MEMORANDUM OF AGREEMENT

KNOW ALLMENBYTHESEPRESENTS:

ThisMEMORANDUM
OFAGREEMENT,madeandenteredintoby:

.,a corporation dulyorganized

and existing under and by virtue of Philip ine Laws
with principal office at
, represented by its
President & CEO,

,hereinafterreferedtoastheCOMPAN
Y;

And

, likewise a health care

institution providingpatienttreatmentwith
specialized medicaland nursingstaff and
medicalequipment,duly organized and existing
under and by virtue of Philip ine Laws,
with principal office at
, represented by
its
,
,hereinafterreferred toas
theHOSPITAL;

WITNESSETH THAT

WHEREAS,theCOMPANYne e ds a facility which can

provideapatient treatmentwith specialized
medicaland nursingstaff and medicalequipment
servicesforitsmembers;

WHEREAS, the HOSPITAL has facilities

ne
e ded/required by the COMPANY
andiswillingtoprovidethesametotheCOMPANY;

NOW,THEREFORE,forandin
considerationoftheforegoingpremises,
thepartieshaveagre
e dandbythesepresents,doherebyagr
e tomakeand
enterintothisAgre
e mentandherebyfurtheragree
toabidewiththefollowing
covenantshereinafterstipulatedtowit:

1. The COMPANY shall refer to the HOSPITAL and

the HOSPITAL shall acc ommodateCOMPANY members
with valid membership card and provide
laboratory/diagnosticservices.

2. The COMPANY shallbe informed by the HOSPITAL

during medical availment of itsmembers and
provide information as requested by the COMPANY
in orderto
verifyeligibilityofmembershipandschedule
ofmedicalbenefits.
 TheCOMPANYshallprovidetheHOSPITALwithaLet ter
ofAuthorization (LOA)forevery medical
availment that is within the schedule of benefit as
declared by the
medicalinsuranceproviderofthemember.

TheCOMPANY willnotbeheld liablebythe HOSPITAL

to payforany
medicalavailmentofitsmemberwithnoLOA.

5. The HOSPITAL shallhonor the LOA iss ued by the

COMPANY forthe
medicalavailmentofitsmember.TheLOA
shallstatepaymentby the
COMPANYoftheexpensesincurredbythememberwithin
benefitlimits.

6. The HOSPITAL shall collect from the member the

exces amount incured during medicalavailment
not covered bythe LOA prior to release from the
facility. The HOSPITAL shallhave no recourse to
anyreimbursement from the COMPANY should
itfailtocharge and collectanyexpenses
chargetoCOMPANY members.

7. The HOSPITAL shall use its best resources and

facilities to provide medical and surgical
services required by COMPANY members.

8. The HOSPITAL shall provide the COMP ANY

with medical information of the case such
as diagnosis, treatment, laboratory/diagnostic
procedure tobedone and complete ac
c es
s to the
member's medical record with the consent ofthe
At
tending Physician.

9. The HOSPITAL shall acc ommodate the COMPANY

Liaison Officers by allowing them toas
sist
COMPANY members during their out- patient
medical availment and be able toexplain
theirmedical insurance benefits andcoverage
limits.

10. The HOSPITAL shall display COMPANY

signage at the Reception/Information Office
whichwould guideCOMPANY members
duringtheirmedicalavailment.

1 .The HOSPITAL shall send original statement

ofacc ount to the COMPANY within seven (7)days
from the time ofavailment atthe following ad d
res
s:

MARZANHEALTHCARE
ClaimsDepartment
#3
3
V.LunaAve.,Brgy.Pinyahan,Qu
ezonCity

The statement of acc ount with cor

responding LOA
reflects the actual laboratory bill(itemized)
forservices rendered toCOMPANY members.
12. The HOSPITAL shallgrantthe COMPANY allowable
credit period of thirty (30)days from receipt
oforiginalstatement ofacc ount. Within this
period, the COMPANY shall set
tle the amount due
to the HOSPITAL.

13. The HOSPITAL shallgrantthe COMPANY a percent (

%)
prompt payment discountfrom the total
medicalbill for payments made within thirty
(30)days from receipt oforiginal statement of
ac
c ount.

14. In case ofdefaultin the paymentofany

obligationsby the COMPANY, the HOSPITAL
shallsuspend the COMP ANY by notacc ommodating the
medical availment ofitsmembers untilsuch time
that the COMPANY has set
tled its
obligations.The suspension of the COMPANY
shalltake effectifpaymentisnotmade within thirty
(30) daysfrom receipt oforiginalstatement
ofacc ount.

15. In caselitigation arising from this Agre

e ment,
the parties hereby agre
e that
exclusivejurisdictionshallbevested
inthecourtsofQuezon City,Metro Manila.

16. This Agree ment shall be for a period of one year

from the date hereof, and shall beautomatically
renewed every year thereafter, unles s either
party gives notice ofits intention to terminate
or modify the condition of the agre e ment at least
sixty (60) days before
intended dateoftermination ormodification.

IN WITNESS
WHEREOF,thepartieshavesettheirhandsthis
at in .

MARZAN HEALTHCARE
COMPANY HOSPITAL

BY: BY:

EDISON B.MARZAN
CEO PRESIDENT HOSPITAL

ACKNOWLEDGMENT
RepublicofthePhilip ines)
) S.S.

Beforeme,aNotaryPublicin andfor ,personallyap

eared thefollowing:

Name T.I.N. DateandPlaceofIsue

Knowntometobethesamepersonswhoexecutedtheforegoi
ngMemorandum ofAgrementand thattheyboth
acknowledgethesametobetheirfre and
voluntaryactandoftheprincipalsthattheyrepresent.

TheforegoingAgrementconsistsof (
)pages,includingth
e
pageonwhichthisacknowledgmentiswritenandissigne
dbythepartiesand theirinstrumentalwitneses atthe
fo tofthe document,and on the left
marginofeverypage.

WITNESS MY HAND AND SEAL,affixed on the date and

place firstabove writen.

NOTARYPUBLIC
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