MAXICARE PLUS Group Account

Membership Fees for VAT-Exempt/Zero-Rated Accounts Valid from November 1, 2010 to December 31, 2011

ANNUAL

Room & Board ACU WITHOUT 9 MAJOR WITH 8 MAJOR HOSPITALS

Plan MBL WITH 8 MAJOR HOSPITALS
Accommodation Type HOSPITALS plus SLMC GC
WITH WITH WITH
WITHOUT WITHOUT WITHOUT
Healthway Healthway Healthway
Healthway Healthway Healthway
(EXCEPT ACU) (EXCEPT ACU) (EXCEPT ACU)
PRINCIPALS
PLATINUM Suite up to 4,000 200,000 n/a 15,586 16,366 20,616 21,647 22,677 23,811
PLATINUM Small Suite 200,000 n/a 14,228 14,939 18,781 19,720 20,659 21,692
PLATINUM Open Pvt 200,000 n/a 12,464 13,087 16,396 17,216 18,036 18,938
PLATINUM Open Pvt 150,000 n/a 12,121 12,727 15,933 16,729 17,526 18,402
PLATINUM Lrg Pvt 150,000 n/a 11,744 12,331 15,424 16,195 16,966 17,814
GOLD Reg Pvt 150,000 n/a 10,650 11,182 13,945 14,643 15,340 16,107
GOLD Reg Pvt 100,000 n/a 10,308 10,823 13,483 14,157 14,831 15,573
GOLD Reg Pvt 75,000 n/a 9,941 10,438 12,987 13,636 14,285 14,999
SILVER Semi-Pvt 75,000 n/a 8,166 8,574 10,588 11,117 11,647 12,229
SILVER Semi-Pvt 60,000 n/a 7,947 8,344 10,290 10,805 11,320 11,886
BRONZE Ward 50,000 n/a 6,628 6,959 8,509 8,934 9,360 9,828
DEPENDENTS
PLATINUM Suite up to 4,000 200,000 n/a 21,346 22,413 28,400 29,820 31,240 32,802
PLATINUM Small Suite 200,000 n/a 19,669 20,652 26,131 27,438 28,744 30,182
PLATINUM Open Pvt 200,000 n/a 16,832 17,674 22,300 23,415 24,530 25,756
PLATINUM Open Pvt 150,000 n/a 16,490 17,315 21,837 22,929 24,021 25,222
PLATINUM Lrg Pvt 150,000 n/a 16,023 16,824 21,207 22,268 23,328 24,494
GOLD Reg Pvt 150,000 n/a 14,468 15,192 19,105 20,060 21,016 22,066
GOLD Reg Pvt 100,000 n/a 14,125 14,832 18,641 19,573 20,506 21,531
GOLD Reg Pvt 75,000 n/a 13,758 14,446 18,146 19,054 19,961 20,959
SILVER Semi-Pvt 75,000 n/a 10,990 11,540 14,404 15,125 15,845 16,637
SILVER Semi-Pvt 60,000 n/a 10,769 11,308 14,107 14,812 15,518 16,293
BRONZE Ward 50,000 n/a 8,892 9,337 11,571 12,150 12,728 13,365

SEPARATE FEE (Optional):

Annual
Standard Dental Package: 285
Basic Dental Package: 168
Life with AD&D (Php25,000): 70
To be availed at Executive Check-up IP: 33,520
Makati Medical Executive Check-up OP: 18,723
City Semi-Executive Check up OP: 8,364
Executive Check-up IP: 47,167
To be availed at
Executive Check-up OP: 30,966
The Medical City
Semi-Executive Check up OP: 14,286
Annual Check-up: Routine (Clinic): 718
Wellness Program per session: 2,500

Notes:
* Executive check-ups and non-coverable benefits can be availed under fee-for-service arrangement. Billing shall be based on actual cost plus
13.5% claims handling fee.
* List of non-coverable benefits should be provided before closing of the account. Any request of additional benefits to be added to the said list
during the effectivity of the account shall not be accommodated.
* Pre-employment examination is covered in lieu of ACU. Reimburseable up to Php 400 per head once the employee is regularized.
MAXICARE PLUS Group Account

