ELECTED EXECUTIVE

BOARD MEMBERS: MEMORANDUM

ATTY. JONALD DC. GUTIERREZ FOR : BUREAU DIRECTORS /

National President REGIONAL and PROVINCIAL DIRECTORS

ATTENTION : AFMD CHIEF/ HRAS Partners

JAY A. ACAR
Vice President for Central Office
FROM : ATTY. JONALD DC. GUTIERREZ
ATTY. CYRUS I. RESTAURO
Vice President North Luzon DATE : 20 March 2024

EDGARDO B. FERINO SUBJECT : 2024-2025 Healthcare Provider

Vice President South Luzon _________________________________________________________________

EPIFANIA F. SURALTA Warm greetings from the DTI Employees’ Union.

Vice President Visayas
We would like to inform the DTI Family that our Healthcare contract under Liberty
Insurance is set to expire on 22 April 2024 (Monday).
ATTY. RUTH SYBIL A. SALVADOR
Vice President Mindanao The Executive Board initiated gathering proposals through email communication and
phone calls from various HMO providers. As in previous years, the criteria for HMO
ANGELO LUIS P. BANTA selection were based on benefits, premium rates, and payment schemes.
Secretary
Based on the criteria and selection process the healthcare program being offered by the
VERSUELO R. GARCIA III current HMO Provider LIBERTY INSURANCE using AMAPHIL link with the same HMO
Treasurer rates offered last year deemed the most beneficial and responsive HMO coverage to the
needs of DTI officials and employees. Attached are the rates, pertinent details, and
JANET M. AVESTRUZ individual enrollment form for the Years 2024- 2025 HMO period, for your reference.
Auditor
With this, may we request your respective HR Partners/ AFMD Chiefs to send us a
consolidated list of voluntary enrollees from your Bureaus/ Offices. All enrollments must
JEREMY BEN P. PANGA
be endorsed by the AFMD Chief/HR Partner to the HR Personnel Officer who shall certify
PRO that the employee has the financial capacity to pay monthly HMO premiums through
deduction from the monthly payroll.
RAMONCHITO R. ROQUE
Administrative Officer Also, due to numerous requests to accommodate Contract of Service/Job order personnel,
the DTI-EU will accept enrollment of JO/COS. However, to ensure prompt payment of the
APPOINTIVE POSITION & HMO premiums, the interested JO/COS should pay 3 months advance payment upon
COMMITTEES enrollment and monthly payment thereafter, for nine (9) months, starting from June 2024.
Attached is a separate enrollment form for the 2024-2025 HMO Coverage under JO/COS
ROMINA PATRICIA G. BLACER personnel.
Assistant Secretary
With the uncertainties and risks we collectively take every day as we continue to face the
threat of COVID-19 infection among other illnesses, we encourage all DTI officials and
ELEANOR A. AFUANG employees to take advantage of this offer for healthcare coverage for the Years 2024-2025
Committee on Membership initiated by the DTI Employees Union.

RONALD JOY TENGCO We would appreciate receiving the abovementioned consolidated list of HMO enrollees to
Committee on Health & Wellness dti.eu@dti.gov.ph on or before 12 April 2024 (Friday) to give our office ample time to
consolidate all enrollees to be submitted to the HMO provider for appropriate action.

For any clarifications or inquiries, you may contact Mr. Chito Roque, DTI-EU Administrative
Officer, at (0905-238-7717) (632) 7791.3171.

Thank you and keep Safe.

DTI – EMPLOYEES’ UNION

Union Office, Lower Ground Floor, Trade and Industry Bldg. (+632) 7791-3171
361 Sen. Gil. J. Puyat Avenue, Makati City, Philippines www.dti.gov.ph dti.eu@dti.gov.ph
 REGULAR EMPLOYEE
HEALTHCARE ENROLLMENT FORM
EMPLOYEE/PRINCIPAL MEMBER.
Complete Name :______________________________________________ Employee ID No. :_________________
Office / Bureau :______________________________________________ Gender :_________________
Mobile No. :______________________________________________ Civil Status :_________________
Date of Birth :______________________________________________ Email Address :_________________
Residence Address : ______________________________________________ Plan type :_________________
Plan type premium amount: _______________

DEPENDENTS
LAST NAME FIRST NAME MI RELATIONSHIP TO GENDER CIVIL STATUS DATE OF BIRTH PLAN TYPE HMO PREMIUM
PRINCIPAL AMOUNT

