A Healthcare

Program Proposal
For
ASSOCIATION OF REGISTRARS
AND DEPUTY REGISTRARS OF THE
PHILIPPINES, INC. (ARDRDPI)
21 NOVEMBER 2024

Atty. Norman Carreon

ASSOCIATION OF REGISTRARS AND DEPUTY REGISTRARS DEEDS
OF THE PHILIPPINES, INC. (ARDRDPI)
16 East Ave., Diliman, Quezon City

Greetings of Good Health!

Most of our fellow Filipinos are worried about their health and that of their loved ones.
COVID - 19 pandemic brought a significant impact on our everyday lives, and we would like to extend our helping hands to
ensure the safety and well-being of your employees during these unprecedented times.

Cocolife Healthcare has been in the business for 25 years now, committed to the vision of making our client/partners Healthy
and Happy. We have made healthcare highly convenient for our members by providing:

1. Easy access to a vast network of service providers nationwide

• Over 800 hospitals

• Over 1,000 clinics
• Over 40,000 doctors and specialists
• Over 700 plan coordinators in hospitals

2. Prompt and ready assistance through dedicated Customer Care Associates

3. 24-hour Medical Helpline manned by Customer Care Agents from various allied medical professions
4. Liaison Officers ready to assist members during confinement
5. Claims Data Warehousing
Cocolife Healthcare is proud of its many firsts: the first ISO Certified Health Insurance Program in the country, your assurance
that our service meets international standards, and one of the first to be regulated by the Philippine Insurance Commission.
Cocolife Healthcare is also a long-time member of the Association of HMOs in the Philippines (AMHOPI).

Our company stands on solid financial ground, further strengthened by the resources of our mother company, Cocolife, which
amounts to over 27 billion pesos. We take care of the healthcare requirements of over 1,000 corporate clients including top
names in the food and beverage, manufacturing, shipping, BPOs, real estate, and other industries that have been enjoying our
tailor-fit services.

Please, also note that as an insurance company, Cocolife is exempt from the Value Added Tax under the provisions of the
National Internal Revenue Code.

For the full details of our Healthcare Program, please see the attached annex pages.

Send us an e-mail at [email protected] and [email protected] or give us a call at (02) 8-8-813-3000 local
116 or 117.

Thank you very much,

ROMMEL ODONO, R.N.

Account Executive II, Business Development Unit
COCOLIFE – Healthcare Division

Noted:

DAVID CRIS Y. BALDEMOR

Assistant Vice President, Business Development Unit
COCOLIFE – Healthcare Division

COMPREHENSIVE GROUP HEALTH & ACCIDENT PROGRAM

COMPREHENSIVE HEALTHCARE PROGRAM - This is an insured program that requires a fixed premium (per enrollee) for a
corresponding set of plans. The extensive program package covers the following benefits:

✓ In-Patient Care
✓ Out-Patient Care
✓ Emergency Care
✓ Preventive Care

Rider Benefits
✓ Dental Benefits through Cocolife Dental Network
✓ Annual Physical exam
✓ Life Insurance (employees only)

PROPOSED PREMIUM TABLE:

Enrollees ANNUAL PREMIUM PER

PLAN ROOM & BOARD MAXIMUM BENEFIT LIMIT
INDIVIDUAL
Principals I Regular Private 150,000 PHP 16,781
Principals II Regular Private 100,000 PHP 15,225

Hospital access: With access to all accredited hospitals including The Medical City (TMC), Makati Medical
Center (MMC), Cardinal Santos Medical Center (CSMC), Capitol Medical Center (CMC), St.
Luke`s Medical Center - Quezon City (SLMC - Q.C.), Asian Hospital and Medical Center (AHMC)
and St. Luke`s Medical Center - Global (SLMC - BGC).

Clinic access: With access to all accredited clinics including Healthway Medical Clinics (HMC).