Membership Fees for VAT-Exempt/Zero-Rated Accounts Valid from November 1, 2010 to December 31, 2011
SEMI-ANNUAL
Room & Board ACU WITHOUT 9 MAJOR WITH 8 MAJOR HOSPITALS WITH 8 MAJOR HOSPITALS
Plan MBL
Accommodation Type WITH WITH WITH
WITHOUT WITHOUT WITHOUT
Healthway Healthway Healthway
Healthway Healthway Healthway
(EXCEPT ACU) (EXCEPT ACU) (EXCEPT ACU)
PRINCIPALS
PLATINUM Suite up to 4,000 200,000 n/a 8,417 8,837 11,133 11,689 12,246 12,858
PLATINUM Small Suite 200,000 n/a 7,683 8,067 10,142 10,649 11,156 11,714
PLATINUM Open Pvt 200,000 n/a 6,730 7,067 8,854 9,297 9,739 10,226
PLATINUM Open Pvt 150,000 n/a 6,545 6,872 8,604 9,034 9,464 9,937
PLATINUM Lrg Pvt 150,000 n/a 6,342 6,659 8,329 8,745 9,162 9,620
GOLD Reg Pvt 150,000 n/a 5,751 6,038 7,530 7,907 8,284 8,698
GOLD Reg Pvt 100,000 n/a 5,566 5,845 7,281 7,645 8,009 8,409
GOLD Reg Pvt 75,000 n/a 5,368 5,636 7,013 7,363 7,714 8,100
SILVER Semi-Pvt 75,000 n/a 4,410 4,630 5,718 6,003 6,289 6,604
SILVER Semi-Pvt 60,000 n/a 4,291 4,506 5,557 5,835 6,113 6,418
BRONZE Ward 50,000 n/a 3,579 3,758 4,595 4,825 5,054 5,307
DEPENDENTS
PLATINUM Suite up to 4,000 200,000 n/a 11,527 12,103 15,336 16,103 16,869 17,713
PLATINUM Small Suite 200,000 n/a 10,621 11,152 14,111 14,816 15,522 16,298
PLATINUM Open Pvt 200,000 n/a 9,089 9,544 12,042 12,644 13,246 13,908
PLATINUM Open Pvt 150,000 n/a 8,905 9,350 11,792 12,382 12,971 13,620
PLATINUM Lrg Pvt 150,000 n/a 8,653 9,085 11,452 12,025 12,597 13,227
GOLD Reg Pvt 150,000 n/a 7,813 8,204 10,317 10,833 11,348 11,916
GOLD Reg Pvt 100,000 n/a 7,628 8,009 10,066 10,570 11,073 11,627
GOLD Reg Pvt 75,000 n/a 7,429 7,801 9,799 10,289 10,779 11,318
SILVER Semi-Pvt 75,000 n/a 5,935 6,231 7,778 8,167 8,556 8,984
SILVER Semi-Pvt 60,000 n/a 5,815 6,106 7,618 7,999 8,379 8,798
BRONZE Ward 50,000 n/a 4,802 5,042 6,248 6,561 6,873 7,217

SEPARATE FEE (Optional):

Semi-Annual
Standard Dental Package: 154
Basic Dental Package: 91
Life with AD&D (Php25,000): 38
To be availed at Executive Check-up IP: 18,101
Makati Medical Executive Check-up OP: 10,110
City Semi-Executive Check up OP: 4,517
Executive Check-up IP: 25,470
To be availed at
Executive Check-up OP: 16,721
The Medical City
Semi-Executive Check up OP: 7,714
Annual Check-up: Routine (Clinic): 388
Wellness Program per session: 1,350

Notes:
* Executive check-ups and non-coverable benefits can be availed under fee-for-service arrangement. Billing shall be based on actual cost plus
13.5% claims handling fee.
* List of non-coverable benefits should be provided before closing of the account. Any request of additional benefits to be added to the said list
during the effectivity of the account shall not be accommodated.
* Pre-employment examination is covered in lieu of ACU. Reimburseable up to Php 400 per head once the employee is regularized.
MAXICARE PLUS Group Account