NOTE: ALL ENROLLEES SHOULD BE AN ACTIVE PHILHEALTH MEMBERS. PLAN TYPE OF THE DEPENDENT (s) SHOULD BE EQUAL TO OR LOWER THAN HIS/HER
PRINCIPAL. ENROLLMENT CUT-OFF PERIOD ENDS 12 APRIL 2024 (FRIDAY)
1. This is to signify my enrollment in HealthCare Services through the DTI Employees Union. It is understood that by signing this Individual Enrollment Form, I authorize the HRAS Payroll Officer/AFMD
Regional HRMO to deduct from my monthly salary the amount due corresponding as PREMIUM for the PRINCIPAL and DEPENDENT/S starting April 23, 2024 (Tuesday)
2. In case my monthly net take home is less than PhP 5,000.00 before the deduction of HMO premiums, I am obliged to pay in cash and directly be deposited to DTI EU HMO BANK LBP ACCOUNT
No. 0052-1334-83 and submit the corresponding deposit slip to DTI EU office in exchange of Official Receipt.
3. Failure to pay within the prescribed period will result in suspension/cancellation of my enrollment to HMO services and the total unpaid premiums or the total amount of utilization whichever is higher
will be deducted from my salary, CNA incentives, terminal leave, and other personal benefits that I expected to receive as prescribed by law.
4. Further, I am authorizing the DTI Central Office – Cashier / DTI Regional Office – Cashier to remit my payment/s to DTI EU HMO BANK LBP ACCOUNT No. 0052-1334-83 without undue delay.
5. This also serves as an authorization to deduct from all future benefits such as (CNA, Mid-Year bonus, Year-End Bonus, PBB, PEI, SRI, Terminal Leave, and other benefits provided by law) for my
outstanding balance/premium arrears.
Note: The member should notify the DTI EU 30 days prior to his/her retirement/resignation/transfer from another agency.
Valid reasons for cancellation are as follows:
6. For the Principal enrollee, if he/she becomes dependent and enrolled with another HMO provider, while for the dependent, if he/she becomes Principal enrollee with another HMO provider (In both cases,
please present your recent/new HMO card to serve as proof that you are enrolled in the other HMO provider with the date of effectivity).
7. Retired member (please inform the DTI EU Office regarding the request for cancellation for endorsement to our HMO provider otherwise you will be continuously billed, kindly attach supporting documents
needed to serve as proof for our endorsement for cancellation) Note: Cancellation is based on LIBERTY INSURANCE receipt date of endorsement or date of resignation whichever is later.
8. Resigned members (please inform the DTI EU Office regarding the request for cancellation for endorsement to our HMO provider otherwise you will be continuously billed, kindly attach supporting
documents needed to serve as proof for our endorsement.) Note: Cancellation is based on LIBERTY INSURANCE receipt date of endorsement or date of resignation whichever is later.
9. Deceased member. Note: In case of cancellation the effective date will be based on LIBERTY INSURANCE approved date of cancellation HMO premium billing is based on the HMO provision that a
fraction of a month is equivalent to one month.

EMPLOYEE/PRINCIPAL CONFORMITY: ENDORSEMENT OF DTI AFMD CHIEF/HRAS PERSONNEL OFFICER

------------------------------------------------------------------------------- ____________________________________________________
(SIGNATURE OVER PRINTED NAME and DATE) (SIGNATURE OVER PRINTED NAME and DATE)
 CONTRACT OF SERVICE/JOB ORDER

HEALTHCARE ENROLLMENT FORM

EMPLOYEE/PRINCIPAL MEMBER.
Complete Name :______________________________________________ Employee ID No. :_________________
Office / Bureau :______________________________________________ Gender :_________________
Mobile No. :______________________________________________ Civil Status :_________________
Date of Birth :______________________________________________ Email Address :_________________
Residence Address : ______________________________________________ Plan type :_________________
Plan type premium amount: _______________

DEPENDENTS
LAST NAME FIRST NAME MI RELATIONSHIP TO GENDER CIVIL STATUS DATE OF BIRTH PLAN TYPE HMO PREMIUM
PRINCIPAL AMOUNT

