WIXLIB

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RESPONSIBILITIES OFAN INTELLICARE MEMBERTo ensure that inconveniences are lessenedduring availment:Always bring your membership card andpresent this during availment of procedures.Read this guidebook to be familiar with yourbenefits and the procedures for availment, orcoordinate with your HR Representative orHealth Plan Administrator with regards to thedetails of your healthcare plan.Give Intellicare feedback (whether positive ornegative) regarding the services of the following:-- Hospital Coordinators-- Accredited and Affiliated Medical Providers-- Patient Relations Officers-- Customer Service Representatives-- Other personnel directly related to theprovision of healthcare servicesYou may contact our Account Management Departmentat (02) 789-4000 or e-mail us atamd@info.intellicare.net.phto report any concern.

Dear Valued Member,Thank you for choosing Intellicare to provide for yourcomprehensive healthcare requirements.We have prepared this guidebook with theobjective of providing you with the basicunderstanding of how your Health Planworks. For easy reference, we have coveredthe important items that you need to know: Features of the healthcare program Plan coverage and procedures for availment General exclusionsShould you have any concerns or questionsregarding the information contained in thisguidebook, our Membership Services Departmentwill be more than willing to assist you. You maycontact us through the numbers listed herein.Special Note:This guidebook serves only as a standard reference and is notan Agreement. In case of differing information or interpretationbetween this handbook and your Healthcare ServicesAgreement, the terms and conditions of the latter shall prevail.

Page No.1 - Features of the Plan12 - Membership Eligibility53 - Plan Benefits7 Preventive HealthcareMaintenance Services9 Out-Patient Care Services9 In-Patient Care Services10 Emergency Care Services10 Additional Benefits11-- Latest Modalities ofTreatments and SpecialProcedures11-- Dental Care Services12-- Financial Assistance124 - Flowchart of AvailmentProcedures135- Exclusions & Limitations196- Frequently Asked Questions217- Customer Service Numbers24

1 - Features of the PlanOBJECTIVES OF THE PLANThe company’s health plan aims to provide its membersaccess to the services and facilities of medical institutions for theirhealthcare and medical needs. The program provides for preventive,diagnostic, and treatment services of Intellicare -accredited and -affiliatedmedical providers to all qualified and accepted members.PARTIES INVOLVED IN THE PLANIntellicare is primarily responsible for the administration of thecompany’s health plan and the provision of comprehensive medicaland healthcare coverage to qualified members through the use of itsnetwork of accredited and affiliated medical service providers.Your HR/Personnel/Benefits Administrator acts as the overallplan administrator and is primarily responsible for internal liaisons withIntellicare to facilitate the medical availment as well as the resolution ofconcerns on behalf of the members.You, as a member, are expected to know the features of your healthplan. You are to understand and comply with the proper procedures ofavailment and give positive or negative feedback on your experiencesduring medical availment.DEFINITION OF TERMS Intellicare Coordinator/Assistant Coordinator — first contactdoctor for primary consultation. Issues referral slip to other affiliatedphysicians/specialists for consultation/treatment, for prescribedout-patient diagnostic evaluations, and for hospital confinement Out-patient Case — any condition which does not require hospitalconfinement In-patient Case — continuous confinement in a hospital for at leastsix (6) hours except in an emergency case Elective Case — non-emergency case that needs no urgent treatment and may be deferred without endangering the member’s life Emergency Case — a condition where a trained medicalprofessional diagnoses that the member’s life or health would be putat serious risk if no immediate attention is provided (Examples: heartattack, stroke, poisoning, loss of consciousness, convulsion, severedehydration, etc.) Relative Value Scale (RVS) — schedule of charges as agreedupon between the Association of Health Maintenance Organizationsof the Philippines, Inc. (AHMOPI) and various Medical Societies usingthe Philippine College of Surgeons book1

Maximum Benefit Limit (MBL) — the maximum amount payableper illness per member per year. It shall include consultations,diagnostic procedures, and hospitalization(Please refer to your HR/Benefits Administrator for yourcorresponding MBL) Pre-Existing Condition (PEC) — an illness or disease themember already has (with or without their knowledge) that has beendiagnosed before enrollment or during his/her membership withIntellicare; OR an illness or disease that do not develop over 24hours; OR any professional advice or treatment has been obtainedfor such illness or injury; OR such illness or injury was evident uponmedical examination; OR the natural history of such illness or injurycan be clinically determined to have started prior to any availmentwhether or not the member is aware of such illness or injury.(Please refer to your HR/Benefits Administratorfor your corresponding PEC coverage)PEC LIST INCLUDES BUT IS NOT LIMITED TO id disease, GoiterCataracts/Glaucoma/PterygiumEye, ear, nose, and/or throat conditions requiring surgeryAsthmaTuberculosisChronic cholecystitis/cholelithiasis and other forms of calcificationHerniaProstate disordersHemorrhoids and anal fistulaeTumorsUterine myoma, ovarian cyst, endometriosisBuerger’s diseaseVaricose veinsScoliosisArthritisChronic allergiesGastric and Duodenal ulcersDreaded diseases* Dreaded Disease — a generally chronic and irreversible conditionrequiring frequent and/or prolonged hospitalization, including thoserequiring continuous confinement for fifteen (15) days or more2

