>    Services of a Physician including surgical services
>    Room and Board according to the type of room accommodation and subject to the maximum rate of Daily Room
          and Board as stated in the Member's Benefit Schedule
>    General Nursing Service
>    Use of operating room and recovery room
>    Anesthesia and its administration
>    Drug and medication during confinement
>    Confinement in Intensive Care Unit up to the maximum benefit limit
>    Other services deemed medically necessary such as but not limited to:
       >>    Oxygen and its administration
       >>    Dressings, plaster casts and other medical supplies
       >>    Laboratory tests, x-rays and other necessary diagnostic services
       >>    Blood and other blood elements transfusion including screening and cross-matching subject to
                  General Exclusions.
       >>    Dialysis, chemotherapy and similar treatment procedures except occupational therapy up to the maximum
                  benefit limit.

Annual Physical Examination (APE) at PhilCare or designated clinics
>    Review of Medical History
>    Physical Examination
>    Chest X-ray
>    Urinalysis
>    Fecalysis
>    Complete Blood Count (CBC)
>    ECG for aged 35 & above
>    Pap Smear for all females aged 35 & above


Preventive Health Care
>    Administration of vaccine (excluding cost of vaccine & determination of susceptibility)
>    Consultations and advice on diet, exercise & healthful habits
>    Periodic monitoring of health problems
>    Family planning counseling


Out-patient Services
>    Consultations, including specialists' evaluation
>    First aid treatment of injury or illness
>    Emergency medicine for the immediate relief of symptoms
>    Necessary x-ray, laboratory and other diagnostic exams
>    Minor surgery not requiring confinement
>    Eye, ear, nose and throat (EENT) care
>    Pre-natal  and  Post-natal consultations at PhilCare clinics


Emergency Care Services
1.    No charge on the following emergency care services rendered at PhilCare Affiliated Hospitals:
        a.    Doctor's services
        b.    Medicines, blood transfusions, intravenous fluids, oxygen, dressings, sutures, and plaster casts
                 (except fiberglass casts)
        c.    X-ray, laboratory and other diagnostic examinations
        d.    Treatment of laceration, pains and other minor injuries
        e.    Medicines for the immediate relief of symptoms and during treatment

2.    Reimbursement of expenses in cases of emergency confinement in a non-affiliated hospital inside or outside the territorial limits of the Philippines up to 100% of the amount that would have been paid by PhilCare had the Member been under the care of an affiliated doctor in an affiliated hospital or medical center or Php 15,000 whichever is lesser.

The availment of Laparoscopic Cholecystectomy, Lithotripsy, Transurethral Microwave Therapy of Prostate, Percutaneous Ultrasonic Nephrolithotomy, Ureterolithotripsy or Cryosurgery procedure is limited only to once per contract year. When a Member chooses the new modalities of treatment enumerated above, PHILCARE will no longer be liable for the cost of further traditional modes of treatment/diagnostics for the same illness or its complications should they be necessary. If a Member refuses to follow the recommended treatment or procedure and the PHILCARE Physician or Affiliated Physician believes that no professionally acceptable alternative exists, then PHILCARE shall no longer be responsible to provide care for the condition under treatment.


Php 10,000 GROUP LIFE for natural death


Php 100,000 GROUP 24-HOUR PLUS AD&D COVERAGE

Loss of Life 100% Accidental Dismemberment of Loss of Limbs     a. Both Hands 100%    b. Both Feet 100%    c. One Hand and One Foot 100%    d. One Hand 50%    e. Arm between Elbow & Wrist 60%    f. Arm at or above Elbow 70%    g. One Foot 50%    h. Leg below Knee 60%    i. Leg at or above Knee 70% Loss of Sight      a. Both Eyes 100%    b. One Eye 50% Loss of Speech 100% Loss of Hearing      a. Both Ears 100%    b. One Ear 50%

Accidental Dismemberment or Loss of Use of Fingers     a. All of One Hand 50%    b. Thumb 15%    c. Index Finger 10%    d. Middle Finger 6%    e. Ring Finger 5%    f. Little Finger 4% Loss of Use of Metacarpals      - First or Second 3% Loss of Use of Metacarpals      - Third, Fourth or Fifth 2% Accidental Dismemberment or Loss of Use of Toes      a. All of One Foot 25%    b. Great Toe 5%   c. Other than Great, Each Toe 1% Fractured leg or patella with established non-union 10% Shortening of Leg by at least 5cm 7.50%

Permanent & Total Disability Indemnity
On the 7th month of continuous, permanent and total disability, we will begin paying a monthly cash benefit equal to 3% of the Principal Sum (less any amount paid or payable) for 32 months. If the Named Insured remains Totally and Permanently Disabled one month after the 32nd monthly benefit payment, we will pay a lump sum benefit of 4% of the Principal Sum.