NOTE: ALL ENROLLEES SHOULD BE AN ACTIVE PHILHEALTH MEMBERS. PLAN TYPE OF THE DEPENDENT (s) SHOULD BE EQUAL TO OR LOWER THAN HIS/HER
PRINCIPAL. ENROLLMENT CUT-OFF PERIOD ENDS 12 APRIL 2024 (FRIDAY)
1. This is to signify my enrollment in HealthCare Services through the DTI Employees Union. It is understood that by signing this Individual Enrollment Form, I authorize the HRAS Payroll
Officer/AFMD Regional HRMO to deduct from my monthly salary the amount due corresponding as PREMIUM for the PRINCIPAL and DEPENDENT/S starting April 23, 2024 (Tuesday)
2. I am obliged to pay in 3 months advance starting from my enrollment date and the following month is from June 2023 and succeeding monthly premium.
3. Further, I am authorizing the DTI Central Office – Cashier / DTI Regional Office – Cashier to remit my payment/s to DTI EU HMO BANK LBP ACCOUNT No. 0052-1334-83 without undue delay.
4. This also serves as an authorization to deduct from my salaryfor my outstanding balance/premium arrears.
Note: The member should notify the DTI EU 30 days prior to his/her retirement/resignation/transfer from another agency.

Valid reasons for cancellation are as follows:

5. For the Principal enrollee, if he/she becomes dependent and enrolled with another HMO provider, while for the dependent, if he/she becomes Principal enrollee with another HMO provider (In both
cases, please present your recent/new HMO card to serve as proof that you are enrolled in the other HMO provider with the date of effectivity).
6.Resigned members (please inform the DTI EU Office regarding the request for cancellation for endorsement to our HMO provider otherwise you will be continuously billed, kindly attach supporting
documents needed to serve as proof for our endorsement.) Note: Cancellation is based on LIBERTY INSURANCE receipt date of endorsement or date of resignation whichever is later.
8.Deceased member. Note: In case of cancellation the effective date will be based on LIBERTY INSURANCE approved date of cancellation HMO premium billing is based on the HMO provision that a
fraction of a month is equivalent to one month.

EMPLOYEE/PRINCIPAL CONFORMITY:

-------------------------------------------------------------------------------
(SIGNATURE OVER PRINTED NAME and DATE)
 SCHEDULE OF BENEFITS
DEPARTMENT OF TRADE AND INDUSTRY
A. IN-PATIENT CARE
1. Professional Fees of attending doctor/s Covered
2. X-ray,laboratory tests and other diagnostic Covered
procedures
3. Anesthesia and its administration Covered
4. Whole blood/human blood products and intravenous Covered
fluids
5. Oxygen and its administration Covered
6. Drugs and medicines for use in the hospital Covered
7. Dressings, conventional casts (plaster of Paris) and Covered
sutures
8. Use of operating and recovery rooms Covered
9. Use of the Intensive Care Unit (ICU) Covered
10. Standard Nursing Services Covered
11. Standard Admission kit (including ice cap, wee bag, Covered
name tag)
12. All other items directly related in the medical Covered
management of the patient, as deemed medically
necessary by the attending Affiliated Physician

B. OUT PATIENT CARE

1. Medically necessary consultations during regular clinic Covered
hours
2. Pre and Post Natal consultations excluding lab & Covered up to 14 sessions
diagnostics
3. Treatment for minor injuries such as lacerations, mild Covered
burns & sprains
4. Eye, ear, nose and throat (EENT) treatment Covered
5. X-Ray, lab examinations, routine, diagnostic and Covered
therapeutic procedures
6. Minor surgery not requiring confinement Covered
7. Wart Cauterization except genital warts & condyloma up to Php 3,000 except for aesthetic
acuminata purposes
8. Allergy Testing/ allergy screening and other related Covered up to Php 4,000
examinations
9. Tuberculin test Covered up to Php 1,000
 10. Sclerotherapy for varicose veins Covered up to Php 5,000 per leg

B.1. THERAPEUTIC PROCEDURES

1. Eye Laser Therapy excluding Lasik, PRK and the like Covered up to Php 30,000 per eye
2. Speech therapy (For stroke patients) Covered up to 12 sessions subject to
MBL
3. Physiotherapy (Physical Therapy/Occupational Covered up to MBL
Therapy)

4. Chemotherapy Covered up to MBL

5. Dialysis Covered up to MBL

6. Radiotherapy Covered up to MBL

B.2. COMMON LABORATORY PROCEDURES

1. Blood Chemistries Covered
2. Complete Blood Count (CBC) Covered
3. Diagnostic Radiographs
a. Face (including sinuses), Head and Neck Covered
b. X-ray of the spine (cervical, thoracic, lumbosacral) Covered

c. Chest, ribs, sternum and clavicle Covered

d. Biliary tract: Cholecystogram and Covered
Cholangiograms
e. Digestive: Plain film of the abdomen, Barium Enema, Covered
Upper GI Series, Lower GI Series
f. Urinary: KUB Pyelograms and cystograms Covered
g. X-ray of the extremities and pelvis Covered
4. Electroencephalogram Covered
5. 12 Lead Electrocardiogram Covered
6. TMST-Treadmill Stress Test Covered
7. Pap smear Covered
8. Urinalysis Covered

