Select 2015-01 (Jan) Lowres

7/25/2019 Select 2015-01 (Jan) Lowres

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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.

Select Medical PlansComprehensive medical protection for you and your family


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Swi reimbursement of medical expenses based on your coverage When you choose Select, you are assured of swi reimbursement of eligible

medical charges! Select provides a maximum coverage limit of up to Php3,000,000.

Your own choice of doctor, hospital and specialist

Select oers you complete freedom of choice. This means you can avail of the

best medical treatment with your own choice of doctor, hospital or specialist.

Comprehensive range of medical insurance benets

Select oers a comprehensive range of in-paent and out-paent medical benets,

all designed to provide you the nancial security and assistance you need in mes

of illness.

Emergency overseas coverage

Select 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.

Coverage exibility

You can opt to use our accredited network and avail of no-cash-outlay in-paent

and emergency out-paent medical treatment through our ACCESSfacility.

Select Plus &

SelectStandard

Some things all applicants should know:

Medical costs are one of the most pressing concerns in todays times. When your familys health is at stake, we knowyou need a no-nonsense medical plan that will give you the best care possible. We offer you value-packed medical plansespecially designed to give you superior medical coverage:

With an aggregate limitper yearof up to Php3,000,000 and stillwith your own choice of medical provider, this plan provides addedand superior protection.

Allows you to choose your own hospital and doctor and reimbursemedical benefts up to Php3,000,000 for each disability perlifetime.

Select StandardSelect Plus

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, pleasenote 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 due to or as a result of an accident

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)

All contracepve methods of birth control; or screening and/or treatment pertaining to inferlity

Pregnancy related expenses and screening, childbirth (including surgical delivery); miscarriage and aboron, including

their complicaons; pre-natal or post-natal care as well as nursing care for the newborn

5. Your contract is guaranteed renewable up to age 65. However, we reserve the right to adjust your premium and other Policy

condions upon wrien advice 45 days prior to each renewal.

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

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.


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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-PRIVATEP 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

PRIVATEP 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

SUITEP 3,000,000

P 6,000 (per day)

As Charged

P 4,200

P 4,200As Charged

As Charged

As ChargedP 360,000

P 126,000As Charged

As Charged


Included

Maximum CoverageBASIC HOSPITAL BENEFITSRoom and Board including general nursing care for a maximum of 45 daysper disability, per year for emergency connement abroad. Unlimitednumber of days for connement in the Philippines.

Miscellaneous Hospital Expensesfor required diagnostic laboratory tests; prescribed medicines;physiotherapies; blood and components; anaesthesia; and surgicalappliancesPhysicians Visit (non-surgical)limit of 45 days per disability per year for emergency connementabroad. Unlimited number 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 Nurseat home only when cered necessary by aending physician to amaximum of 5 days, immediately aer hospitalizaon. Daily visit feeto a limit ofProcedure Done on an Out-Paent Basisfor selected procedures as approved by Pacic Cross

CRITICAL CARE BENEFITSIntensive Care Unit, Coronary Care Unit & Telemetrymaximum of 10 days per disability, per yearSURGICAL BENEFITSOperang Theater & Recovery RoomSurgeons Fee

Select Standard: for each disability based on the Basic SurgicalSchedule (BSS). The BSS is an index set by Pacic Cross thatassigns a weight for each surgical service in order to calculate themaximum amount payable for the surgical procedure. In eect,this means that the payment you receive from us may be less thanthe professional fee charged by the surgeon. A copy of the BSS isavailable upon request from our Customer Service Department.

Select Plus: per disability, per year limit of

Anaesthests Fee not to exceed 35% of the approved Surgeons FeeArcial Limb including rental of mechanical devices (as approved byPacic Cross) excluding implantable devicesEMERGENCY BENEFITSEmergency Out-Paentfor treatment of emergency cases/condions not leading to connementprovided by the out-paent department of a hospital or a licensed doctorin his clinic for a covered disability. Maximum limit per disability, per year.Emergency Dental Services due to a covered accidentEmergency Local Ambulance Servicefrom place of occurrence to the nearest hospital facility or from hospitalto hospital using land transportaon service.(If local land transportaon facility is not available, other transportaon

facilies are allowed subject to the approval of Pacic Cross. Maximumlimit per disability, per year is P15,000.)