Please refer to the attached Annex for the detailed Schedule of Benefits.
NOTES AND GENERAL ASSUMPTIONS

Inclusive of the processing fee, ID card, E-guidebook & directories, and rider benefits.

The company will guarantee any excess and incremental charges incurred by the member during confinement.

Eligibility:
✓ This program assumes enrollment of 100% of total employees.
✓ Covers all regular and full-time employees. (18 years old up to 65 years old)

Pre-Existing Medical Conditions:

a. Initial principals - covered up to MBL.
b. Additional principals – covered up to MBL.

Standard Annual Physical Examination benefits.

Standard Dental benefits through Cocolife Dental Network.

Life Insurance (employees only):

a. Natural death - Php 10,000
b. Accidental death - Php 20,000

The above rates are based on 200 regular full-time employees, a 5% reduction of enrollees will be subject to re-
computation.

All benefits and provisions are subject to Cocolife General Exclusion Conditions

The validity of our proposal will be 30 days from the release date.

INDICATIVE RATES ONLY. (Subject to change upon submission of complete requirements: MASTERLIST).

WHY COCOLIFE

Financial strength and stability.

One-stop shop market that offers a complete array of life insurance, non-life insurance, healthcare, and mutual fund
products.

Reputation for offering fast, customized, and comprehensive solutions at competitive rates.

Fast and accurate claims processing.

Preferred healthcare provider of the top corporations in the Philippines

 COCOLIFE STANDARD GUIDELINES

a. APE (ANNUAL PHYSICAL EXAMINATION)

1. Criteria for eligibility

o Payment scheme
✓ Annual and Semi-annual > full settlement of the billing
✓ Quarterly > minimum of three (3) quarters billing
✓ Monthly> minimum of nine (9) months billing

o With no previous pending arrears or any unresolved contestable transactions material to suspension or
termination of coverage.
o Availment shall only be allowed within the policy period only.
o Only enrolled employees/dependents are entitled to APE.
o APE benefit of new/additional members will have six (6) months waiting period of availment.
o Those members who avail the pre-employment exam will no longer be entitled for APE benefit

2. Formal request for APE must be sent to Cocolife Healthcare’s APE Coordinators through fax (02-812-3363) or
email.

o Send request at least two weeks or 14 working days before the preferred scheduled date. This applies both
to mobile (on-site) and clinic-based (walk-in) APE availment
o Please fill up the attached APE form. AE will acknowledge receipt of fax or email and will do the necessary
endorsement to CCA – APE.

3. Cocolife reserves the right to designate an accredited APE clinic provider capable of providing quality services
and determine the number of days APE will be conducted (unless otherwise specifically stipulated in the
Schedule of Benefits).
4. APE services are provided only by Cocolife designated APE clinic provider, either walk-in or mobile.

o Mobile APE
✓ Minimum of 100 enrolled employees are required.
✓ 100 employee / day (8 hours) – office hours only. Graveyard shift is subject to imposition of
corresponding additional charges to the Client Company and subject for approval.
✓ In the event that the required minimum number of employees is not met, then the client
company will be required to shoulder the cost of the APE of employees who did not show up OR
implement automatic forfeiture of the APE benefit for those who did not show up.
o Walk-in APE
✓ For company with less than 100 enrolled employees.
✓ Minimum 1-week conduction to maximum of 2 months.
✓ Extension will not be allowed.
 5. Cocolife will exert its best effort to schedule the APE on client’s preferred date. However, should it be not
possible, then broker /client will be informed of other alternative dates not later than 1 week before the
original schedule.
6. Requests for APE conduction outside office hours or during graveyard shifts are subject to additional costs
chargeable to the client company (unless otherwise specifically stipulated in the Schedule of Benefits).
7. Cocolife shall confirm and inform the broker / client of the final schedule and designated APE clinic within 7
working days from receipt of the formal request and / or completion of the required information but not later
than 1 week before the scheduled date.
8. For mobile APE, Cocolife APE coordinator shall initiate coordination with the contact person assigned by the
client company for the scheduling of the onsite ocular inspection by the designated APE provider.
9. The APE provider will release the result based on the details stated in the Letter of Endorsement
10. Non-availment of APE on the scheduled date, regardless of any reason, shall mean forfeiture of this benefit
for the existing policy year. On the other hand, under no circumstances will a member can be allowed to
avail APE more than once in a given policy year.
11. Provision of APE services is limited only to those examinations and Procedures included in the Schedule of
Benefits and specifically stated in The Letter of Endorsement. Any additional examinations requested or
done during the APE conduction shall be charged directly to the client/company/individual member unless
otherwise included in the Letter of Endorsement.
12. Neither client companies nor intermediaries will be allowed to directly transact with any of Cocolife
accredited medical providers with regard to the conduction of APE. Any unofficial transaction will not
be binding and Cocolife will not be held liable for any adverse consequences that may ensue and will not
guarantee payment of any fee to the involved parties.
13. In case of pre termination of contract, and the APE has been rendered; additional premium shall be paid in
full by the client

