Common use of BENEFITS AND COVERAGES Clause in Contracts

BENEFITS AND COVERAGES. All the benefits provided for in this Agreement are detailed in “Schedule A – Benefit Coverage”, and subject to the following terms and conditions: 1. In case of Out-Patient, the MEMBER can go directly to the primary physician of any accredited hospital/clinic for out-patient consultation. The primary physician will request for laboratory or diagnostic examinations or refer the MEMBER to a specialist. The MEMBER may avail of services from any accredited hospital/clinic of his/her choice upon issuance by MediCard of the Out-Patient Consultation Form or Laboratory Request Form. 2. For In-Patient services, all limits are inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure. A Letter of Authorization (LOA) together with other necessary documents shall be issued by MediCard prior to confinement. The maximum benefit limit and annual benefit limit shall be inclusive of consultations, diagnostic procedures and hospitalization. Before being discharged from the Hospital, a Member must fill up the prescribed discharge form and settle that portion of the medical bill not covered by the Agreement. That portion of the bill covered by the Agreement shall be settled directly by the HMO with the hospital and/or Attending Physician(s). 3. All procedures or benefits are subject to the limitations on pre-existing conditions as stated in this Agreement. 4. Non-emergency confinement or surgery (elective cases) shall be subject to prior review and approval by the MediCard review board. MediCard reserves the right to direct the MEMBERS to other physicians or specialists for further opinions as needed so as to protect the interest of both the MEMBER and MediCard. 5. In all circumstances of Emergency Care Services, MediCard reserves the right to validate whether treatment received is emergency in nature and/or the illness or condition is covered under the provisions of this Agreement. 6. In case a MEMBER is simultaneously covered under more than one corporate or group health maintenance agreements with MediCard, the ASO Fund in Schedule B for which are paid by the COMPANY and/or Principal Member, the MEMBER on a per confinement basis, shall only avail of the benefits accruing from one agreement. The MEMBER must choose which agreement will apply and his/her confinement will be governed by the terms and conditions and the limits of the agreement of his/her choice. The provision is without prejudice to the other benefits availed of by the MEMBER under another agreement which may apply for other confinements. 7. Hospitalization or in-patient coverage of a MEMBER will depend on his/her final diagnosis. All diagnostic procedures will only be covered if results are within inclusions of this Agreement. 8. All MediCard patient-MEMBER are considered to be patients of the MediCard Medical Director handled by his authorized designates. As such, coverage or non-coverage of certain illness not listed herein shall be upon his discretion after proper consultation with the concerned medical accredited physician.

BENEFITS AND COVERAGES. All the benefits provided for in this Agreement are detailed in “Schedule A – Benefit Coverage”, and subject to the following terms and conditions: 1. In case of Out-Patient, the MEMBER can go directly to the primary physician of any accredited hospital/clinic for out-patient consultation. The primary physician will request for laboratory or diagnostic examinations or refer the MEMBER to a specialist. The MEMBER may avail of services from any accredited hospital/clinic of his/her choice upon issuance by MediCard of the Out-Patient Consultation Form or Laboratory Request Form. 2. For In-Patient services, all limits are inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure. A Letter of Authorization (LOA) together with other necessary documents shall be issued by MediCard prior to confinement. The maximum benefit limit and annual benefit limit shall be inclusive of consultations, diagnostic procedures and hospitalization. Before being discharged from the Hospital, a Member must fill up the prescribed discharge form and settle that portion of the medical bill not covered by the Agreement. That portion of the bill covered by the Agreement shall be settled directly by the HMO with the hospital and/or Attending Physician(s). 3. All procedures or benefits are subject to the limitations on pre-existing conditions as stated in this Agreement. 4. Non-emergency confinement or surgery (elective cases) shall be subject to prior review and approval by the MediCard review board. MediCard reserves the right to direct the MEMBERS to other physicians or specialists for further opinions as needed so as to protect the interest of both the MEMBER and MediCard. 5. In all circumstances of Emergency Care Services, MediCard reserves the right to validate whether treatment received is emergency in nature and/or the illness or condition is covered under the provisions of this Agreement. 6. In case a MEMBER is simultaneously covered under more than one corporate or group another health maintenance agreements with MediCard, the ASO Fund in Schedule B for which are paid by MEMBER shall not use the COMPANY and/or Principal Memberbenefits of his other MediCard coverage (if any) simultaneously with the benefits of this MediCard Health Program Agreement, the MEMBER on a per confinement basis, shall only avail of the benefits accruing from one agreement. The MEMBER must choose which agreement will apply and his/her confinement will be governed by the terms and conditions and the limits of the agreement of his/her choice. The provision is without prejudice to the other benefits availed of by the MEMBER under another agreement which may apply for other confinements. 