Emergency Overseas Connement Coverageworldwide cover is included for 90 days only of accumulated stay(no more than 30 days per trip) or travel overseas during the Policyyear. Reimbursement of medical expenses for overseas treatment ofconnement will be based on currently applicable Philippine medicalrates.Worldwide Emergency Assistance ServicesPacic Cross, through our emergency assistance partner, will provide theassistance and advice (24 hours a day, 7 days a week) for free but theclient will be responsible for any third party charges incurred as a resultof such advice or assistance unless otherwise specied elsewhere in thePolicy. Insured Person must be traveling 100 miles (or 150 kilometers)or more from his primary and legal address or in another country whichis not his Country of Residence for less than 91 days unless otherwiseendorsed in the Policy.

Services* include but not limited to the following: Emergency Medical Evacuaon: Evacuaon under appropriate

medical supervision to the nearest medical facility Medical Repatriaon: Repatriaon under medical supervision to

the Insured Persons legal residence or to a medical or rehabilitaonfacility near the Insured Persons residence

Return of Mortal Remains: The return of mortal remains will bearranged and paid for.

Select Plusand Select Standardprovide the same benet limits but at dierent maximum coverage levels. Under these plans,you can choose your own doctor and hospital. Claims will be paid via reimbursement of all eligible expenses based on coverage.All benets shown in the table below are applicable for each disability per year, unless indicated otherwise.

CORE BENEFITS (In-Patient & Emergency)

Subject to the limits of the Basic Hospital Benets


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OPTIONAL BENEFITS

WARD SEMI-PRIVATE PRIVATE SUITE

P 50,000combined limit

Not Available

Included

Included

P 50,000


P 100 (per day)

Included

Included

P 75,000


P 200 (per day)

Included

Included

P 100,000

STANDARD

P 500 (per visit)

P 400 (per visit)

P 7,500 (limit per year)

P 6,000 (per year)

EXECUTIVE

P 900 (per visit)

P 800 (per visit)

P 15,000 (limit per year)

P 12,000 (per year)

OUTPATIENT BENEFITS

Pacic Cross pays 80% of eligible claimed amount for reasonable, normal and customary fees.

Reimbursement only.

Consultaon in Doctors Oce covers Physicians and Specialists fee, maximum of 20 visits per year

Physiotherapist or Chiropractor maximum of 10 treatments per year, limit of one per day

Medicines and Drugs prescribed by a Doctor for a covered condion or disability and procured from a

recognized pharmacy

Diagnosc, X-rays and Laboratory Tests necessary for the treatment of a covered disability

Direct Selement of covered poron of connement & treatment cost

by Pacic Cross.

Enhance your coverage!Add theACCESSfacility to your Select Plus & Select Standard Plan. Available under Semi-Privateand Private,

and sharing the same inner benet limits as those of Select Plus and Select Standard, ACCESS allows you to avail of no-cash-outlay in-

paent and emergency out-paent medical treatment using our accredited network of hospitals. However, in the event that you choose

not to go to an accredited medical provider, you sll retain the opon of ling your eligible claims for reimbursement with Pacic Cross.

Payment of Professional Fees (Aending Physicians Visit, Specialists Fee, Surgeons Fee, Anaesthests Fee) will be based on the Companys

Philhealth Relave Value Scale if claims are directly seled by the Company to the Physician or Hospital. The Philhealth Relave Value Scale

shows the values per procedure as provided by the Philhealth that the Company will apply for the payment of a parcular Professional fee in

an Accredited Network.

COVERAGE ENHANCEMENT

As Charged and on top of the Maximum Coverage Limit

Compassionate Visit: When an Insured Person is traveling aloneand will be hospitalized for more than 7 consecuve days, aneconomy, round- trip, common carrier transportation will beprovided to a family member or a friend to accompany the InsuredPerson.

Care of Minor Child(ren): One-way economy common carriertransportaon will be provided to the place of residence of minorchild(ren) when they are le unaended as a result of medicalemergency or death of an Insured Person.

