Premier Brochure 2013-07(July) P2015!03!4p

7/25/2019 Premier Brochure 2013-07(July) P2015!03!4p

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For your healthcare needs, you trust only a professional.For your medical insurance, trust Pacic Cross.

We make sure professional also means personal.

PremierA medical insurance plan for Senior Citizens


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A plan especially designed for senior cizens

Premier breaks new ground by oering the only medical insurance plan especially

designed for those over 65 years of age. A plan that understands your connuing need

for protecon, this innovave product from Pacic Cross can take care of you and your

loved ones, even in old age.

Swi reimbursement of medical expenses based on your coverage

When you choose Premier, you are assured of swi reimbursement of eligible medical

charges.

Your own choice of doctor, hospital and specialist

For the best medical care, Premier oers you complete freedom of choice: your own

doctor, hospital, or specialist.

Comprehensive range of medical insurance benets

With a maximum coverage limit of up to Php1,500,000, you get the most comprehensive

range of medical insurance benets available in the Philippines.

Emergency overseas coverage

Premier also covers you for emergencies and accidents when you travel, so you can

receive the best medical assistance anyme, anywhere in the world.

24-Hour worldwide customer assistance and emergency hotline

Pacic Cross, with its emergency assistance partner, has a worldwide network of alarm

centers and full me medical professionals ready to help you 24 hours a day, seven days

a week, 365 days a year.

Premier

Some things all applicants should know:

Pacic Cross understands your need to ensure that you and your loved ones are secured and protected, even in your lateryears. In order to help you better deal with lifes physical and nancial uncertainties, we offer you our Premier Product.

As with all insurance, there are some important points you should know before entering into a contract. In this secon, we

idenfy some key Policy provisions.

1. Your coverage begins thirty (30) days aer the date shown on your Policy. However, you already have immediate coverage

for accidental injury.

2. A pre-exisng condion is a disability or illness which existed before the commencement of cover. The existence of a pre-

exisng condion can be clinically determined given its natural history, irrespecve of whether or not the insured is aware

of the illness or condion. Providing cover for a pre-exisng condion is subject to evaluaon by our Medical Director, and

if it is excluded from cover we will nofy the insured accordingly.

3. While your Policy is issued in the Philippines, it can provide Emergency Coverage when you are overseas. However, please

note that the maximum period of cover is for 90 days only of accumulated stay or travel abroad during the Policy year, with

each trip not exceeding 30 days.

4. Certain condions are permanently excluded from being covered. These condions include:

Congenital condions, birth defect and abnormalies

Arcial implants, durable medical equipment, gras, prosthec devices and correcve devices other than arcial limbs

Cosmec surgery or related complicaons, contact lenses, hearing aids and prescripons thereof, except those that may

be required for reconstrucve surgery

Suicide, aempted suicide or intenonal self-inicted injury

Pre-exisng condions unless such have been declared and approved by the Company

Acquired Immune Deciency Syndrome (AIDS), Aids Related Complex (ARC), and Sexually Transmied Diseases (STDs)

Osteoporosis/Benign Prostac Hypertrophy (for age 50 and above)

5. Your contract is guaranteed renewable up to age 100. However, we reserve the right to adjust your premium and otherPolicy condions upon wrien advice 45 days prior to each renewal.

6. For full details, please refer to the Policy.

What else would you like to know? Contact us at (632) 899-8001 or e-mail [email protected].


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CORE BENEFITS (In-Patient & Emergency) REIMBURSEMENT: Your own choice of doctor and/or hospital. 10% CO-PAYMENT: means that Pacic Cross will pay 90% of the approved claim amount.

Maximum Coverage for each disability for the life of the insuredBASIC HOSPITAL BENEFITS

Room and Board including general nursing care for a maximum of 45 days per disability, per yearfor emergency connement abroad. Unlimited number of days for connement in the Philippines.