7. Hospitalization or in-patient coverage of a MEMBER will depend on his/her final diagnosis. All diagnostic procedures will only be covered if results are within inclusions of this Agreement. 8. All MediCard patient-MEMBER MEMBERS are considered to be patients of the MediCard Medical Director handled by his authorized designates. As such, coverage or non-coverage of certain illness not listed herein shall be upon his discretion after proper consultation with the concerned medical accredited physician. 9. For purposes of determining the amount utilized by the MEMBER of his/her “per disease, per year limit,” it shall be understood that any Disease Complication shall share the same limit as the primary disease which caused it, and any amount expended for the treatment of the Disease Complication shall be included in the total amount expended for the said primary disease for the year. Similarly, the exclusion of a primary disease from coverage by MediCard shall cover any Disease Complication that may have been caused by the said excluded primary disease. This provision shall be applicable to all benefits provided by MediCard under this Agreement, especially those provided for under this “Schedule A – Benefit Coverage”. Note that this Section is applicable only for Accounts which limit is MBL.

BENEFITS AND COVERAGES. All the benefits provided for in this Agreement are detailed in “Schedule A – Benefit Coverage”, and subject to the following terms and conditions: 1. In case of Out-Patient, the MEMBER can go directly to the primary physician of any accredited hospital/clinic for out-patient consultation. The primary physician will request for laboratory or diagnostic examinations or refer the MEMBER to a specialist. The MEMBER may avail of services from any accredited hospital/clinic of his/her choice upon issuance by MediCard of the Out-Patient Consultation Form or Laboratory Request Form.. SPECIMEN COPY 2. For In-Patient services, all limits are inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure. A Letter of Authorization (LOA) together with other necessary documents shall be issued by MediCard prior to confinement. The maximum benefit limit and annual benefit limit shall be inclusive of consultations, diagnostic procedures and hospitalization. Before being discharged from the Hospital, a Member must fill up the prescribed discharge form and settle that portion of the medical bill not covered by the Agreement. That portion of the bill covered by the Agreement shall be settled directly by the HMO with the hospital and/or Attending Physician(s). 3. All procedures or benefits are subject to the limitations on pre-existing conditions as stated in this Agreement. 4. Non-emergency confinement or surgery (elective cases) shall be subject to prior review and approval by the MediCard review board. MediCard reserves the right to direct the MEMBERS to other physicians or specialists for further opinions as needed so as to protect the interest of both the MEMBER and MediCard. 5. In all circumstances of Emergency Care Services, MediCard reserves the right to validate whether treatment received is emergency in nature and/or the illness or condition is covered under the provisions of this Agreement. 6. In case a MEMBER is simultaneously covered under more than one corporate or group another health maintenance agreements with MediCard, the ASO Fund in Schedule B for which are paid by MEMBER shall not use the COMPANY and/or Principal Memberbenefits of his other MediCard coverage (if any) simultaneously with the benefits of this MediCard Health Program Agreement, the MEMBER on a per confinement basis, shall only avail of the benefits accruing from one agreement. The MEMBER must choose which agreement will apply and his/her confinement will be governed by the terms and conditions and the limits of the agreement of his/her choice. The provision is without prejudice to the other benefits availed of by the MEMBER under another agreement which may apply for other confinements. 7. Hospitalization or in-patient coverage of a MEMBER will depend on his/her final diagnosis. All diagnostic procedures will only be covered if results are within inclusions of this Agreement. 8. All MediCard patient-MEMBER MEMBERS are considered to be patients of the MediCard Medical Director handled by his authorized designates. As such, coverage or non-coverage of certain illness not listed herein shall be upon his discretion after proper consultation with the concerned medical accredited physician. 9. For purposes of determining the amount utilized by the MEMBER of his/her “per disease, per year limit,” it shall be understood that any Disease Complication shall share the same limit as the primary disease which caused it, and any amount expended for the treatment of the Disease Complication shall be included in the total amount expended for the said primary disease for the year. Similarly, the exclusion of a primary disease from coverage by MediCard shall cover any Disease Complication that may have been caused by the said excluded primary disease. This provision shall be applicable to all benefits provided by MediCard under this Agreement, especially those provided for under this “Schedule A – Benefit Coverage”. Note that this Section is applicable only for Accounts which limit is MBL.