b. ENROLLMENT AND BILLING

I. Age Eligibility
1. Employees who are actively at work and at least Eighteen (18) up to Sixty-five (65) years old
2. Adult Dependents who are at least Eighteen (18) up to Sixty-five (65) years old
3. Minor Dependents who are at least 90 days up to 21 years old

II. Participation Requirement

1. If the dependents premium is 100% company paid – Cocolife shall require 100% of employees with
eligible dependents to enroll their qualified dependents
2. If the dependents premium is shared between the employer and the employee, or if 100% paid for by
the employee – Cocolife shall require at least 75% of employees to enroll their qualified dependents

III. Hierarchy
Dependents must be enrolled in a certain order of priority, i.e.:
1. Married Employees – Spouse first, then children (legitimate, legitimated and legally adopted) in the
order of descending age
2. Single Employees – Parents first (in no particular order), then siblings (unemployed and financially
dependent to the principal) in the order of descending age
3. Single Parents – shall choose to enroll either:
3.a. Children (in the order of descending age), or
3.b. Parents (in no particular order)
IV. Enrolment of New and Additional Insureds

1. Policyholder shall fill-out the Enrollee Data Sheet (EDS) and submit to Cocolife representative, servicing
agent or broker or submit directly to Cocolife Healthcare Office on or before the enrolment cut-off dates.
From the EDS, our Underwriting Section will be able to secure information needed to enroll additional
Insureds or change in membership data.

In cases wherein the volume of additional enrollees is substantial a soft file list shall be provided
following Cocolife’s required format and shall be endorsed by the Policyholder’s authorized
representative/s.

Cocolife shall only honor enrollee listings coming directly from the Policyholder’s authorized personnel.
This is to ensure accuracy and security of data to be submitted and processed.

The Company authorizes the following personnel:

Name: ___________________________________

Position: _________________________________

EDS and/or Enrollee lists that are emailed or clearly faxed may be accepted to meet the cut-off dates.
However, submission of the original copy of documents is required to avoid discrepancy in insured
data.

2. Eligibility – only the following additional enrollees are allowed in the middle of the policy:
a. Principal/Employee –
i. Newly hired/regularized employee (whichever is the company provided eligibility)
b. Dependents -
i. Spouse of newly married employee
ii. Newly born child

Note: the policyholder is allowed 30 days from date of eligibility of enrollment to advise Cocolife.

3. The effective date of coverage or the assignment of effectivity date for new / additional applications shall
be as follows:

3.1. Change of effectivity date within the coverage period shall not be allowed.

3.2. Request for late enrolment shall no longer be accommodated even on a retroactive effectivity
date.

3.3. Effectivity dates of pending enrollees held due to needed additional requirements/verifications
shall be based on the original date of advice.

