S80 — VIP Rates Rev. 25 1 January 2017, . MEDICARD PHILIPPINES, INC. MediCard sesoornice ror, the word cote Bung, 380 Sen. ciPuyat Avene, Makati chy 1200 VIP PROGRAM oaaE Regular Private Regular Private large Private Sue upto 6000] Dreaded Disease Lint # 200,000 250,000, —P 300,000 500,000 ‘Additional init for aecidents | 50,000 P 100,000, 150,000 7 200,000 Dre-evstng condltions coverage in-patient & Outpatient [P5000 [F000 55 000 720,000 Free Consultations at MediCard owned Clinics from the following primary care physicians & specialists: 1) General Surgeon 4) Obstetrician Gynecologist 2} Pediatrician 5} Family Medicines 3) General Practitioner 65) lncermal internist, ‘Above consults will not be charged to the members! Maximum Benefit Limit amber aka aT eT erator exams] Laboratory eaniations]_labororyexminaors| labor exrinatns camatins een fr coains | pep okaneaum | "upto 20%ascoon | apro.ox aacoum | ptostx dren Emons wnch oe rotcores, | MatwntyAeited | _waterniyneed | —_Maeniyneaved | _waternyRetes Ontepa hs, members can vai [borate &utasound| barat utreround | borate ueseued | labrtery dure sound of dcaunt on” boratery | uptos0¥ascoum | "oprosoRascout | upiosom acount | upto3Ox dicunt Enger Cre TG Tato | Ta pto— | ToT To) TOOT apo screed cy diesdevauanslint | drsdevauenetnt | denied dueelimt | dreded dsese it harper means 700 zi 050 ceo Pot of es Bee = Scolision at | 10coaionrat | —conatonsat | nied onaatow Out-patient consultation P 250/consultation P 300/consultation P-350/consultation at P350/consultation | OE cn somuptarsaco | soxuptor qa | somwptovz000 | _s00x uptoP 20000 InpstertAeprovedhowmat son upcopanace | somuptorsoave | sonwpioo 7000 | _sokuptoP 100000 Professional fees TO%MAV upto DDL_| _75%MRVuptoDDL__| 80% MRVupto DDL 100% MAV up to DDL PANES SAtBED beste checkup rinchoeset: | Pus chtect wo 2) | fivedeaselnka | pranvenciace | expanoeo Aiinyrunctons | "“edneytnctons | ier Frcs Uhr urcon Gabetertencons | Dobetsrunctors er ene Damond Feel] Oaand ea Semon] —Ouand Peed REA | —Bamond rel | yada 8 ody ‘Gueony | yFacal@sesons)” | Bsentonsead) | seins aca! Tewtacor | (sens Reval or Theemotit(2sessons)_| Theme Seen) TT Sanaa wear Tee] —Vogn cies upto | —Yoprchwvarvpto | — Vous cauesup oJ Yowocsesup to conte "or cecone Ssestont_|1monh snlmted cas | 2 nats nme ses ST weenneosement7 | coeraan Mescard | Comredatwedicard | coveredatMedCard | Covered at MedCard : Minas Comer” | “Uiesie enet | Use Caner ties Cntr OT Gee of Meares Centr = Fnss ere (rowed they hove own | covered covered comed conned pesonal ter ot pecanal tarer wil be prod wa cha) 7 tie of edard Cae Gener =conference room | One-time Twieeuaveer | Twe(nayent | Thee (tne year [maximum of 4 hours)$80 - Vip Rates Rev.25 1 January 2017 . MEDICARD PHILIPPINES, INC. MediCard _ ssoornce:9 oc, the wor conve ing, 30 Sen, i Payot Aan, Makati Cy 200 ‘Coverage for sipped dsc 75,000 10,000 P20,000 730,000 Brann oral Brannual oral Brannual ort Brannval orl prophylaxis prophylaxis prophylaxis prophyianis 4} Dental Standard pus) Light cue iting (2 Light eure filing (2 Ligne cure filing surface) surfaces) (6 surfaces) Root canal upto P 5,000 | HU Assst America Covered Covered Covered Covered i Lifeline Rescue Covered Covered Covered Covered ‘With AHMC, MMC, SLMC (Quezon City & Global City), TMC & CsMe “Annual ‘Annual Annual ‘Annual Principal Member Only 25379 30,096 05,733 66983 | Principal + 1 Dependent 45,908. 34,391 82,493 120,666, | Principal +2 Dependents e769 75.224 136,657 | Principal+ 3 Dependents 38.266 94.982 151,896 | Principal + 4 Dependents 311,31, 316,839 168,756, | “in excess of 4 Deps. (per dep) 22517 23,582 25,565 J PREMIUM FOR 61-65 YEARS OLD: “anual “anna nwa anual Frincpal ember Onl 32,993 “38.25 734 109432 "*MtediCard Relative Value notes: ‘+ Non-PhilHeaith members (e.9. parents below 60 and unemployed, etc) sholl pay the Phlhealth portion of ther total hospito bills during confinement. + Executive check-ups are for principal member plus one (1) dependent only (provided that dependent enrolled is Eighteen (18]yeors old and above} + Medical evaluation for enrollees age 41 and above is woived. ‘+ Medica, surgical, haspital and professional services expenses NOT EXPLICITLY COVERED under this Agreement must be settled by the member upon discharge from the hospital. f MediCard will advance the payment, member shall pay MedlCara the advanced amount within seven (7} days {from receipt ofthe statement of account with an administration fee of 15%. if settlement isnot made within seven (7) days, a penalty of 2% per ‘month of the amount owing will be imposed until the debt fs satisfied. MediCard has the option to suspend the 1D card ofthe member(s) involved nti fll settlement is made. + Above rates are inclusive of VAT. AHMC Asin Hospitol ond Medical Center me Mokoti Medical Center SUMC St Luke's Medical Center -Quezan City & Global City t™ec The Medical City SMC Cardiol Sontos Medical Center