BENEFITS AND COVERAGES. All the benefits provided for in this Agreement are detailed in “Schedule A – Benefit Coverage”, and subject to the following terms and conditions: 1. In case of Out-Patient, the MEMBER can go directly to the primary physician of any accredited hospital/clinic for out-patient consultation. The primary physician will request for laboratory or diagnostic examinations or refer the MEMBER to a specialist. The MEMBER may avail of services from any accredited hospital/clinic of his/her choice upon issuance by MediCard of the Out-Patient Consultation Form or Laboratory Request Form. 2. For In-Patient services, all limits are inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure. A Letter of Authorization (LOA) together with other necessary documents shall be issued by MediCard prior to confinement. The maximum benefit limit and annual benefit limit shall be inclusive of consultations, diagnostic procedures and hospitalization. Before being discharged from the Hospital, a Member must fill up the prescribed discharge form and settle that portion of the medical bill xxxx not covered by the Agreement. That portion of the bill xxxx covered by the Agreement shall be settled directly by the HMO with the hospital and/or Attending Physician(s). 3. All procedures or benefits are subject to the limitations on pre-existing conditions as stated in this Agreement. 4. Non-emergency confinement or surgery (elective cases) shall be subject to prior review and approval by the MediCard review board. MediCard reserves the right to direct the MEMBERS to other physicians or specialists for further opinions as needed so as to protect the interest of both the MEMBER and MediCard. 5. In all circumstances of Emergency Care Services, MediCard reserves the right to validate whether treatment received is emergency in nature and/or the illness or condition is covered under the provisions of this Agreement. 6. In case a MEMBER is simultaneously covered under more than one corporate or group another health maintenance agreements with MediCard, the ASO Fund in Schedule B for which are paid by MEMBER shall not use the COMPANY and/or Principal Memberbenefits of his other MediCard coverage (if any) simultaneously with the benefits of this MediCard Health Program Agreement, the MEMBER on a per confinement basis, shall only avail of the benefits accruing from one agreement. The MEMBER must choose which agreement will apply and his/her confinement will be governed by the terms and conditions and the limits of the agreement of his/her choice. The provision is without prejudice to the other benefits availed of by the MEMBER under another agreement which may apply for other confinements. 7. Hospitalization or in-patient coverage of a MEMBER will depend on his/her final diagnosis. All diagnostic procedures will only be covered if results are within inclusions of this Agreement. 8. All MediCard patient-MEMBER MEMBERS are considered to be patients of the MediCard Medical Director handled by his authorized designates. As such, coverage or non-coverage of certain illness not listed herein shall be upon his discretion after proper consultation with the concerned medical accredited physician. 9. For purposes of determining the amount utilized by the MEMBER of his/her “per disease, per year limit,” it shall be understood that any Disease Complication shall share the same limit as the primary disease which caused it, and any amount expended for the treatment of the Disease Complication shall be included in the total amount expended for the said primary disease for the year. Similarly, the exclusion of a primary disease from coverage by MediCard shall cover any Disease Complication that may have been caused by the said excluded primary disease. This provision shall be applicable to all benefits provided by MediCard under this Agreement, especially those provided for under this “Schedule A – Benefit Coverage”. Note that this Section is applicable only for Accounts which limit is MBL.

