SME LUXE 20-150 EMPLOYEES AND DEPENDENTS RATES

EMPLOYEES: DIRECT ACCESS (HOSPITAL BASED)

OPTION 1: WITH ACCESS TO ALL AFFILIATED PROVIDERS EXCLUDING SIX (6) MAJOR HOSPITAL*

Room & Board MBL* o Annual Fee w/o o Semi-Annual o Quarterly Fee
Rider Fee w/o Rider w/o Rider
 Suite up to 4,000 400,000 P18,144.00 P9,707.04 P4,989.60

 Suite up to 3,000 400,000 P16,822.40 P8,999.98 P4,626.16

 Private Open 250,000 P14,179.20 P7,585.87 P3,899.28

 Regular Private 250,000 P12,572.00 P6,726.02 P3,457.30

 Semi-Private Open 200,000 P10,304.00 P5,512.64 P2,833.60

 Ward Open 100,000 P7,901.60 P4,227.36 P2,172.94

OPTION 2: WITH ACCESS TO ALL AFFILIATED PROVIDERS INCLUDING SIX (6) MAJOR HOSPITAL*

Room & Board MBL* o Annual Fee w/o o Semi-Annual Fee o Quarterly Fee
Rider w/o Rider w/o Rider
 Suite up to 4,000 400,000 P24,505.60 P13,110.50 P6,739.04

 Suite up to 3,000 400,000 P22,590.40 P12,085.86 P6,212.36

 Private Open 250,000 P19,180.00 P10,261.30 P5,274.50

 Regular Private 250,000 P16,648.80 P8,907.11 P4,578.42

 Semi-Private Open 200,000 P13,451.20 P7,196.39 P3,699.08

 Ward Open 100,000 P10,371.20 P5,548.59 P2,852.08

Notes:
 In compliance to BIR, rates provided above are inclusive of applicable 12% EVAT; If VAT Exempt,
pls. provide a copy of the VAT Exempt Certification
 Rates provided are based on the minimum of 20 to maximum of 150 employees only, per
company and based on the assumption that 100% of eligible employees are being enrolled in
the HMO program.
 With coverage for Pre-existing Conditions up to MBL
 Non-Medical Requirement;
 *MBL works on a per illness, per injury, per member, per year
  Optional access to Six (6) Major Hospitals: Asian Hospital and Medical Center, St. Luke's Medical
Center(QC), Makati Medical Center, The Medical City and Cardinal Santos Medical Center
including SLMC Global
 Rates excludes access to Philippine Orthopedic Institution, Notre Dame Hospital, Manila
Adventist, Marikina Valley and Healthway clinics

DEPENDENTS: DIRECT ACCESS (HOSPITAL BASED)

OPTION 1: WITH ACCESS TO ALL AFFILIATED PROVIDERS EXCLUDING SIX (6) MAJOR HOSPITAL*

Room & Board MBL* o Annual Fee w/o o Semi-Annual o Quarterly Fee
Rider Fee w/o Rider w/o Rider
 Suite up to 4,000 400,000 P23,755.20 P12,709.03 P6,532.68

 Suite up to 3,000 400,000 P22,120.00 P11,834.20 P6,083.00

 Private Open 250,000 P18,435.20 P9,862.83 P5,069.68

 Regular Private 250,000 P16,290.40 P8,715.36 P4,479.86

 Semi-Private Open 200,000 P13,053.60 P6,983.68 P3,589.74

 Ward Open 100,000 P10,108.00 P5,407.78 P2,779.70

OPTION 2: WITH ACCESS TO ALL AFFILIATED PROVIDERS INCLUDING SIX (6) MAJOR HOSPITAL*

Room & Board MBL* o Annual Fee w/o o Semi-Annual o Quarterly Fee
Rider Fee w/o Rider w/o Rider
 Suite up to 4,000 400,000 P32,614.40 P17,448.70 P8,968.96

 Suite up to 3,000 400,000 P30,251.20 P16,184.39 P8,319.08

 Private Open 250,000 P25,334.40 P13,553.90 P6,966.96

 Regular Private 250,000 P22,024.80 P11,783.27 P6,056.82

 Semi-Private Open 200,000 P17,427.20 P9,323.55 P4,792.48

 Ward Open 100,000 P13,568.80 P7,259.31 P3,731.42

Notes:

 In compliance to BIR, rates provided above are inclusive of applicable 12% EVAT; If VAT Exempt, pls.
provide a copy of the VAT Exempt Certification
 Rates provided are based on the minimum of 20 to maximum of 150 employees only
 Rates provided for dependents are based on the required 75% participation based on the total
employee’s headcount.
 With coverage for Pre-existing Conditions up to MBL
 Direct Access – For Out-patient, In-patient and emergency members can avail in accredited
providers of Philcare.
 Non-Medical Requirement;
 *MBL works on a per illness, per injury, per member, per year
 Optional access to Six (6) Major Hospitals: Asian Hospital and Medical Center, St. Luke's Medical
Center(QC), Makati Medical Center, The Medical City and Cardinal Santos Medical Center including
SLMC Global
 ***Rates excludes access to Philippine Orthopedic Institution, Notre Dame Hospital, Manila
Adventist, Marikina Valley and Healthway clinics
 Rates includes access to Fortmed Clinics and TMC Satellite except Healthway Clinics.
 Rates are provided based on the assumption that company is under the category of “Group A
accounts”; otherwise, rates are subject for actuarial’s review and re-cost
 Additional Php2,400.00 (VAT Exclusive) or Php2,688.00 (VAT Inclusive) for non Philhealth Members
(must be declared upon enrolment).

OPTIONAL RIDER BENEFIT

DENTAL BENEFIT (WITH 12% VAT)

Type of Package  ANNUAL

 SEMI ANNUAL  QUARTERLY
FEE
 Standard Dental
(1 Oral Prophylaxis, No
Permanent Fill) 296.80 158.79 81.62

 Standard + 1 Addtl Oral

Prophylaxis + 2 surfaces 448.00 239.68 123.20
Light cure
 Standard + 1 Addtl Oral
Prophylaxis + 2 teeth 515.20 275.63 141.68
Light cure
 LIFE INSURANCE RIDER: GROUP LIFE AND AD&D (WITH 12% VAT)

COVERAGE  ANNUAL
 SEMI ANNUAL  QUARTERLY
FEE
 10,000 100.80 53.93 27.72

 20,000 201.60 107.86 55.44

 50,000 504.00 269.64 138.60

 100,000 1,008.00 539.28 277.20

*Note:

Group Life and AD&D coverage is only applicable for employees below 65 years old. Dependents are not
entitled to the Life Insurance Rider. AD&D requires Group Life coverage