➢ Pending requirements shall be completed within 30 calendar days from date of advice of
Cocolife, non-compliance would mean automatic forfeiture to enroll with Cocolife.

3.4. Should the effectivity date of applicants/enrollees be considered as date of regularization of the
employee, the Policyholder shall ensure endorsement prior to the date of regularization or thirty
(30) days thereafter. The effectivity date of the newly regularized employees shall then follow the
date of regularization. Failure to submit the abovementioned requirements within thirty (30) days
after the date of regularization would result to the disapproval of the application.
 Effectivity date of approved upgrading due to promotion shall follow certain Employee
classification/grade and the standard cut-off for the effectivity date.

Certain considerations on late submission of within 60 days only from the date of regularization
may be given on a case-to-case basis due to reasons deemed acceptable and approved by
Cocolife.

3.5. All additional enrollees/dependents during the renewal period must be endorsed within the first
month or within 30 days of the coverage period and shall follow the original /renewal effective
date for the assignment of effectivity date.

3.6. For new enrollees to be enrolled within the last quarter of the coverage period, list of enrollees
should be endorsed to Cocolife within two (2) months prior to the maturity date of the account
and shall follow the date of regularization, otherwise, they will be considered and accepted as
additional enrollees during renewal.

➢ Certificate of coverage shall be issued in lieu of the Cocolife ID cards.

V. Upgrading of Plans
Benefit plans should follow the schedule of benefits indicated in the policy.

1. Upgrading should only occur in case of change in employee classification. Effectivity date shall be
based on the date of promotion.
2. Dependent’s plan should follow the employee’s plan or as specified in the eligibility provisions stated
in the schedule of benefits
VI. Cancellation and/or Termination of Insureds

1. The effective date of Cancellation of Insureds should be based on the date specified in the
cancellation notice, provided that Cocolife received it prior to the effective date of the said
cancellation and/or termination. Otherwise, the cancellation of Insureds shall be based on Cocolife’s
receipt of the cancellation notice.
2. ID cards of cancelled, resigned/ separated Insureds must be submitted returned to Cocolife. If cards
are not returned, any availments or possible access of such Insureds after the cancellation date shall
be charged accordingly to the Policyholder’s account and will form part of the Policyholder’s total
utilization.
3. Refund premium are put on hold and will be release after retrieval of their Cocolife IDs or three (3)
months after the expiry date of the policy.
4. If cancelled members have availed after the effectivity of cancellation, refund premium will be
forfeited.

VII. Reactivation

Reactivation shall be allowed within 30 days from date of cancellation.

1. No replenishment of the MBL

2. No need to issue new ID card.
3. If ID card re-issuance is necessary, a corresponding cost of Php 100 shall be charged.
VIII. Extension

1. Request for policy extension shall be made in writing (email of hard copy)
2. The Policy may be extended for 1 month subject to Cocolife’s approval
3. If further extension is required, the policyholder shall formally request in writing
4. During the extension period, additions, deletions, or any changes in the list of existing insureds shall
not be allowed.
5. There shall be no replenishment of the MBL
6. Pro-rated premium shall be computed based on the renewal analysis and other assumptions

c. PREMIUM REFUND

* Premium Refund Computation

((Annual Premium/365 days) X number of days insured) - Annual Premium

* The effective date of cancellation of insured's should be based on the date specified in the cancellation notice,
provided that Cocolife received it prior to the effective date of the said cancellation and/or termination. Otherwise,
the cancellation of insured's shall be based on Cocolife's receipt of the cancellation notice.

* ID cards of cancelled, resigned/ separated Insureds must be submitted/returned to Cocolife within seven (7)
calendar days from the date of cancellation. If cards are not returned, any availments or possible access of such
Insureds after the cancellation date shall be charged accordingly to the Policyholder’s account and will form part of
the Policyholder’s total utilization/collectible.