BENEFITS AND COVERAGES. All the benefits provided for in this Agreement are detailed in “Schedule A – Benefit Coverage”, and subject to the following terms and conditions: 1. In case of Out-Patient, the MEMBER can go directly to the primary physician of any accredited hospital/clinic for out-patient consultation. The primary physician will request for laboratory or diagnostic examinations or refer the MEMBER to a specialist. The MEMBER may avail of services from any accredited hospital/clinic of his/her choice upon issuance by MediCard of the Out-Patient Consultation Form or Laboratory Request Form... 2. For In-Patient services, all limits are inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure. A Letter of Authorization (LOA) together with other necessary documents shall be issued by MediCard prior to confinement. The maximum benefit limit and annual benefit limit shall be inclusive of consultations, diagnostic procedures and hospitalization. Before being discharged from the Hospital, a Member must fill up the prescribed discharge form and settle that portion of the medical bill not covered by the Agreement. That portion of the bill covered by the Agreement shall be settled directly by the HMO with the hospital and/or Attending Physician(s). 3. All procedures or benefits are subject to the limitations on pre-existing conditions as stated in this Agreement. 4. Non-emergency confinement or surgery (elective cases) shall be subject to prior review and approval by the MediCard review board. MediCard reserves the right to direct the MEMBERS MEMBER to other physicians or specialists for further opinions as needed so as to protect the interest of both the MEMBER and MediCard. 5. In all circumstances of Emergency Care Services, MediCard reserves the right to validate whether treatment received is emergency in nature and/or the illness or condition is covered under the provisions of this Agreement. 6. In case a MEMBER is simultaneously covered under more than one corporate or group another health maintenance agreements with MediCard, the ASO Fund in Schedule B for which are paid by MEMBER shall not use the COMPANY and/or Principal Memberbenefits of his other MediCard coverage (if any) simultaneously with the benefits of this MediCard Health Program Agreement, the MEMBER on a per confinement basis, shall only avail of the benefits accruing from one agreement. The MEMBER must choose which agreement will apply and his/her confinement will be governed by the terms and conditions and the limits of the agreement of his/her choice. The provision is without prejudice to the other benefits availed of by the MEMBER under another agreement which may apply for other confinements. 7. Hospitalization or in-patient coverage of a MEMBER will depend on his/her final diagnosis. All diagnostic procedures will only be covered if results are within inclusions of this Agreement. 8. All MediCard patientpatients-MEMBER MEMBER’s are considered to be patients of the MediCard Medical Director handled by his authorized designates. As such, coverage or non-coverage of certain illness not listed herein shall be upon his discretion after proper consultation with the concerned medical accredited physician.

BENEFITS AND COVERAGES. All the benefits provided for in this Agreement are detailed in “Schedule A – Benefit Coverage”, and subject to the following terms and conditions: 1. In case of Out-Patient, the MEMBER can go directly to the primary physician of any accredited hospital/clinic for out-patient consultation. The primary physician will request for laboratory or diagnostic examinations or refer the MEMBER to a specialist. The MEMBER may avail of services from any accredited hospital/clinic of his/her choice upon issuance by MediCard of the Out-Patient Consultation Form or Laboratory Request Form... 2. For In-Patient services, all limits are inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure. A Letter of Authorization (LOA) together with other necessary documents shall be issued by MediCard prior to confinement. The maximum benefit limit and annual benefit limit shall be inclusive of consultations, diagnostic procedures and hospitalization. Before being discharged from the Hospital, a Member must fill up the prescribed discharge form and settle that portion of the medical bill xxxx not covered by the Agreement. That portion of the bill xxxx covered by the Agreement shall be settled directly by the HMO with the hospital and/or Attending Physician(s). 3. All procedures or benefits are subject to the limitations on pre-existing conditions as stated in this Agreement. 4. Non-emergency confinement or surgery (elective cases) shall be subject to prior review and approval by the MediCard review board. MediCard reserves the right to direct the MEMBERS MEMBER to other physicians or specialists for further opinions as needed so as to protect the interest of both the MEMBER and MediCard. 5. In all circumstances of Emergency Care Services, MediCard reserves the right to validate whether treatment received is emergency in nature and/or the illness or condition is covered under the provisions of this Agreement. 6. In case a MEMBER is simultaneously covered under more than one corporate or group another health maintenance agreements with MediCard, the ASO Fund in Schedule B for which are paid by MEMBER shall not use the COMPANY and/or Principal Memberbenefits of his other MediCard coverage (if any) simultaneously with the benefits of this MediCard Health Program Agreement, the MEMBER on a per confinement basis, shall only avail of the benefits accruing from one agreement. The MEMBER must choose which agreement will apply and his/her confinement will be governed by the terms and conditions and the limits of the agreement of his/her choice. The provision is without prejudice to the other benefits availed of by the MEMBER under another agreement which may apply for other confinements. 7. Hospitalization or in-patient coverage of a MEMBER will depend on his/her final diagnosis. All diagnostic procedures will only be covered if results are within inclusions of this Agreement. 8. All MediCard patientpatients-MEMBER MEMBER’s are considered to be patients of the MediCard Medical Director handled by his authorized designates. As such, coverage or non-coverage of certain illness not listed herein shall be upon his discretion after proper consultation with the concerned medical accredited physician.