Dreaded diseases include but are not limited to thefollowing:-- Cerebrovascular accident (Stroke), Paralysis, Epilepsy-- Central nervous system lesions (Poliomyelitis, Meningitis/Encephalitis/Neurosurgical conditions)-- Cardiovascular diseases (Coronary/Valvular/HypertensiveHeart Diseases)-- Chronic obstructive pulmonary diseases (Asthma/Bronchitis/Emphysema)-- Liver parenchymal diseases (Cirrhosis, Hepatitis, Newgrowth)-- Chronic kidney/Urological diseases (Urolithiasis, ObstructiveUropathies, etc.)-- Chronic gastrointestinal tract diseases-- Collagen diseases (Rheumatoid arthritis, Systemic lupuserythematosus)-- Diabetes-- Malignancies and blood dyscrasia (Cancers, Leukemia, IdiopathicThrombocytopenic Purpora)-- Burns (if occurring prior to enrollment)-- Single or multiple organ failure requiring dialysis-- Any illness other than the above which would require intensive careunit confinement Philhealth/ECC Provision — Intellicare’s benefits underPhilhealth/Employees Compensation Commission (ECC) will bededucted first from the amount otherwise payable. Intellicare willnot pay or advance the costs of such benefits, nor will Intellicarebe responsible for filing any claims under Philhealth or ECC.-- Philhealth members must file all required Philhealth forms anddocuments prior to hospital discharge as well as Philhealth-requiredout-patient procedures. Non filing or late filing would mean paymentof the Philhealth portion by the member.-- Non-Philhealth members must pay the Philhealth portion.Please consult with your Human Resource Department or visitwww.philhealth.com should you have any concern or question regardingyour Philhealth:-- Benefits & Coverage-- Eligibility-- Membership/payments/requirements3

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2 - Membership EligibilityWho may enroll under the healthcare program? Principal member — Eligible employees (asdetermined by the enrolling company) aged 18 and not morethan 65 years old DependentsFollowing the Hierarchy Rule*, enrollment of dependents shallstrictly follow the order indicated below:For Married Principals Legal Spouse — not more than 65 years old Children — legitimate, legally adopted or legitimated;unmarried, unemployed, wholly dependent financially uponthe Principal member; not more than 21 years old*Enrollment of children must be in order of age, starting with theeldestFor Single/Unmarried Principals Biological children — unmarried, unemployed, not morethan 21 years old Parents — not more than 65 years old Siblings — unmarried, unemployed, wholly dependentfinancially upon the Principal member; not more than 21years old*Enrollment of children/siblings must be in order of age, startingwith the eldestNote: Enrollment period is within 30 days from effective date ofcoverage.No additional dependents may be enrolled after the 30-dayperiod except for new born babies, spouse of newly marriedemployees, and dependents of newly-hired or regularizedemployees who may be enrolled within 30 days from date ofbirth/date of marriage/effective date of coverage of Principalmember.Newly-born babies shall be covered on the 30th day providedthey are enrolled within 15 days from date of birth.5

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3 - Plan BenefitsOverview of Plan BenefitsPreventive Healthcare MaintenanceServicesOut-Patient Care ServicesIn-Patient Care ServicesEmergency Care ServicesAdditional BenefitsLatest ModalitiesDental Care Services (Optional Benefit)Financial AssistanceNOTE: Only the major components are listed in thisguidebook. For the complete list and the detaileddescription of your benefits, you may consult with yourHuman Resources Representative or call Intellicare’sMembership Services Department for assistance.Coverage of a member will depend on the final diagnosis.7

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PREVENTIVE HEALTHCAREMAINTENANCE SERVICESA. ANNUAL PHYSICAL EXAMINATION (APE) The APE will be conducted:-- Based on a pre-determined schedule in coordination with yourHuman Resources/Personnel Department-- At any Aventus Clinic or at the company site through a mobileclinic (for 50 persons per half day)-- The APE will include:-- Physical examination-- Complete Blood Count (CBC)-- Urinalysis-- Fecalysis-- Chest x-ray-- Electrocardiogram (for members 35 years old andabove, or if indicated by the attending affiliatedphysician)-- Pap smear (for female members 35 years old andabove, or if indicated by the attending affiliatedphysician)-- Evaluative doctor’s consultation Routine immunization (except cost of vaccines) Counseling, medical seminars, wellness programs(e.g. family planning, first aid application, stress management) Management of health problems Record-keeping of medical historyB. OUT-PATIENT CARE SERVICES Medical consultations during regular clinic hours, with anyIntellicare-affiliated physician (excluding cost of prescribedmedicines) Referral to Intellicare-affiliated specialist/s Eye, ear, nose, and throat consultations Treatment of minor injuries or illnesses such as lacerations, mildburns, sprains, and the like, including ATS and Toxoid vaccines ifindicated (except anti-rabies) Laboratory tests, x-ray, and other diagnostic examinationsprescribed by an Intellicare-affiliated physician Minor surgery not requiring confinement Speech and physical therapy up to 12 sessions per year,respectively Pre-natal and post-natal consultations up to 14 sessions per yearwith any Intellicare-affiliated OB-GYN (excluding cost of diagnostictests and laboratory exams)9