampanga 11. MediCard Philippines, Inc. – Cebu Clinic – Unit 204 and 704, FLB Corporate Center, Cebu Business Park Mabolo, Archbishop Reyes Avenue, Cebu City 12. MediCard Philippines, Inc. – McKinley – G/F Morgan Executive Suite, McKinley Hill, Bonifacio Global City, Taguig 13. MediCard Philippines, Inc. – Sta. Lucia – G/F Sta. Lucia East Grand Mall, Marcos Highway corner Felix Avenue, Cainta, Rizal 14. MediCard Philippines, Inc. – Lipa Clinic – G/F RDC Plaza, J.P. Laurel Highway (in front of Lipa Medix Medical Center), Lipa City, Batangas 15. MediCard Philippines, Inc.- Uptown Bonifacio – LG05, Lower Ground Floor, One Uptown Residences, 9th Avenue corner 36th Street, Bonifacio Global City, Taguig

C. Out-patient Care Services** Out-patient Services will be provided to MEMBERS in any MediCard accredited hospital/clinics Health Care Benefits Coverage/Limit

1. Referral to specialists Covered

2. Regular consultations & treatment (______Covered prescribed medicines)

3. Eye, Ear, Nose & Throat treatment Covered 4. Treatment of minor injuries and surgery not requiring confinement Covered 5. X-ray and laboratory examinations prescribed by MediCard physician Covered

6. Physical Therapy / Speech Therapy Covered

7. Laser treatment of Glaucoma & Retinal Detachment Up to ______8. Cataract Extraction including phacoemulsification); Up to ______cost of lens

9. Cauterization of warts (including facial warts) Up to ______

10. ______of anti-rabies, anti-venom, anti-tetanus Up to ______

11. Tuberculin Test (______screening) Up to ______

12. Pre & Post natal consults Covered; including labs

13. Sclerotherapy (______sclerosing agent) Up to ______

14. Chronic Dermatoses (______) Covered

15. Scabies (______) Covered

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Health Care Benefits Coverage/Limit

16. Allergy Testing Up to ______**Inclusive of operating room charges, professional fees and other incidental expenses relative to the procedure

D. Dental Care Services MEMBERS may avail of the following dental care services from any of the accredited dental clinics: Health Care Benefits Coverage/Limit

1. Oral prophylaxis (______) Covered

2. Consultations and oral examinations Covered

3. Tooth extractions Covered; ______surgery for impacted or ankylosed tooth

4. Temporary fillings Covered

5. Gum treatments for cases like inflammation or bleeding Covered and adjustment of dentures 6. Recementation of loose jackets, crowns, in-lays and on- Covered lays

7. Treatment of mouth lesions, wounds and burns Covered

8. Emergency out-patient dental treatment Covered

9. Temporomandibular Joint (TMJ) consultations Covered

10. Restorative and Prosthodontic consultations Covered

11. Dental Nutrition & Dietary Counseling Covered

12. Dental Health Education Covered

13. Prenatal & Postnatal consultations Covered

14. Light cure fillings Covered

15. Deep scaling Covered

16. Root canal Covered

17. Dental X-ray Covered

E. In-patient Care Services The following hospitalization (In-Patient) services shall apply when MediCard physicians prescribe the hospitalization of MEMBERS in any MediCard Accredited Hospitals:

Health Care Benefits Coverage/Limit

1. No deposit upon admission Covered

2. Room and board Regular Private Open

3. Use of operating theatre and Recovery Room Covered

4. Services of MediCard specialist like anesthesiologists, Covered internists, surgeons, etc.

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Health Care Benefits Coverage/Limit 5. Services and medications for general/spinal anesthesia or other forms of anesthesia deemed necessary for a surgical Covered procedure 6. Fresh whole blood (including screening/ processing), and Covered intravenous fluids

7. X-ray and laboratory examinations Covered

8. Administered medicines Covered

9. Dressings, sutures and plaster casts, etc. Covered

10. ICU confinements Covered

11. Chemotherapy Up to ______

12. Radiotherapy a. Intensified Modulated Radiotherapy b. Three-Dimensional Conformal Radiotherapy (3DCRT) Up to ______c. Tomotherapy d. Brachytherapy 13. Dialysis Up to ______a. Continuous Renal Replacement Therapy (CRRT) 14. Human Blood Products (including screening/ processing) Covered except gamma globulin