BENEFITS AND COVERAGES. All the benefits provided for in this Agreement are detailed in “Schedule A – Benefit Coverage”, ,” and subject to the following terms and conditions: 1. In case of Out-Patient, the MEMBER can go directly to the primary physician of any accredited hospital/clinic for out-patient consultation. The primary physician will request for laboratory or diagnostic examinations or refer the MEMBER to a specialist. The MEMBER may avail of services from any accredited hospital/clinic of his/her choice upon issuance by MediCard of the Out-Patient Consultation Form or Laboratory Request Form.. SPECIMEN COPY 2. For In-Patient services, all limits are inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure. A Letter of Authorization (LOA) together with other necessary documents shall be issued by MediCard prior to confinement. The maximum benefit limit and annual benefit limit shall be inclusive of consultations, diagnostic procedures and hospitalization. Before being discharged from the Hospital, a Member must fill up the prescribed discharge form and settle that portion of the medical bill not covered by the Agreement. That portion of the bill covered by the Agreement shall be settled directly by the HMO with the hospital and/or Attending Physician(s). 3. All procedures or benefits are subject to the limitations on pre-existing conditions as stated in this Agreement. 4. Non-emergency confinement or surgery (elective cases) shall be subject to prior review and approval by the MediCard review board. MediCard reserves the right to direct the MEMBERS to other physicians or specialists for further opinions as needed so as to protect the interest of both the MEMBER and MediCard. 5. In all circumstances of Emergency Care Services, MediCard reserves the right to validate whether treatment received is emergency in nature and/or the illness or condition is covered under the provisions of this Agreement. 6. In case a MEMBER is simultaneously covered under more than one corporate or group another health maintenance agreements with MediCard, the ASO Fund in Schedule B for which are paid by MEMBER shall not use the COMPANY and/or Principal Memberbenefits of his other MediCard coverage (if any) simultaneously with the benefits of this MediCard Health Program Agreement, the MEMBER on a per confinement basis, shall only avail of the benefits accruing from one agreement. The MEMBER must choose which agreement will apply and his/her confinement will be governed by the terms and conditions and the limits of the agreement of his/her choice. The provision is without prejudice to the other benefits availed of by the MEMBER under another agreement which may apply for other confinements. 7. Hospitalization or in-patient coverage of a MEMBER will depend on his/her final diagnosis. All diagnostic procedures will only be covered if results are within inclusions of this Agreement. 8. All MediCard patient-MEMBER are considered to be patients of the MediCard Medical Director handled by his authorized designates. As such, coverage or non-coverage of certain illness not listed herein shall be upon his discretion after proper consultation with the concerned medical accredited physician. 9. For purposes of determining the amount utilized by the MEMBER of his/her “per disease, per year limit,” it shall be understood that any Disease Complication shall share the same limit as the primary disease which caused it, and any amount expended for the treatment of the Disease Complication shall be included in the total amount expended for the said primary disease for the year. Similarly, the exclusion of a primary disease from coverage by MediCard shall cover any Disease Complication that may have been caused by the said excluded primary disease. This provision shall be applicable to all benefits provided by MediCard under this Agreement, especially those provided for under this “Schedule A – Benefit Coverage”. Note that this Section is applicable only for Accounts which limit is MBL.