Membership Fees for VAT-Exempt/Zero-Rated Accounts Valid from November 1, 2010 to December 31, 2011
QUARTERLY
Room & Board ACU WITHOUT 9 MAJOR WITH 8 MAJOR HOSPITALS WITH 8 MAJOR HOSPITALS
Plan MBL
Accommodation Type WITH WITH WITH
WITHOUT WITHOUT WITHOUT
Healthway Healthway Healthway
Healthway Healthway Healthway
(EXCEPT ACU) (EXCEPT ACU) (EXCEPT ACU)
PRINCIPALS
PLATINUM Suite up to 4,000 200,000 n/a 4,364 4,582 5,772 6,061 6,350 6,667
PLATINUM Small Suite 200,000 n/a 3,984 4,183 5,259 5,522 5,785 6,074
PLATINUM Open Pvt 200,000 n/a 3,490 3,664 4,591 4,820 5,050 5,303
PLATINUM Open Pvt 150,000 n/a 3,394 3,564 4,461 4,684 4,907 5,153
PLATINUM Lrg Pvt 150,000 n/a 3,288 3,453 4,319 4,535 4,750 4,988
GOLD Reg Pvt 150,000 n/a 2,982 3,131 3,905 4,100 4,295 4,510
GOLD Reg Pvt 100,000 n/a 2,886 3,031 3,775 3,964 4,153 4,360
GOLD Reg Pvt 75,000 n/a 2,783 2,923 3,636 3,818 4,000 4,200
SILVER Semi-Pvt 75,000 n/a 2,287 2,401 2,965 3,113 3,261 3,424
SILVER Semi-Pvt 60,000 n/a 2,225 2,336 2,881 3,025 3,169 3,328
BRONZE Ward 50,000 n/a 1,856 1,948 2,383 2,502 2,621 2,752
DEPENDENTS
PLATINUM Suite up to 4,000 200,000 n/a 5,977 6,276 7,952 8,349 8,747 9,184
PLATINUM Small Suite 200,000 n/a 5,507 5,783 7,317 7,683 8,048 8,451
PLATINUM Open Pvt 200,000 n/a 4,713 4,949 6,244 6,556 6,868 7,212
PLATINUM Open Pvt 150,000 n/a 4,617 4,848 6,114 6,420 6,726 7,062
PLATINUM Lrg Pvt 150,000 n/a 4,486 4,711 5,938 6,235 6,532 6,858
GOLD Reg Pvt 150,000 n/a 4,051 4,254 5,349 5,617 5,884 6,179
GOLD Reg Pvt 100,000 n/a 3,955 4,153 5,220 5,481 5,742 6,029
GOLD Reg Pvt 75,000 n/a 3,852 4,045 5,081 5,335 5,589 5,869
SILVER Semi-Pvt 75,000 n/a 3,077 3,231 4,033 4,235 4,437 4,658
SILVER Semi-Pvt 60,000 n/a 3,015 3,166 3,950 4,147 4,345 4,562
BRONZE Ward 50,000 n/a 2,490 2,614 3,240 3,402 3,564 3,742

SEPARATE FEE (Optional):

Quarterly
Standard Dental Package: 80
Basic Dental Package: 47
Life with AD&D (Php25,000): 20
To be availed at Executive Check-up IP: 9,385
Makati Medical Executive Check-up OP: 5,242
City Semi-Executive Check up OP: 2,342
Executive Check-up IP: 13,207
To be availed at
Executive Check-up OP: 8,670
The Medical City
Semi-Executive Check up OP: 4,000
Annual Check-up: Routine (Clinic): 201
Wellness Program per session: 700

Notes:
* Executive check-ups and non-coverable benefits can be availed under fee-for-service arrangement. Billing shall be based on actual cost plus
13.5% claims handling fee.
* List of non-coverable benefits should be provided before closing of the account. Any request of additional benefits to be added to the said list
during the effectivity of the account shall not be accommodated.
* Pre-employment examination is covered in lieu of ACU. Reimburseable up to Php 400 per head once the employee is regularized.