15. Admission kit including wee bag Covered

16. Laparoscopic Procedures (______) Up to ______a. Single Incision Laparoscopy Surgery (SILS)

17. Lithotripsy/ESWL (______) Up to ______

18. Hysteroscopic Procedures (______) Up to ______

19. Stereotactic Brain Biopsy / Up to ______Stereotactic Breast Biopsy (______)

20. Gamma Knife Surgery (______) Up to ______

21. Percutaneous Ultrasonic Nephrolithotomy Up to ______(______) 22. Transurethral Microwave Therapy (TUMT) of the prostate Up to ______(______)

23. Arthroscopically-guided Procedures Up to ______

24. CT Scan / MRI / Ultrasound guided excisions a. Percutaneous Discectomy CT Guided Intradiscal Up to ______b. Electrothermal Ablation Technic (IDET) 25. Endoscopically-guided excisions / treatments / procedures Up to ______

26. Laser / Coblation Tonsillectomy Up to ______27. Endovenous Laser Therapy/Endovenous Laser Ablation/Radiofrequency Ablation (except for cosmetic Up to ______purposes) 28. Coblation Procedures Up to ______

29. Ductoscopy (Breast) guided Up to ______excisions/treatment/procedures 30. Endoscopic Ultrasound guided Up to ______excisions/treatment/procedures

31. Infrared Coagulation Hemorrhoidectomy Up to ______

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Health Care Benefits Coverage/Limit

32. Mammotome/Vacuum Assisted Breast Biopsy Up to ______

33. Stereotactic Radiation Therapy / Stereotactic Radiosurgery Up to ______

34. Thyroplasty (implant not covered) Up to ______

35. Transarterial Hemorrhoidal Dearterialization (THD) Up to ______

36. Ultroid Hemorrhoid Management Up to ______

37. Any other modern therapeutic procedure not mentioned Up to ______above 38. Magnetic Resonance Imaging (MRI) / Magnetic Resonance Angiography (MRA) Up to ______a. Tractography / Diffusion Tensor Imaging b. Superparamagnetic Iron Oxide (SPIO) enhanced MRI 39. CT scan a. Multislice / multidetector / spiral / multirow CT Up to ______b. Ultrafast Electron Beam Computed Tomography 40. Ultrasound a. Intravenous Ultrasound / Intravascular Ultrasound Up to ______b. Contrast Enhanced Ultrasound

41. Robotic Surgery / Robotically-assisted Surgery Up to ______

42. Photodynamic Therapy Up to ______

43. Acoustic Radiation Force Up to ______

44. Capsule Endoscopy Up to ______

45. New diagnostic and treatment procedures for conditions with established etiologies and its use is only as alternative Up to ______to the conventional methods. 46. Laboratory/ancillary services for conditions whose pathogenesis or subsequent clinical improvement is not Up to ______yet fully established in Medical Science 47. Other medically necessary modalities not mentioned above and those for which there are no comparable, Up to ______conventional or traditional counterparts 48. Positron Emission Tomography (PET) Scan Up to ______

49. Stapled Hemorrhoidectomy Up to ______

50. Cryosurgery Up to ______

51. Work-related illness/accidents (______) Up to ______

52. Unprovoked/Provoked Assault Up to ______

53. Hyperventilation syndrome Up to ______

54. Congenital Illnesses (regardless of PEC limit) Up to ______

55. Slipped Disc, Scoliosis, Spondylosis, Spinal Stenosis Up to ______

56. Open heart surgery (______cost of stent and Up to ______pacemaker) 57. Organ transplant (______cost of organ and Up to ______donor’s expense) 58. The following complex diagnostic examinations and

therapeutic procedures:

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Health Care Benefits Coverage/Limit a. Angiography (e.g. Coronary, cerebral, retinal/fluorescein, pulmonary, GI, etc.) b. Serum chemistry panels (e.g. Chem 23, Spec M, etc.) c. Pulmonary perfusion scan d. Tests involving use of Nuclear Technologies (e.g. Radionuclide Ventriculography / Thallium stress testing / Radionuclide (Isotope) Scanning, Pyrophosphate Scintigraphy, etc.) e. Electromyography, Nerve Conduction Velocity Studies f. 24-Hour Holter Monitoring, 2-D Echo and Doppler g. Treadmill Stress Test h. Myelogram i. Diagnostic Endoscopy (including one of video) i.1 Multiphoton endoscopy j. Diagnostic Arthroscopy k. Diagnostic Hysteroscopy l. Plasma/Urinary Cortisol, Plasma Aldosterone, Adrenocortical Function, etc. m. Mammogram and Sonomammogram n. Bone densitometry scan (Dexascan) o. Immunologic Studies: o.1 Anti-nuclear antibody (ANA) o.2 C-Reactive protein o.3 Lupus cell exam o.4 Enhanced Luciferase Complementation / Luciferase Immunoprecipitation Assay o.5 Enzyme-linked Immunosorbent Spot (ELISPOT) Up to ______Assay o.6 ESAT-6 and CFP-10 Antigens o.7 QuantiFERON Tuberculosis (QFTB) p. Genetic studies: p. 1 Alpha Globin / Globulin Genotyping p. 2 Beta Globin / Globulin Genotyping p. 3 BCR-ABL by Quantitative Real-time Polymerase Chain Reaction (QRT-PCR, RT-PCR) p. 4 Duolink In-Situ Fluoresence Hybridization (DISH) / Array Comparative Genomic Hybridization (aCGH) p. 5 Epidermal Growth Factor Receptor (EGFR) Mutation Assay / Test p. 6 Fluorescence In-Situ Hybridization (FISH) p. 7 JAK-2 Mutation p. 8 Karyotyping p. 9 KRAS Testing p. 10 Philadelphia chromosome p. 11 Polymerase Chain Reaction (PCR) for katG and rpoB p. 12 Polymerase Chain Reaction Single Strand Conformation Polymorphism (PCR-SSCP) p. 13 Reverse Transcription Polymerase Chain Reaction (RT-PCR)

q. Magnetic Resonance Spectroscopy Up to ______

r. Platelet Aggregation Test Up to ______

s. 3D & 4D Ultrasound (except for maternity cases) Up to ______

t. Ductoscopy (Breast) Up to ______

u. Endoscopic Ultrasound Up to ______

v. Peritoneal Dialysis Adequacy Test Up to ______

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Health Care Benefits Coverage/Limit

w. Peritoneal Equilibration Test Up to ______

x. Spinal Angiogram Up to ______

y. Any other complex diagnostic procedure not Up to ______mentioned above 59. Professional fee of the assisting physician in surgical Covered procedures 60. All other items directly related to the management of the Covered case

61. Visitation of MediCard liaison officer Covered

F. Emergency Care Services

1. In Accredited Hospitals

In cases of emergency where the MEMBER avails of the services of MediCard Accredited Hospitals/ Clinics, the following will be provided: Health Care Benefits Coverage/Limit

a. Doctor’s services Covered

b. Medicines used during treatment or for immediate relief Covered

c. Oxygen and intravenous fluids Covered

d. Dressings, plaster casts and sutures Covered

e. Laboratory, x-ray and other diagnostic examinations Covered

2. In Non-Accredited Hospitals

For emergency medical services in non-participating hospitals and clinics, members must advance payment and later file reimbursement from MediCard. Reimbursement shall be based on the table below:

Health Care Benefits Coverage/Limit a. When a MEMBER is in immediate danger of losing a limb, eye or other parts of the body or is in severe pain that requires immediate relief and enters a non-MediCard accredited hospital for treatment. b. MediCard shall pay the said amount when it is verified that MediCard facilities were not used because to have Covered; Reimburse 100% of Approved Hospital Bills and done so would entail a delay resulting in death, serious Professional Fees based on MediCard Relative Value (MRV)* disability or significant jeopardy to the MEMBER's condition or the choice of hospital was beyond the control of the MEMBER or the MEMBER's family. Other expenses not covered in using non-MediCard Accredited Hospitals for emergency care is follow up care *MRV – what it would have cost had the service been rendered in an accredited hospital through the services of an accredited doctor

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3. In Foreign Countries

In cases of emergency where a MEMBER avails of services in a foreign territory, members must advance payment and later file reimbursement from MediCard. Reimbursement shall be based on the table below:

Health Care Benefits Coverage/Limit

Approved Hospital Bills Covered; 100% based on MediCard Relative Value (MRV)* and Philippine Currency Doctor’s Professional Fees *MRV – what it would have cost had the service been rendered in an accredited hospital through the services of an accredited doctor

4. In Areas without Accredited Hospitals

In cases of emergency where the MEMBER avails of services in areas without accredited hospitals , members must advance payment and later file reimbursement from MediCard. Reimbursement shall be based on the table below:

Health Care Benefits Coverage/Limit

Approved Hospital Bills Covered; 100% based on MediCard Relative Value (MRV)* Doctor’s Professional Fees *MRV – what it would have cost had the service been rendered in an accredited hospital through the services of an accredited doctor

5. Ambulance Services and Emergency Medical Assistance Health Care Benefits Coverage/Limit

Ambulance services (Land transport) Covered; on a reimbursement basis

Health Care Benefits Coverage/Limit Member may avail of the next higher room available except suite within the first 24 hours of confinement upon admission. 6. In cases of non-availability of room according to plan All incremental costs incurred after the first 24 hours shall be during confinements for the personal account of the member, except when the Accredited Hospital issues a certification of non-availability of the member’s room and board accommodation.

G. Other Benefits & Considerations

Health Care Benefits Coverage/Limit

1. Medical evaluation for enrollees age 41 and above is waived for Principal and Dependent members. Application Forms are waived for SME Account. Maternity assistance for all female members subject to the limits on the table below: Type of Delivery Coverage Caesarean Normal Delivery D&C (For Miscarriage and Abortion) Up to ______Abnormal Pregnancies* 2. Maternity Benefit (Outright Coverage) Maternity complications** H.Mole/ Gestational Trophoblastic Disease (including D&C) *Abnormal Pregnancy refers to all pregnancy related conditions whose onset occurred from conception to puerperium (six weeks after delivery), including pre-delivery availments / confinements. This is an additional limit on top of Manner of Delivery/Termination. ** Maternity Complications refers to all maternity related conditions whose onset occurred beyond puerperium, including but not limited to incisional

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Health Care Benefits Coverage/Limit hernia, pelvic relaxation, rectocoele, uterine prolapse, etc.

NOTE: All maternity benefits except “Maternity Complications” may be availed ONLY for one (1) pregnancy per contract year. It is hereby declared and agreed that hospitalization benefits due under the PHILHEALTH and/or Employee Compensation Commission (ECC) program are assigned to and integrated with the MediCard program such that any of the PhilHealth/ECC Provision MediCard benefits due under this Agreement shall be net of the MEMBER's PHILHEALTH and/or Employee Compensation Commission (ECC) benefits. MediCard will not pay or advance the costs of such benefits, nor be responsible for filing any claims under PHILHEALTH and/or ECC.

H. Pre-Existing Conditions Coverage

Principal Members Pre-existing conditions are covered up to ______

Dependent Members Pre-existing conditions are covered up to ______

NOTES:  All other limits mentioned in this proposal are subject to the Pre-Existing Condition limit, if applicable, based on the given diagnosis

2. Any illness, injury or any adverse medical condition shall be considered pre-existing if prior to the effectivity date of membership, the pathogenesis or onset of such illness, injury or adverse medical condition has started as determined by MediCard's Medical Director or accredited physicians. The determination of the pre-existing condition shall not be limited to one (1) year from the effectivity date of membership.

3. Without necessarily limiting the following enumeration, the following are automatically considered as pre-existing conditions if consultation or treatment is sought within the first twelve (12) months of coverage:

a. Annual Benefits listed below except for letters k & l b. Hypertension c. Goiter (Hypo/Hyperthyroidism) d. Cataracts/Glaucoma e. ENT conditions requiring surgery f. Bronchial Asthma /Allergy / Urticaria g. Tuberculosis h. Chronic Cholecystitis/Cholelithiasis (gall bladder stones) i. Acquired Hernias j. Prostate disorders k. Hemorrhoids and Anal Fistulae l. Benign Tumors m. Uterine Myoma, Ovarian cysts, Endometriosis n. Buergher's Disease o. Varicose Veins p. Arthritis q. Migraine headache r. Gastritis/duodenal or gastric ulcers

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Dreaded Disease Dreaded Diseases are potentially or actually life-threatening conditions or illnesses which may require prolonged or repeated hospitalization or intensive care management. MediCard shall pay for hospitalization services up to the maximum limit subjec t to the pre-existing conditions coverage.