Miscellaneous Hospital Expensesfor required diagnosc laboratory tests; prescribed medicines; physiotherapies; bloodand components; anaesthesia; and surgical appliancesPhysicians Visit (non-surgical)

limit of 45 days per disability per year for emergency connement abroad. Unlimitednumber of days for connement in the Philippines. Daily visit fee to a limit ofSpecialists Fee for 10 days for each disability per year to a daily limit ofPrivate Duty Nurse

at home only when cered necessary by aending physician to a maximum of 5 days,immediately aer hospitalizaon. Daily visit fee to a limit ofProcedure done on an Out-Paent Basis

for selected procedures as approved by Pacic CrossCRITICAL CARE BENEFITS

Intensive Care Unit, Coronary Care Unit & Telemetry max 10 days per disability, per yearSURGICAL BENEFITS

Operang Theater & Recovery Room

Surgeons Fee

for each disability based on the Basic Surgical Schedule (BSS). The BSS is an index set byPacic Cross that assigns a weight for each surgical service in order to calculate the maximumamount payable for the surgical procedure. In eect, this means that the payment you receivefrom us may be less than the professional fee charged by the surgeon. A copy of the BSS isavailable upon request from our Customer Service Department.Anaesthests Fee not to exceed 35% of the approved Surgeons FeeArcial Limb

including rental of mechanical devices (as approved by Pacic Cross) excluding implantable devicesEMERGENCY BENEFITS

Emergency Out-Paentfor treatment of emergency cases/condions not leading to connement provided bythe out-paent department of a hospital or a licensed doctor in his clinic for a covereddisability. Maximum limit per disability, per year.Emergency Dental Services due to a covered accidentEmergency Local Ambulance Service

from place of occurrence to the nearest hospital facility or from hospital to hospitalusing land transportaon service.(If local land transportaon facility is not available, other transportaon facilies are allowed subject to the

approval of Pacic Cross. Maximum limit per disability, per year is P15,000.)

Emergency Overseas Connement Coverage

worldwide cover is included for 90 days only of accumulated stay (no more than 30 days pertrip) or travel overseas during the Policy year. Reimbursement of medical expenses for overseas

treatment of connement will be based on currently applicable Philippine medical rates.Worldwide Emergency Assistance ServicesPacic Cross, through our emergency assistance partner, will provide the assistance andadvice (24 hours a day, 7 days a week) for free but the client will be responsible for anythird party charges incurred as a result of such advice or assistance unless otherwisespecied elsewhere in the Policy. Insured Person must be traveling 100 miles (or 150kilometers) or more from his primary and legal address or in another country which is nothis Country of Residence for less than 91 days unless otherwise endorsed in the Policy.Services* include but not limited to the following:

Emergency Medical Evacuaon: Evacuaon under appropriate medical supervisionto the nearest medical facility

Medical Repatriaon: Repatriaon under medical supervision to the Insured Personslegal residence or to a medical or rehabilitaon facility near the Insured Persons residence

Return of Mortal Remains: The return of mortal remains will be arranged and paid for. Compassionate Visit: When an Insured Person is traveling alone and will be hospitalized

for more than 7 consecuve days, an economy, round-trip, common carrier transportaonwill be provided to a family member or a friend to accompany the Insured Person.

Care of Minor Child(ren): One-way economy common carrier transportaon will beprovided to the place of residence of minor child(ren) when they are le unaendedas a result of medical emergency or death of an Insured Person.

WARD

P 500,000

As Charged

As Charged

P 900

P 900P 600

As Charged

As ChargedP 60,000

P 21,000As Charged

P 5,000

As ChargedAs Charged

Included

SEMI-PRIVATE

P 750,000

As Charged

As Charged

P 1,200

P 1,200P 900

As Charged

As ChargedP 90,000

P 31,500As Charged

P 6,000


Included

PRIVATE

P 1,500,000

As Charged

As Charged

P 2,400

P 2,400P 1,800

As Charged

As ChargedP 180,000

P 63,000As Charged

P 7,000


Included

Subject to the limits of Basic Hospital Benets


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he Name we live by...T Pacic Cross is EXCELLENCE. We are commied to bringing nothing but the best to ourclients. Our decisions are based on an intricate understanding

of our clients needs, demands and expectaons. We strive

to create and innovate programs that will best serve our

customers.