* Availment of services through our designated assistance provider,

limit per year of* Availment of servicesnotthrough our designated assistance provider,limit per year ofThe actual cost will be paid via reimbursement by the Companysubject to the limits specied which will form part of the MaximumCoverage Limit of the plan provided that such assistance is a resultof a covered illness, accidental injury or death occurring during thePeriod of Insurance.

VALUE ADDED BENEFITSElecve Surgeryscheduled surgery arranged by Pacic Cross within accredited network only.Direct selement of covered poron of connement and treatment cost byPacic Cross (10-days noce must be given to Pacic Cross by the Client).Companion Allowanceallowance given to companion (maximum of 5 days per given Policy year)

Sports Coveragefor recreaonal sports including skiing & scuba; excluding contact sports(subject to Policy limits)Free Child Coveragefree coverage for infant from 15 days old up to Policy renewal (for a newbornof a female insured)PERSONAL ACCIDENT BENEFITcoverage for accidental death. Covers new business clients age 16 to60, renewable unl age 65


Not Available

Included

Included

P 25,000

BENEFITS

Over-all Limit per year (excluding dentures)

X-rays (required prior to the performance of

dental service. Limit per year.)

Amalgam Fillings (per surface)

i) Pre-Molar

ii) Molar

iii) Cusp Restoraon

iv) Amalgam Cores

v) Amalgam Pins

Anterior Filling (per surface)

i) Composite

ii) Acid Etch

LIMIT

P 9,000

450

300

350

600

500

100

500

500

BENEFITS

Root Canal Fillings (per tooth)

Extracons (per tooth)

i) Simple

ii) Surgical: Impacted Wisdom Teeth

iii) Apicoectomy

Dentures (as a result of accident only)i) Complete Set

ii) Paral Sets

Roune Oral Examinaon

(not to exceed 2 per year)

Oral Prophylaxis

(not to exceed 2 per year)

LIMIT

P 1,500

300

1,500

1,500

4,000

7,000

200

400

Pacic Cross pays 80% of eligible claimed amount for reasonable, normal and customary fees. Reimbursement only.

DENTAL PLAN

EMERGENCY BENEFITS


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ANNUAL PREMIUMSCORE BENEFITS (In-Paent & Emergency)

As of 1 July 2013

ANNUAL PHYSICAL EXAMINATION (To be done in accredited Pacic Cross clinics or laboratories with prior appointment)

Includes: Taking of medical history Comprehensive physical examinaon

Complete blood count

Chest x-ray

Notes: 1. Issue age is up to 65 years old.2. Available only for Group Accounts with at least 4 employees, or Families with at least 4 members (all members should enroll).

3. Premium quotaons are available upon request from our Account Execuves.

Stool analysis

Urinalysis

Pap smear for female clients 35 years old and above

Electrocardiogram (ECG) for clients 40 years old and above

Pacic Cross pays 80% of reasonable, normal and customary fees. Reimbursement only.

Premiums are applicable to:(1) Individual policies, or Families with less than 4 members*, or Groups with

less than 4 employees(2) Group Accounts with at least 4 employees, or Families with at least 4

members* (all members should enroll)* Members mean Principal and eligible Dependents.

Coverage for death, dismemberment and total and permanent disablementcaused directly and solely by accident. Occupaonal Class I (Standard Risk).Premiums of other occupaonal classicaons are available upon request.

OPTIONAL BENEFITS (Available for all Select Plans)

Out-PaentSTANDARD EXECUTIVE

Child - 20

21 - 40

41 - 5051 - 65

P 5,733

5,385

7,8249,773

P 11,835

11,442

18,59224,209

AGE

Dental PlanINDIVIDUAL (1) GROUP (2)

Adult (19 - 65 yrs old)

Child (15 days - 18 yrs old)

P 3,808

P 2,770

P 2,232

P 1,623

PREMIUMS (Per Annum)

Addional Personal Accident CoverageWARD S-PRIVATE PRIVATE SUITE

P 500,000

P 1,000,000

P 835

P 1,670

P 835

P 1,670

P 835

P 1,670

P 835

P 1,670

Notes: 1. Premiums are inclusive of all applicable taxes.2. Premiums are available in annual and semi-annual

modes of payment (except for Personal Accident &Annual Physical Exam).