The following are considered Dreaded Disease: a. Cerebrovascular Accident (stroke) b. Central nervous system lesions (Poliomyelitis/Meningitis/Encephalitis/Neurosurgical conditions) c. Cardiovascular Disease(Coronary/Valvular/Hypertensive Heart Disease/Cardiomyopathy) d. Chronic Obstructive Pulmonary Disease (Chronic Bronchitis/Emphysema), Restrictive lung disease e. Liver Parenchymal Disease [Cirrhosis, Hepatitis (except type A), New growth] f. Chronic Kidney/Urological disease (Urolithiasis, Obstructive Uropathies, etc.) g. Chronic Gastrointestinal Tract Disease requiring bowel resection and/or anastomosis h. Collagen diseases (Rheumatoid Arthritis, Systemic Lupus Erythematosus) i. Diabetes Mellitus and its complications j. Malignancies and Blood Dyscrasias (Cancer, Leukemia, Idiopathic Thrombocytopenic Purpura) k. Injuries from accidents or assaults, frustrated homicide or frustrated murder l. Complications of an apparent ordinary illness including MODS and SIRS (e.g. sepsis due to pneumonia, typhoid ileitis, cerebral malaria, etc.) m. Single or multiple organ dysfunction and failure (MODS and MOF) n. Conditions that may require dialysis o. Chronic pain syndrome (greater than six weeks) p. Any illness other than the above which would require Intensive Care Unit confinement q. Et cetera

I. Members Satisfaction Service

Benefit Remarks

24/7 Call Center Service/Access Trunkline: 8841-8080; Toll Free: 1-800-1888-9001

Hospitals 456 nationwide

Clinics 512 nationwide

Doctor 19,567 nationwide

Direct Access to the MediCard Dentists 776 nationwide healthcare network

Hospital Satellite Clinics 8 satellite clinics

Referral desks 13 referral desks

Stand-alone Full Service 15 Full Service Clinics Clinics (MediCard) Access to TEXT MediCard Service providing members real time access to the database of Text MediCard accredited hospital, doctors and clinic schedules; Key in MediCard and send to Smart - 0908-884-1814 Globe and Sun Subscribers - 0917-851-2648 for more information  Membership Information e-MediCard  Latest payment Made e-Member Services  Medical and Dental Availments A secured web-based application -is the virtual place for all MediCard (Principal and Dependents) which maximizes the backbone of the members  Request for ID Replacement (For internet to deliver value. Individual and Family Accounts)  Reimbursement Status/Details Added services to MediCard’s  On site APE scheduling clientele. It ensures privacy and  Benefits and Exclusions integrity as provided by MySecureSign, the Philippine affiliate  Utilization reporting of Verisign the worlds largest e-Corporate Data Administration -is  Reimbursement Status/Details Certification Authority. intended for authorized and registered  Membership endorsement representatives from MediCard Corporate  ECU scheduling / Group accounts  Request for ID Replacement To experience MediCard’s newest innovation, log on now @  List of Active Members www.MediCardphils.com.  List of Resigned Members  List of Enrollees with Action Memo

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Benefit Remarks e-Account Management -is specially designed for MediCard sales It is a replica of their active accounts’ e- agents and intermediaries to help them Corporate Data Administration screens. manage clients more efficiently.

K. Membership Fees

We shall require the setting up of a REVOLVING FUND (See below for the options) to start the program. This fund will be exclusively used to pay all approved hospital bills, professional fees and our corresponding administrative fee of 15%; and it shall be replenished on a regular basis to maintain the required fund balance stated. In addition, an Annual Network Access Fee of P3,000.00 per member shall be charged to cover the processing of application and identification card (QR Code IDs), access fee to our accredited providers, Annual Physical Exam including eight (8) blood chemistries for members 30 years old and above and anti-flu vaccines for members below 30 years old and other incidental expenses. Annual Network Access Fee and fund are inclusive of 12% VAT. The administrative fees are subject to 12% VAT.

ROOM AND BOARD: REGULAR PRIVATE OPEN

FOR INDIVIDUAL ACCOUNT

WITH ACCESS TO ALL MALL-BASED CLINICS WITHOUT AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY

AGE REVOLVING FUND* Projected Coverage

60 years old and below ------61 years old and up ------*Possible fund adjustments after review of duly filled-out application forms

WITH ACCESS TO ALL MALL-BASED CLINICS WITH AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY

AGE REVOLVING FUND* Projected Coverage

60 years old and below ------61 years old and up ------*Possible fund adjustments after review of duly filled-out application forms

FOR FAMILY ACCOUNT (All members must be below 60 years and 6 months old and younger upon enrollment*)

WITH ACCESS TO ALL MALL-BASED CLINICS WITHOUT AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY REVOLVING FUND** Projected Coverage Number of Family Members (per family) (per family) Family of 2-4 ------Family of 5 and up ------**Possible fund adjustments after review of duly filled-out application form WITH AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY WITH ACCESS TO ALL MALL-BASED CLINICS