* Refund premium of unreturned/lost ids are put on hold and will be release three (3) months after the expiry date
of the policy / (less collectible/Premium Balance Admin & Taxes if any)

* If cancelled members have availed after the effectivity of cancellation, total availments will be deducted from the
total premium refund of the account.
 COCOLIFE GENERAL EXCLUSIONS

1. Intentionally self-inflicted injury, suicide, death, self-destruction or any attempt thereat while sane or insane.

2. Illness, injury or death attributable to the Insured's own misconduct, gross negligence, intemperate or under
the influence of drugs or alcohol, vicious or immoral habits; participation in the commission of a crime,
violation of law or ordinance.

3. Unnecessary exposure to needless perils including firecracker injuries, hazardous sports and activities (such
as aqualung diving, boxing, climbing, flying except air travel, football, hang-gliding, hunting, hurling, ice
hockey, motor competitions, motorcycling in any form, parachuting, polo, pot-holing, power boating, racing,
show jumping, skydiving, use of wood-working machinery, water ski-jumps and tricks, winter sports,
wrestling, and yachting beyond 5 kilometers of a coastline).

4. War, invasion, act of foreign enemy, hostilities or warlike operations (whether declared or undeclared),
mutiny, riot, civil commotion, strike, civil war, rebellion, revolution, insurrections, conspiracy, military or
usurped power, martial law or state of siege, or any of the events or causes which determine the
proclamation or maintenance of martial law or state of siege, seizure, quarantine or customs regulations; or
nationalization by or under the order of any government or public or local authority; or any weapon or
instrument employing atomic fission or radioactive force whether in time of peace or war.

5. Services in the Armed Forces of any country or international authority, whether in peace or war; participating
in any political, police, investigative, fire fighting, military or para-military activity; or any bodily injury or
sickness contracted while in the military, naval, or air service.

6. Murder or assault, homicide or any attempt thereof; or physical injuries, occasioned by provocation of the
Insured.

7. Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the
combustion of nuclear fuel.

8. Mental, nervous or other functional disorders of the mind; congenital anomalies and conditions arising there
from.

9. Treatment of any pre-existing medical conditions.

10. Hospitalization primarily for diagnosis, x-ray examinations, therapies, routine physical examinations, check-
ups, dialysis, rest cures, or non-surgical care for tuberculosis. Custodial, domicilliary, convalescent or
intermediate care; long term rehabilitation. Treatment for neo-natal and post-natal abnormalities
developing within 6 months and their complications.

11. Any dental work (except if dental benefits are covered in this Policy as indicated in the Schedule of Benefits),
treatment or surgery; oral surgery, procedure for treatment of error of refraction, fitting of eye glasses or
hearing aids; cosmetic including treatment for warts, plastic or reconstructive surgery, except to the extent
that any of them are necessary for the repair and alleviation of damage to the Insured caused solely by
accidental bodily injury covered under this Policy.
12. Treatment involving sophisticated procedures such as thallium scintigraphy, angiography, dialysis,
hyperalimentation, allergy testing, radiotherapy, chemotherapy, brachytherapy, organ transplantation or
open heart surgery or treatments where comparable traditional/conventional modes of treatment exist.
Respiratory therapy, speech therapy, physical therapy, occupational therapy and the like.

13. Human blood products; human anti-rabies or anti-tetanus vaccine (excluding first dose); other vaccines; out-
patient benefits such as take home drugs and medicines.

14. Any treatment in connection to pregnancy or resulting childbirth or miscarriage or complications therefrom
(except if maternity benefits are covered in this Policy as indicated in the Schedule of Benefits); sterilization
of either sex or reversal of such, artificial insemination, sex transformation or care for infertility; treatment
of venereal diseases and other sexually transmitted diseases and Acquired Immune Deficiency Syndrome
(AIDS); treatment of cataract, benign prostatic hypertropy, scoliosis, guillain-barre syndrome, chronic
glomerulonephritis, spinal stenosis or vitiligo, epilepsy, cardiac valvular or rheumatic heart disease and
chronic dermatoses.