B.3. SPECIAL DIAGNOSTIC PROCEDURES

1. Adrenocortical Function Covered
2. Ambulatory Cardiac Monitoring (Holter) Covered
3. Anti-Nuclear Antibody, C-Reactive Protein, Lupus Cell Covered
Exam
4. Arterial Blood Gas Covered
5. Audiograms and Tympanograms Covered
6. Bone Densitometry Scan (Dexascan) Covered
7. Bone Mineral Density Studies Covered
8. Cardiac Stress Tests (Thallium and Dipyridamole Stress Covered
Tests)
9. Computed Tomography Scans Covered
10. Diagnostic Ultrasounds: 2D-Echo, Doppler, Ultrasound Covered
(except for maternity cases), Digestive and Urinary
Systems, Abdomen, and Deep Vein Thrombosis
ultrasonic scanning
11. Electromyelography and Nerve Conduction Studies Covered
12. Fluorescein Angiography Covered
13. Impedance Plethysmography Covered
14. Lung Function Studies Covered
15. Magnetic Resonance Imaging Covered
16. Magnetic Resonance Angiography Covered

17. Mammography and Sonomammogram Covered

18. Microscopic Examinations Covered
19. Myelogram Covered
20. Neuroscan (professional fee on reimbursement basis) Covered
21. Nuclear Radioactive Isotope Scan Covered
22. Perfusion Scan Covered
23. Plasma Urinary Cortisol, Plasma Aldosterone Covered
24. Polysomnograms (Sleep Study/Recording) Covered
25. Radionuclide Ventriculography Covered
26. Radio-isotope Scans and Function Studies
a. Thyroid Scans Covered
b. Liver Covered
c. Renal Covered
d. GI - Gastro Intestinal Covered
e. Cardiac Covered
 f. Parathyroid Bone, Pulmonary (Perfusion/Ventilation Covered
Lung Scans)
27. Thallium Scintigraphy Covered

B.4. OTHER SPECIAL PROCEDURES

1. Arthroscopic Procedures Covered
2. Coronary Angiogram Covered
3. Angioplasty Covered
4. Coronary Artery Bypass Graft Covered
5. Open Heart Surgery Covered
6. Cryosurgery up to 3,000 per area
7. Endoscopic procedures Covered
8. Flourescein Angiogram Covered
9. Gamma Knife Surgery
Covered
(based on cobalt/radiotherapy)
10. Hemorrhoidectomy (Conventional) Covered
11. Hemorrhoidectomy (Scalpel) Covered
12. Hemorrhoidectomy (Stapled) Covered
13. Herniorrhaphy (except cost of mesh) Covered except congenital hernia
14. Hysteroscopic Myoma Resection Covered
15. Hysterospically-guided D&C Covered
16. Laparoscopic Procedures Covered
17. Laparoscopic Cholecystectomy Covered
18. Lithotripsy Covered
Covered up to MBL if without
conventional counterparts.
19. New/Special modalities not specified
Covered up to Php30,000 if with
conventional counterparts
20. Organ Transplant (except cost of organs & procedure
Covered
for donor)
21. Percutaneous Ultrasonic Adrenalectomy Covered
22. Percutaneous Ultrasonic Nephrolithomy Covered
23. Stereotactic Brain Biopsy Covered
24. Testing involving Nuclear Technologies Covered
(Thallium Stress Testing, Radionuclide,
Thyroid Scan,
Pyrosphosphate Scintigraphy, Positron Emission
 Tomography, Radio Isotope Scanning)

25. Transurethral Microwave Therapy of Prostate Covered

26. Video Gastroscopy Covered

C. ANNUAL PHYSICAL EXAMINATION (PRINCIPAL AND To be availed at Designated APE

DEPENDENTS) Providers
1. Routine Check Up Covered
2. Physical Examination and History Taking Covered
3. Complete Blood Count Covered
4. Urinalysis Covered
5. Fecalysis Covered
6. Chest X-ray Covered
7. Electrocardiogram (ECG) Covered for 35 years old and up
8. Pap Smear Covered for 35 years old and up