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REVOLVING FUND** Projected Coverage Number of Family Members (per family) (per family) Family of 2-4 ------Family of 5 and up ------*For a member age 61 and up, the member must apply for an individual account **Possible fund adjustments after review of duly filled-out application forms

FOR SME ACCOUNT

WITH ACCESS TO ALL MALL-BASED CLINICS WITHOUT AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY

ROOM & BOARD REVOLVING FUND* Projected Coverage

REGULAR PRIVATE OPEN ------

WITH ACCESS TO ALL MALL-BASED CLINICS WITH AHMC, MMC, TMC, CSMC, SLMC-Q.C. & SLMC-GLOBAL CITY

ROOM & BOARD REVOLVING FUND* Projected Coverage

REGULAR PRIVATE OPEN ------

All enrolled members shall be provided with a MediCard ID. Availment of medical benefits shall be similar to our usual procedures as outlined in our Medical and Health Care Handbook. All hospital bills and professional fees shall be charged to MediCard and shall be subsequently paid through withdrawals from the FUND. MediCard shall bill all hospital charges and professional fees as they are incurred, including therein corresponding administrative charges and Value Added Tax (VAT). MediCard shall indicate in the billing statement the fund balance, which must be replenished within seven (7) calendar days from the time it reaches 50% of its required level.

Legend: AHMC Asian Hospital and Medical Center MMC SLMC-QC St. Luke’s Medical Center - Quezon City SLMC-Global St. Luke’s Medical Center - Global City TMC The Medical City CSMC Cardinal Santos Medical Center Limitations and Guidelines

HOSPITALIZATION

1. All confinement shall be upon recommendation of the corporate health program holder's MediCard accredited Physician, or the MediCard Medical Director or the Emergency Room Resident Physician of the MediCard Accredited Hospital w ho decides to admit MediCard patient-member in cases of life threatening emergencies.

2. Hospital bills for the follow ing hospital services shall be charged to the account of the MediCard patient-member: services of a private nurse or doctor, use of ex tra food and/or bed, T.V., electric fan, VCD, ID bracelet, thermometer, admission kit and all other items not directly related to the medical management of the patient.

3. Hospitalization and treatment outside the Philippines is not covered.

4. MediCard is not responsible and w ill not recognize any hospital bills incurred by a corporate health program holder in hospitals not accredited by MediCard, ex cept for emergency care services under the terms provided in this Agreement.

5. Cost of hospitalization, medical services, medicine and other expenses incurred as a result of a member's decision to avail of such hospitalization, medical services, treatment or procedure, not prescribed or contrary to

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w hat has been prescribed by the attending MediCard provider, or w ithout MediCard’s express w ritten report shall not be shouldered by MediCard.

B. OUT-PATIENT SERVICES

1. Prescribed medicines on an out-patient basis are not provided by MediCard Medical Center or Medical Service Units.

2. The absolutely no charge out -patient medical and health care services are provided only during clinic hours of Medical Service Units.

3. Second opinions and cost of treatment incurred in non-accredited hospital or clinic should the member unilaterally decide to seek such recourse.

C. ELIGIBILITY 1. Deadline for enrollment of dependents:

a. For new & renew ing accounts - 30 days from the effectivity date of the agreement.

b. For dependents w ho meet the eligibility requirements w ithin the agreement period - 30 day s from the date dependent become eligible for membership. (copy of birth certificate or marriage agreement must be submitted)

c. For additional principal members of the company, dependent/s must be enrolled together w ith the principal.

d. Any additional dependents other than the above can be enrolled upon the renew al of agreement, w ithin the one (1) month enrollment period.

After the lapse of the periods specified above, MediCard w ill no longer receive, evaluate and accept any designation or application to be a qualified dependent from any PRINCIPAL MEMBER.

2. Underw riting cut-off dates in assigning effectivity date:

Date of Receipt of Application/Endorsement Effectivity Date 11th to 25th of the month 1st of the follow ing month 26th to 10th of the month 16th of the same month

CONFIRMATION:

This is to signify that all benefits, exclusions and premium incorporated to this proposal are amenable to us. By this, we have decided to avail the services of MediCard Philippines, Inc. under the MediCard Select Program effective ______.

______CONFORME SIGNATURE OVER PRINTED NAME

MEDICARD SELECT PROGRAM – INDIVIDUAL/FAMILY/SME

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