15. Any charges where expenses are provided or covered by law or government including PhilHealth or treatment
where charges are provided free of charge by any local or national government or treatment for any
communicable disease declared by any government agency or entity as causing a state of emergency in an
area.

16. Any treatment which are not recommended and performed by a Physician as being medically necessary
including any charges for non-medical services such as telephone, radio, television, extra bed, extra food,
toilet articles and the like, private duty nurse or physician.

17. Purchase or use of durable medical equipment, oxygen dispensing unit except rental for use only while
confined; expenses for corrective/prosthetic appliances, artificial aids, surgically implanted external devices
and orthopedic hardware.
 ANNEX A
SCHEDULE OF BENEFITS

ASSOCIATION OF REGISTRARS AND DEPUTY REGISTRARS DEEDS OF THE PHILIPPINES, INC. (ARDRDPI)
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 Covered
intravenous 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 Covered
clinic hours
2. Pre and Post Natal consultations excluding lab & Covered up to 14 sessions
diagnostics
3. Treatment for minor injuries such as lacerations, Covered
mild 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 & up to Php 1,000 except for aesthetic
condyloma acuminata purposes
8. Allergy Testing/ allergy screening and other related Covered up to Php 1,200
examinations
9. Tuberculin test Covered up to Php 600
10. Sclerotherapy for varicose veins Covered up to Php 5,000 per leg

B.1. THERAPEUTIC PROCEDURES

1. Eye Laser Therapy for retinal hole, retinal Covered up to Php 10,000 per eye
detachment, and glaucoma, excluding eye
correction such as Lasik, PRK and the like
 2. Speech therapy Covered up to 12 sessions subject to MBL
3. Physiotherapy (Physical Therapy/Occupational Covered up to 12 sessions subject to MBL
Therapy)
4. Chemotherapy Covered up to 12 sessions subject to MBL
5. Dialysis Covered up to 12 sessions subject to MBL
6. Radiotherapy Covered up to 12 sessions subject 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, lumbo- Covered
sacral)
c. Chest, ribs, sternum, and clavicle Covered
d. Biliary tract: Cholecystogram and Cholangiograms Covered
e. Digestive: Plain film of the abdomen, Barium Covered
Enema, 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 Covered
Cell 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 Covered
Stress Tests)
9. Computed Tomography Scans Covered
10. Diagnostic Ultrasounds: 2D-Echo, Doppler, Covered
Ultrasound (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 Covered
basis)
21. Nuclear Radioactive Isotope Scan Covered
22. Perfusion Scan Covered
23. Plasma Urinary Cortisol, Plasma Aldosterone Covered
24. Polysomnograms (Sleep Study/Recording) up to Php 10,000
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 Covered
(Perfusion/Ventilation Lung Scans)
27. Thallium Scintigraphy Covered

B.4. OTHER SPECIAL PROCEDURES

1. Arthroscopic Procedures Covered
2. Coronary Angiogram up to Php 30,000
3. Angioplasty up to Php 30,000
4. Coronary Artery Bypass Graft up to Php 30,000
5. Open Heart Surgery up to Php 30,000
6. Cryosurgery up to 1,000 per area
7. Endoscopic procedures Covered
8. Flourescein Angiogram up to Php 30,000
9. Gamma Knife Surgery
Covered
(Based on cobalt/radiotherapy)
10. Hemorrhoidectomy (Conventional) Covered
11. Hemorrhoidectomy (Scalpel) Covered
12. Hemorrhoidectomy (Stapled) up to Php 10,000
13. Herniorrhaphy (except cost of mesh) Covered except congenital hernia
14. Hysteroscopic Myoma Resection up to Php 40,000
15. Hysterospically-guided D&C Covered
16. Laparoscopic Procedures 80% up to Php 40,000
17. Laparoscopic Cholecystectomy 80% up to Php 40,000
18. Lithotripsy 80% up to Php 40,000
Covered up to MBL if without conventional
19. New/Special modalities not specified counterparts; Covered up to Php10,000 if
with conventional counterparts
 20. Organ Transplant (except cost of organs & procedure
Covered
for donor)
21. Percutaneous Ultrasonic Adrenalectomy up to Php 40,000
22. Percutaneous Ultrasonic Nephrolithomy up to Php 40,000
23. Stereotactic Brain Biopsy up to Php 40,000
24. Testing involving Nuclear Technologies (Thallium
Stress Testing, Radionuclide, Thyroid Scan,
Covered
Pyrosphosphate Scintigraphy, Positron Emission
Tomography, Radio Isotope Scanning)
25. Transurethral Microwave Therapy of Prostate up to Php 40,000
26. Video Gastroscopy Covered