BENEFITS AND COVERAGES. All the benefits provided for in this Agreement are detailed in “Schedule A – Benefit Coverage”, and subject to the following terms and conditions: 1. In case of Out-Patient, the MEMBER can go directly to the primary physician of any accredited hospital/clinic for out-patient consultation. The primary physician will request for laboratory or diagnostic examinations or refer the MEMBER to a specialist. The MEMBER may avail of services from any accredited hospital/clinic of his/her choice upon issuance by MediCard of the Out-Patient Consultation Form or Laboratory Request Form. 2. For In-Patient services, all limits are inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure. A Letter of Authorization (LOA) together with other necessary documents shall be issued by MediCard prior to confinement. The maximum benefit limit and annual benefit limit shall be inclusive of consultations, diagnostic procedures and hospitalization. Before being discharged from the Hospital, a Member must fill up the prescribed discharge form and settle that portion of the medical bill not covered by the Agreement. That portion of the bill covered by the Agreement shall be settled directly by the HMO with the hospital and/or Attending Physician(s). 3. All procedures or benefits are subject to the limitations on pre-existing conditions as stated in this Agreement. 4. Non-emergency confinement or surgery (elective cases) shall be subject to prior review and approval by the MediCard review board. MediCard reserves the right to direct the MEMBERS to other physicians or specialists for further opinions as needed so as to protect the interest of both the MEMBER and MediCard. 5. In all circumstances of Emergency Care Services, MediCard reserves the right to validate whether treatment received is emergency in nature and/or the illness or condition is covered under the provisions of this Agreement. 6. In case a MEMBER is simultaneously covered under more than one corporate or group another health maintenance agreements with MediCard, the ASO Fund in Schedule B for which are paid by MEMBER shall not use the COMPANY and/or Principal Memberbenefits of his other MediCard coverage (if any) simultaneously with the benefits of this MediCard Health Program Agreement, the MEMBER on a per confinement basis, shall only avail of the benefits accruing from one agreement. The MEMBER must choose which agreement will apply and his/her confinement will be governed by the terms and conditions and the limits of the agreement of his/her choice. The provision is without prejudice to the other benefits availed of by the MEMBER under another agreement which may apply for other confinements. 7. Hospitalization or in-patient coverage of a MEMBER will depend on his/her final diagnosis. All diagnostic procedures will only be covered if results are within inclusions of this Agreement. 8. All MediCard patient-MEMBER MEMBERS are considered to be patients of the MediCard Medical Director handled by his authorized designates. As such, coverage or non-coverage of certain illness not listed herein shall be upon his discretion after proper consultation with the concerned medical accredited physician. 9. For purposes of determining the amount utilized by the MEMBER of his/her “per disease, per year limit,” it shall be understood that any Disease Complication shall share the same limit as the primary disease which caused it, and any amount ex pended for the treatment of the Disease Complication shall be included in the total amount expended for the said primary disease for the year. Similarly, the exclusion of a primary disease from coverage by MediCard shall cover any Disease Complication that may have been caused by the said excluded primary disease. This provision shall be applicable to all benefits provided by MediCard under this Agreement, especially those provided for under this “Schedule A – Benefit Coverage”. Note that this Section is applicable only for Accounts which limit is MBL.

BENEFITS AND COVERAGES. All the benefits provided for in this Agreement are detailed in “Schedule A – Benefit Coverage”, and subject to the following terms and conditions: 1. In case of Out-Patient, the MEMBER can go directly to the primary physician of any accredited hospital/clinic for out-patient consultation. The primary physician will request for laboratory or diagnostic examinations or refer the MEMBER to a specialist. The MEMBER may avail of services from any accredited hospital/clinic of his/her choice upon issuance by MediCard of the Out-Patient Consultation Form or Laboratory Request Form.. SPECIMEN COPY 2. For In-Patient services, all limits are inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure. A Letter of Authorization (LOA) together with other necessary documents shall be issued by MediCard prior to confinement. The maximum benefit limit and annual benefit limit shall be inclusive of consultations, diagnostic procedures and hospitalization. Before being discharged from the Hospital, a Member must fill up the prescribed discharge form and settle that portion of the medical bill not covered by the Agreement. That portion of the bill covered by the Agreement shall be settled directly by the HMO with the hospital and/or Attending Physician(s). 3. All procedures or benefits are subject to the limitations on pre-existing conditions as stated in this Agreement. 4. Non-emergency confinement or surgery (elective cases) shall be subject to prior review and approval by the MediCard review board. MediCard reserves the right to direct the MEMBERS to other physicians or specialists for further opinions as needed so as to protect the interest of both the MEMBER and MediCard. 