D. EMERGENCY CARE
1. In Accredited Hospitals
a. Doctor’s services Covered
b. Emergency Room Fees Covered
c. Medicines used for immediate relief during Covered
treatment
d. Whole blood/human blood products Covered
e. Oxygen and IV fluids Covered
f. X-ray, laboratory tests and other diagnostic Covered
procedures
2. In Non-Accredited Hospitals Reimbursement subject to provider
RUV Rates
a. Areas with Accredited Facilities within 50km Radius Up to 80% of eligible expenses up to
Php 30,000
b. Areas w/o Accredited Hospital outside 50km Radius Up to 100% of eligible expenses up to
Php 30,000
c. Outside the Philippines Up to 100% of eligible expenses based
on customary and reasonable costs
3. Room Upgrading Provision in case of unavailability of Covered up to 48 hours (except Suite
entitled room room)
a. Waiver of Room rate difference Covered up to 48 hours
 b. Waiver of Incremental charges (except suite room) Covered up to 48 hours

E. PREVENTIVE CARE
1. Health habits and Family Planning counseling Covered
2. Passive and active vaccines for treatment of tetanus, Covered up to MBL
animal bites, snake bites
3. Periodic monitoring of health problems Covered
4. Wellness programs/lectures Covered up to four (4) sessions

F. FINANCIAL ASSISTANCE
1. Natural Death Covered up to Php 25,000
2. Accidental Death Or Covered up to Php 50,000
ACCIDENTAL DEATH AND DISMEMBERMENT
When injury results in any of the following losses within one hundred eighty (180) days after the date of
accident, the Company shall pay for the loss based on the schedule below:
Percentage of Principal Sum
Loss of life, or two limbs 100%
Loss of both hands, or all fingers and both thumbs 100%
Total loss of sight of both eyes 100%
Loss of arm at or above elbow 70%
Loss of arm between elbow and wrist, or leg or above knee 60%
Loss of a hand, a foot, a leg below the knee, or sight of eye 50%
Loss of four fingers 35%
Loss of thumb 15%
Loss of index finger 10%
Loss of middle finger 6%
Loss of ring finger, or big toe 5%
Loss of little finger 4%
Loss of metacarpals - first or second (additional) 3%
third or fifth (additional) 2%
Loss of toes all of one foot 25%
Loss of any toe other than the big toe, each 1%
Loss of hearing of each ear 25%
G. DENTAL BENEFITS
1. Dental consultation (Dental Exam, TMJ, Ortho, Unlimited
Aesthetic)
2. Routine Oral Prophylaxis (Simple Scaling) Covered twice a year
3. Simple Tooth Extraction Unlimited
4. Temporary Fillings Unlimited
5. Treatment of Lession, Wounds and Burns Unlimited
6. Adjustment of dentures Unlimited
7. Recementation of Jacket Crowns, Inlays and Onlays Unlimited
8. Emergency Desensitization of hypersensitive teeth Unlimited
9. Relief of acute dental pain (Except Prescribed Unlimited
Medicines)
10. Pre-natal Check of Teeth and Gums Unlimited
11. Other Dental Services (Outside the Dental Benefit) Discounted at 25%
12. Permanent Fillings 2 teeth
13. Oral Health Education through chair side instruction Covered
14. TMJ Consultaion Covered

H. OTHER SPECIAL BENEFITS

1. Ambulance Service (hospital transfer) Covered up to 5,000 per conduction
subject to reimbursement
2. Ambulance Service Covered up to MBL
(if hospital has own ambulance facilities)
3. Benign Prostatic Hypertrophy Covered
4. Congenital Conditions Covered up to Php60,000
5. Cataract Extraction (except cost of lens) Covered

6. Hernia (Acquired) Covered

7. Medicines Covered only for Confinement and ER
Cases
a. Out Patient Not Covered
b. Take Home Not Covered
8. Medico Legal Cases without violation with Exclusion Subject to exclusion conditions and
Conditions police report
a. Motor Vehicular Accidents Covered
b. Motorcycle Accident Covered
c. Unprovoked Assault Covered
9. Scoliosis, whether congenital, pre- Covered up to Php60,000
existing, developmental or acquired
10. Slipped Disc, Spondylosis and Spinal Stenosis Covered
 11. Sports Related Injuries Covered except professional and
extreme sports
12. Work Related Conditions based on conditions Covered up to MBL
covered by ECC
13. Benign Prostatic Hypertrophy/ PSA Covered up to MBL
14. POINT-OF-SERVICE (POS) POS options shall be a. Out of network availment whether
extended to Principal / Dependent members subject to emergency or not - 100% of Hospital bill
the following provisions: and professional fee actual cost but
not to exceed standard rate subject to
MBL, reimbursement type.
15. ACCREDITATION OF COMPANY DOCTOR Issuance of LOA/referral slips for BASIC 5
only. Designated clinic only.