C. ANNUAL PHYSICAL EXAMINATION To be availed at Cocolife Designated APE

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 Cocolife RUV
Rates
a. Areas with Accredited Facilities within 50km Up to 80% of eligible expenses up to Php
Radius 30,000
b. Areas w/o Accredited Hospital outside 50km Up to 100% of eligible expenses up to Php
Radius 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 24 hours (except Suite room)
entitled room
a. Waiver of Room rate difference Covered up to 24 hours
b. Waiver of Incremental charges (except suite Covered up to 24 hours
room)
E. PREVENTIVE CARE
1. Health habits and Family Planning counseling Covered
2. Anti-tetanus, Rabies, Venom Covered up to 18,000
3. Periodic monitoring of health problems Covered
4. Wellness programs/lectures Covered up to two (2) sessions

F. LIFE INSURANCE (employees only)

1. Natural Death Covered up to Php 10,000
2. Accidental Death Or Covered up to Php 20,000
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 COCOLIFE DENTAL NETWORK
1. Dental consultation (Dental Exam, TMJ, Ortho, Unlimited
Aesthetic)
2. Routine Oral Prophylaxis (Simple Scaling) Once (1) 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%

H. OTHER SPECIAL BENEFITS

1. Ambulance Service (hospital transfer) Covered up to 2,500 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 Php 20,000
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 police
Conditions report
a. Motor Vehicular Accidents Covered
b. Motorcycle Accident Covered
c. Unprovoked Assault Covered
9. Scoliosis, whether congenital, pre-existing, Covered up to Php 20,000
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

I. PRE-EXISTING CONDITIONS
a. Initial Principals Covered up to MBL
b. Additional Principals Covered up to MBL
J. ELIGIBILITY PROVISIONS
Principals All regular and full-time employees
(18 years old up to 65 years old)

K. OTHER PROVISIONS
1. 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
plan (including excess in limits) before
discharge Failure of the patient to settle in
full such charges shall be borne by Cocolife
but will be subject to Bill-back Arrangement.
2. 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.
3. Philhealth (Required to be filed at the hospital The plan pays benefits up to its limits after
whenever applicable) Philhealth Benefits have been exhausted
4. Additional Premium Option for non-Philhealth Php 3,600 per individual
Eligible members
5. 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
viii. Capitol Medical Center With access

L. ADDITIONAL SERVICES:
1. E-Guidebook and Provider Directory:
a. Click this link:
https://www.cocolife.com/knowledgebase/
b. Once you are on Cocolife's website, go to
download forms. Covered
c. Find the Cocolife Healthcare's Benefits
Guidebook, Providers Directories, and Dental
Directories.
d. Download the files and have easy access
through your mobile phone.
2. ID Processing and Enrollment Fee Waived
3. Card Replacement Fee Correction: Php 50;
Lost ID: Php 200
4. Benefit Orientations Covered upon request
Note: Coverage for all procedures will be based on the diagnosis/medical impression of Cocolife
Accredited Physician and shall be subject to the plan limits