5. In all circumstances of Emergency Care Services, MediCard reserves the right to validate whether treatment received is emergency in nature and/or the illness or condition is covered under the provisions of this Agreement. 6. In case a MEMBER is simultaneously covered under more than one corporate or group another health maintenance agreements with MediCard, the ASO Fund in Schedule B for which are paid by MEMBER shall not use the COMPANY and/or Principal Memberbenefits of his other MediCard coverage (if any) simultaneously with the benefits of this MediCard Health Program Agreement, the MEMBER on a per confinement basis, shall only avail of the benefits accruing from one agreement. The MEMBER must choose which agreement will apply and his/her confinement will be governed by the terms and conditions and the limits of the agreement of his/her choice. The provision is without prejudice to the other benefits availed of by the MEMBER under another agreement which may apply for other confinements. 7. Hospitalization or in-patient coverage of a MEMBER will depend on his/her final diagnosis. All diagnostic procedures will only be covered if results are within inclusions of this Agreement. 8. All MediCard patient-MEMBER are considered to be patients of the MediCard Medical Director handled by his authorized designates. As such, coverage or non-coverage of certain illness not listed herein shall be upon his discretion after proper consultation with the concerned medical accredited physician. 9. For purposes of determining the amount utilized by the MEMBER of his/her “per disease, per year limit,” it shall be understood that any Disease Complication shall share the same limit as the primary disease which caused it, and any amount expended for the treatment of the Disease Complication shall be included in the total amount expended for the said primary disease for the year. Similarly, the exclusion of a primary disease from coverage by MediCard shall cover any Disease Complication that may have been caused by the said excluded primary disease. This provision shall be applicable to all benefits provided by MediCard under this Agreement, especially those provided for under this “Schedule A – Benefit Coverage”. Note that this Section is applicable only for Accounts which limit is MBL.

BENEFITS AND COVERAGES. All the benefits provided for in this Agreement are detailed in “Schedule A – Benefit Coverage”, and subject to the following terms and conditions: 1. In case of Out-Patient, the MEMBER can go directly to the primary physician of any accredited hospital/clinic for out-patient consultation. The primary physician will request for laboratory or diagnostic examinations or refer the MEMBER to a specialist. The MEMBER may avail of services from any accredited hospital/clinic of his/her choice upon issuance by MediCard of the Out-Patient Consultation Form or Laboratory Request Form. 2. For In-Patient services, all limits are inclusive of room and board, operating room charges, professional fees and other incidental expenses relative to the procedure. A Letter of Authorization (LOA) together with other necessary documents shall be issued by MediCard prior to confinement. The maximum benefit limit and annual benefit limit shall be inclusive of consultations, diagnostic procedures and hospitalization. Before being discharged from the Hospital, a Member must fill up the prescribed discharge form and settle that portion of the medical bill not covered by the Agreement. That portion of the bill covered by the Agreement shall be settled directly by the HMO with the hospital and/or Attending Physician(s). 3. All procedures or benefits are subject to the limitations on pre-existing conditions as stated in this Agreement. 4. Non-emergency confinement or surgery (elective cases) shall be subject to prior review and approval by the MediCard review board. MediCard reserves the right to direct the MEMBERS MEMBER to other physicians or specialists for further opinions as needed so as to protect the interest of both the MEMBER and MediCard. 5. In all circumstances of Emergency Care Services, MediCard reserves the right to validate whether treatment received is emergency in nature and/or the illness or condition is covered under the provisions of this Agreement. 6. In case a MEMBER is simultaneously covered under more than one corporate or group another health maintenance agreements with MediCard, the ASO Fund in Schedule B for which are paid by MEMBER shall not use the COMPANY and/or Principal Memberbenefits of his other MediCard coverage (if any) simultaneously with the benefits of this MediCard Health Program Agreement, the MEMBER on a per confinement basis, shall only avail of the benefits accruing from one agreement. The MEMBER must choose which agreement will apply and his/her confinement will be governed by the terms and conditions and the limits of the agreement of his/her choice. The provision is without prejudice to the other benefits availed of by the MEMBER under another agreement which may apply for other confinements. 7. Hospitalization or in-patient coverage of a MEMBER will depend on his/her final diagnosis. All diagnostic procedures will only be covered if results are within inclusions of this Agreement. 8. All MediCard patientpatients-MEMBER MEMBERS are considered to be patients of the MediCard Medical Director handled by his authorized designates. As such, coverage or non-coverage of certain illness not listed herein shall be upon his discretion after proper consultation with the concerned medical accredited physician.