Pacic Cross is STABILITY.

We are one of the leading and most nancially stable

companies in the industry today. Our Premiums Earned in

recent years put us in the top 20 non-life insurance companies

in the Philippines.

Pacic Cross is EXPERIENCE.

We draw from more than sixty years of experience in the

insurance industry. Our acons are guided by a deep insight

brought about by the knowledge we have gained through the

years.

ANNUAL PREMIUMSCORE BENEFITS (In-Paent & Emergency)

1. Premiums are inclusive of all applicable taxes.

2. Premiums are available in annual and semi-annual modes of payment.

3. Premiums may change subject to the results of medical evaluaon of

applicaon form.

NO. OF MEMBERS* DISCOUNT

7 - 15

16 or more

5 %

10 %

Group Discounts apply only to New Business and to the premiums of Core Benets.

* Members mean Principal and eligible Dependents.

* Members must be under one Policyonly.

GROUP DISCOUNT

H E A D O F F I C E

Pacic Cross Center, 8000 Maka Avenue, 1200 Maka City,Metro Manila, Philippines

Tel. No.: +63 2 899-8001 Fax No.: +63 2 325-0635Email: [email protected] Website: www.Paciccross.comph

S U B I C

Suite 64, West Gate Bldg., Sampson Road,Subic Bay Freeport Zone, Zambales

Tel. No.: +63 47 250-0197 Telefax: +63 47 250-0199Email: [email protected]

C E B U

Unit 202, Avagar Building, No. 09, Escario corner Molave Street,Lahug, Cebu City

Tel. Nos.: +63 32 233-5812; +63 32 233-5816; +63 32 416-4468Fax No.: +63 32 233-5814 Email: [email protected]

D A V A O

2ndFloor, Le Wing, Door No. 6, Mana Town Square,Mac Arthur Highway, Mana, Davao City

Tel. No.: +63 82 297-7314 Telefax: +63 82 297- 7151Email: [email protected]

V03.15_CebAd (P07.15_NR)

P 50,000combined limit

WARD

Not Available


SEMI-PRIVATE

Not Available


PRIVATE

P100 (per day)

Notes:

WARD S-PRIVATE PRIVATE

66

67

68

6970

71

72

73

74

75

76 - 80

81 - 85

86 - 100

P 25,487

26,904

28,320

29,73630,585

32,271

33,324

35,077

36,831

38,585

47,295

78,727

128,879

P 41,245

43,537

45,828

48,11949,494

51,314

52,987

55,776

58,565

61,354

76,580

127,736

208,469

P 69,299

73,148

76,998

80,84883,158

87,045

89,883

94,614

99,345

104,075

128,629

214,500

350,679

AGE

As of 1 July 2013

WARD SEMI-PRIVATE PRIVATE

As Charged and on top of the Maximum Coverage Limit*Availment of services through our designated assistance provider, limit per year of*Availment of servicesnotthrough our designated assistance provider, limit per year of

The actual cost will be paid via reimbursement by the Company subject to the limits speciedwhich will form part of the Maximum Coverage Limit of the plan provided that such assistance isa result of a covered illness, accidental injury or death occurring during the Period of Insurance. VALUE ADDED BENEFITS

Elecve Surgery

scheduled surgery arranged by Pacic Cross within accredited network only. Directselement of covered poron of connement and treatment cost by Pacic Cross (10-day noce must be given to Pacic Cross by the client).Companion Allowance

allowance given to companion (maximum of 5 days per given Policy year).

EMERGENCY BENEFITS

Direct Selement of covered poron of connement& treatment cost by Pacic Cross

The Documentary Stamp Tax (DST) should be deducted from the Core Benets

Premium before applying any discount and/or loading (i.e., addional premium).

The DST should be added back aer all discounts and loadings have been applied.

The DST amounts are as follows: P25 (Ward), P50 (S-Private), P100 (Private).

Documents

Premier Brochure 2013-07(July) P2015!03!4p