I. PRE-EXISTING CONDITIONS

1. Employees
a. Existing/Initial Enrollees - covered up to MBL
b. New/Future Enrollees - covered up to MBL
2. Dependents
a. Existing/Initial Enrollees - covered up to MBL
b. New/Future Enrollees - covered up to MBL
J. ELIGIBILITY PROVISIONS All Regular and Full-time Employees
1. AGE ELIGIBILITY up to 65 years old
Single Employees Parents up to 65 years old and Siblings
from 15 days to 23 years old
Married Employees Legal Spouse up to 65 years old and
Children from 15 days to 23 years old
Single Parent Employees Children from 15 days to 23 years old
and Parents up to 65 years old
K. OTHER PROVISIONS The aggregate of all benefits covered
under all of the benefits provisions shall
be as specified in the Schedule of

Benefits under Dreaded Disease Limit.

The maximum limit shall be for one
complete Policy year and applicable
on a per disability basis.
2. Philhealth (Required to be filed at the The plan pays benefits up to its limits
after Philhealth Benefits have been
exhausted
3. Additional Premium Option for non-Philhealth Php 3,300 per individual
members
4. Makati Medical Center All insured's are allowed access to
confinement/consultations at Makati
Medical Center (MMC). In connection
with the Blanket Authority policy of
MMC, patients are required to settle all
medical expenses which are not
covered under the (including excess in
limits) before discharge Failure of the
patient to settle in full such charges
shall be borne by the provider but will
be subject to Bill-back Arrangement.
5. Bill-back Arrangement Medical expenses, which are not
covered under the policy, which is
advanced by the Company, shall be
billed back to the Policyholder.
The Policyholder commits to
reimburse the Company within 15
working days from the billed amount
advise, inclusive of a service fee of 12
%. Interest at the rate of 3 % per
month shall be charged to the
Policyholder counted from the date the
Billing Notice was received for any
amount not paid within 15 working
days. And for the purpose of interest
charging a fraction of a month shall be
considered as one full month. The use
of the Company's network of
accredited service providers may be
suspended by the Company should
any Bill not withstanding that such
amount in full or in part is being
contested or subject to further scrutiny
by giving 5 days notice to the
Policyholder.
6. Provider Access:

a. All Accredited Hospitals Yes

b. All Accredited Clinics Yes

c. Exceptions:

i. Healthway Medical Center With Access

 ii. Makati Medical Center With Access

iii. The New Medical City With Access

iv. St. Luke’s Medical Center – Quezon City With Access

v. St. Luke’s Medical Center – Global City With Access
vi. Asian Hospital Medical Center With Access
vii. Cardinal Santos Medical Center With Access

7. Payment Scheme
Covering Period Date of Payment
April 23-May 22, 2024 June 15, 2024
May 23-June 22, 2024 July 15, 2024
June 23-July 22, 2024 August 15, 2024
July 23-August 22, 2024 September 15, 2024
August 23-September 22, 2024 October 15, 2024
September 23-October 22, 2024 November 15, 2024
October 23- November 22, 2024 December 15, 2024
November 23-December 22, 2024 January 15, 2025
December 23-January 22, 2025 February 15, 2025
January 23- February 22, 2025 March 15, 2025
February 23-March 2025 April 15, 2025
March 23-April 22, 2025 May 15, 2025

L. ADDITIONAL SERVICES:
1. Welcome Kit with Provider Directory and Guidebook Covered (Per Family)
2. ID Processing and Enrollment Fee Waived
3. Benefit Orientations Covered upon request

Notes: Coverage for all procedures will be based on the diagnosis/medical impression of
provider Accredited Physician and shall be subject to the plan limits.

**With 1 Special Child dependent (existing enrollee) - 24 years old

For Common Law partner - eligible to enroll provided to submit a Barangay Certificate stating proof of common
law partner relationship and proof of c o h a b i t a t i o n .

Existing overage enrollees (66 - 70 years old) are covered until end of the policy year with twice the premium.
Enrollees who are 65 years old upon enrollment who will turn 66 years old within the contract period should
be billed regular premium until end of the policy year. Same will apply to dependent members who will turn
24 years old within the contract period.