Special Major Accidental Dismemberment or Loss of Use Coverage
We will pay 25% of the Principal Sum in addition to the Accidental Disablement provision if the Named Insured suffers an injury that results in any of the following losses:

a.  Accidental Dismemberment or Loss of Use of Both Hands

b.  Accidental Dismemberment or Loss of Use of Both Feet

c.  Accidental Dismemberment or Loss of Use of One Hand & One Foot

d.  Loss of Sight or Both Eyes


Murder and Assault
Up to 50% of the benefits payable but not exceeding Php 100,000 for injury due to murder or any attempt thereof. Up to 100% of the benefits payable for injury due to homicide or any attempt thereof not occasioned by provocation of Named Insured.


MOTOR VEHICLE LIABILITY PROVISION
PhilCare shall cover motor vehicular accident or if the member's body injuries are claimed to have been caused by any act or omission of a third party through a motor vehicle provided that the member executes an agreement to subrogate to PhilCare whatever rights the member may have by reason of such accident or event that gave to such claim to the extent of the value of the services so rendered.


PHILHEALTH PROVISION
The Agreement is integrated with the benefits under PhilHealth and as such, benefits to which a Member is entitled under PhilHealth, whether or not the member is eligible for PhilHealth benefits, shall be made deductible in the computation of benefits under the Agreement. PHILCARE is therefore under no obligation to pay or advance the costs of such benefits under PhilHealth. Should the Member fail to pay the PhilHealth portion of his availment prior to discharge, then, CLIENT COMPANY shall be obliged to pay PHILCARE this portion within 15 days upon receipt of billing statement.


OPTIONAL DENTAL BENEFIT (with additional costs)
>    Annual dental examination
>    Annual scaling and polishing (light cases only)
>    Simple tooth extraction
>    Treatment of pain, lesions, wounds, and burns
>    Gum treatment, except alveolectomy and gingivectomy
>    Recementation of fixed bridges, crowns, inlays and onlays
>    Temporary fillings and consultations
>    Simple repair and adjustment of dentures
>    Unlimited professional consultations
>    Diagnosis of oral diseases and treatment planning


PROVISIONS ON PRE-EXISTING CONDITIONS
The Pre-Existing Condition Clause shall apply to all accounts with less than one hundred (100) employees.

An illness or condition shall be considered Pre-existing if, during the period prior to the Effective Date of the Agreement or the approval date of reinstatement in case of lapse, any of the following conditions are present: a) any professional advice or treatment was given for such illness or condition; b) such illness or condition was in any way evident to the Member; or c) the pathogenesis of such illness or condition has started whether or not a Member is aware of such illness or condition.

The following conditions and their complications, but not limited to, when occurring during the first year of coverage after the Effective Date or reinstatement date shall be considered Pre-existing: (a) cancer or tumor of all organs or malignancies of the blood or bone marrow (b) endometriosis; (c) hemorrhoids; (d) diseased tonsils requiring surgery; (e) pathological abnormalities of nasal septum and turbinates; (f) hyperthyroidism/goiter; (g) cataracts; (h) sinus condition requiring surgery; (a) epilepsy; (j) asthma; (k) cirrhosis of the liver; (l) tuberculosis; (m) anal fistulae; (n) cholecystitis/cholelithiasis; (o) calculi of the urinary system; (p) gastric or duodenal ulcer; (q) hallux valgus; (s) diabetes mellitus; (t) hypertension; (u) collagen disease; (v) cardiovascular diseases; (w) hernia; and (x) HIV/AIDS.

The Pre-existing Condition Provision shall no longer be applicable after a Member has been covered for twelve (12) consecutive months and the Agreement is renewed except for illnesses or condition specifically excluded by an endorsement which is made part of the Agreement. This is on the condition that there is no failure to disclose or there is no misrepresentation and concealment, whether intentional or unintentional, of material information in the original application or application for reinstatement.

PHILCARE shall reimburse according to its standard rates all expenses related to necessary diagnostics to determine or rule out pre-existing illness or condition as stated in the previous paragraph if the results are negative. If the results of the medical tests are positive, PHILCARE shall not reimburse the cost of such diagnostics. If the Member is issued an exclusion, whether on initial application, renewal or reinstatement, which the Member questions or objects to, the diagnostic procedure(s) which may be necessary to resolve the issue shall be for the account of the Member.

The Pre-Existing Condition Clause may be waived for accounts with one hundred (100) or more employees provided said number represents at least seventy five percent (75%) of the account's total workforce.


GENERAL EXCLUSIONS
"Notwithstanding any provisions to the contrary, the following shall not be covered except otherwise specified in List of Benefits"