Individual and Family Program

INDIVIDUAL & FAMILY RATES (Plan Category)

Without AHMC, MMC, SLMC-QC, SLMC-Global City, TMC &CSMC

Ward Semi-Private
Limit for Dreaded Disease 50,000.00 60,000.00
ANNUAL ANNUAL
Principal Member only 10,739.00 12,049.00
Principal + 1 dependent 19,468.00 21,828.00
Principal + 2 dependents 28,696.00 31,490.00
Principal + 3 dependents 37,930.00 41,153.00
Principal + 4 or more deps 47,161.00 50,820.00

 

With AHMC, MMC, SLMC-QC, TMC & CSMC; without SLMC-Global City

Semi-Private
w/o AHMC
Small-Private
w/ AHMC
Limit for Dreaded,Disease 100,000.00 120,000.00
ANNUAL ANNUAL
Principal Member,only 18,850.00 21,908.00
Principal + 1 dependent 34,133.00 39,625.00
Principal + 2 dependents 50,315.00 57,428.00
Principal + 3 dependents 66,491.00 75,230.00
Principal + 4 or,more deps 82,663.00 93,031.00

NOTE:

• Non-PhilHealth members (e.g. parents below 60 and unemployed, etc.) shall pay the corresponding portion during confinements

• For medical, surgical, hospital and professional services expenses NOT EXPLICITLY COVERED under this Agreement, member must settle all billings upon discharge from the hospital. If MEDICard will advance the payment, member shall pay MediCard within seven (7) days of receiving of statement of account with an administration fee of 15%. If not settled within seven (7) days, a penalty of 2% per month of the amount owing until the debt is satisfied. MediCard has the option to suspend the ID card of the member(s) involved until settlement.

• Above rates are inclusive of VAT.

AHMC Asian Hospital and Medical Center
SLMC-QC St. Luke’s Medical Center-Quezon City
CSMC Cardinal Santos Medical Center
MMC Makati Medical Center
TMC The Medical City
SLMC-Global City St. Luke’s Medical Center-Global City

*rates may change without prior notice
MEMBERSHIP ELIGIBILITY

Principal Member:
Company or self-employed individual 18 yearls old up to age 60.

Dependents:

1. For Married Principal Members
– The legal spouse at least 18 years old up to 60 years old
– Legitimate and/or legally adopted children 30 days and up to 21 years of age unmarried and unemployed and living under the same roof as the principal member

2. For Single Principal Members
– Parents up to age 60, unemployed and dependent upon the principal member.
– Brothers and sisters 30 days old and up to 21 years of age who are not gainfully employed, unmarried and living under the same roof as the principal member.

Note: The choice of enrolling dependents must follow a hierarchy. This means that the spouse first must be enrolled followed by the eldest child, second child and so on for principal member. For single, the parents must be enrolled first followed by the eldest brother/sister and so on.

 

Deadline for enrollment of dependents:

For dependents who meet the eligibility requirements within the agreement period -30 days form the date dependent become eligible for membership. (copy of birth certificate or marriage contract must be submitted)
Any additional dependents other than the above can be enrolled upon the renewal of agreement.
After the lapse of the period specified above, MediCard will no longer receive, evaluate and accept any designation or application to be a qualified dependent from any PRINCIPAL MEMBER.

 

Underwriting cut-off dates in assigning effectivity date:

Date of Receipt of Application/Endorsement Effectivity Date
11th to 25th of the month 1st of the following month
26th to 10th of the month 16th of the same month

 

New enrollees who are approaching age of ineligibility must be enrolled at least six (6) months counting from the date of effectivity up to the date that the enrollees become ineligible for them to be accepted as members. All pre-existing condition/ dreaded disease limits will be computed on a prorated basis (i.e. If age of eligibility is up to 60 years old, only who are 60 years and 6 months old and younger will be accepted for membership).

Renewing members who will become age eligible within the next renewal agreement year will be allowed to renew regardless of the remaining months that the member will remain eligible. However, pre-existing conditions/dreaded disease limits will be computed on a prorated basis (i.e. If age of eligibility is up to 60 years old. A renewing member who is 60 years and 9 months old will still be renewed but pre-existing condition/ dreaded disease limits will be computed based on the following formula:

(Total months that member remains eligible/12) x PEC/DD limit = Pro-rated Limit

In relation to his dependents, the MEMBER shall be known as the PRINCIPAL and he shall be deemed to have undertaken to comply with all the requirements and obligations of individual regular membership under this MMA on behalf of said dependent/s, particularly the payment of all the required fees, dues and charges.