3. Premiums may change subject to the results of medicalevaluaon of applicaon form.

Pacic Cross pays 80% of claimed amount (80/20 co-payment opon).Applied to the premiums of Core Benets only.

Co-Payment(Available for Select Plus & Select Standard Plans only)

WARD S-PRIVATE PRIVATE SUITE

25%

Discount

25%

Discount

25%

Discount

25%

Discount

Group Discount(Available for all Select Plans)

NO. OF MEMBERS* DISCOUNT

7 - 15

16 or more

5 %

10 %

Group Discounts apply to New Business only. Applied to the premiumsof Core Benets & Oponal Out-Paent Benets only.

* Members mean Principal and eligible Dependents.

* Members must be under one Policyonly.

ACCESS premiums are subject to PhP250 Annual Access Fee per member.

Select PlusWARD S-PRIVATE PRIVATE SUITE

0 - 20

21 - 25

26 - 30

31 - 35

36 - 40

41 - 45

46 - 50

51 - 55

56 - 6061 - 65

P 4,568

7,396

8,053

8,382

9,039

10,192

11,493

12,462

13,54514,900

P 7,365

12,408

13,511

14,063

15,166

17,833

20,109

21,817

23,71426,086

P 12,051

20,198

21,993

22,891

24,687

29,767

35,733

41,382

45,98150,579

P 25,129

33,364

36,330

37,813

40,778

48,169

54,318

58,800

63,91370,305

AGE

Select StandardWARD S-PRIVATE PRIVATE SUITE

0 - 20

21 - 25

26 - 30

31 - 35

36 - 40

41 - 45

46 - 50

51 - 55

56 - 6061 - 65

P 3,843

6,051

6,588

6,858

7,395

8,289

9,346

10,465

11,37412,512

P 6,098

9,937

10,923

11,476

12,377

14,316

16,143

18,646

20,07721,877

P 10,428

16,982

18,668

19,612

21,151

24,363

28,070

30,571

33,96837,365

P 17,717

24,912

27,127

28,233

30,448

35,246

39,746

43,540

47,32652,059

AGE

The Documentary Stamp Tax (DST) should be deducted from the Core Benets Premium before applyingany 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 and Suite). For Select Plus and Select Standard only.

Select Plus with ACCESSS-PRIVATE PRIVATE

0 - 20

21 - 25

26 - 30

31 - 35

36 - 40

41 - 4546 - 50

51 - 55

56 - 60

61 - 65

P 9,757

16,439

17,899

18,630

20,092

23,62526,390

29,973

32,579

35,838

P 15,965

26,753

29,130

30,320

32,698

39,79547,330

56,809

61,847

68,032

AGE

Select Standard with ACCESSS-PRIVATE PRIVATE

0 - 20

21 - 25

26 - 30

31 - 35

36 - 40

41 - 4546 - 50

51 - 55

56 - 60

61 - 65

P 8,079

13,415

14,607

15,203

16,396

18,96521,185

25,058

27,843

30,627

P 13,815

22,926

24,964

25,982

28,020

31,57437,187

42,000

46,200

50,819

AGE

DISCOUNTS


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Pacic Cross is EXCELLENCE.

We are commied to bringing nothing but the best to our

clients. 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 companiesin 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.

Pacic Cross is CUSTOMER SERVICE.

We are rooted in a commitment to ever improving

customer service. We aim to be connuously progressive and

professional. Our commendable track record and competentsupport sta ensure that you are given immediate and excellent

service at all mes.

Pacic Cross is a PARTNERSHIP OF TRUST.

We build and value enduring relaonships. We consistently

prove that we are worthy of the highest condence---by our

strict standards, the integrity of our promises and the results

we deliver. In the event of a crisis, we assure you that Pacic

Cross will be your friend and ally.

he Name we live by...

T

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 2 325-0638

Email: [email protected]

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 47 250-0199


C E B U

Unit 202, Avagar Bldg., No. 9, Molave Street,

Lahug, Cebu City

Tel. Nos.: +63 32 233-5812; +63 32 233-5816; +63 32 416-4468

Fax 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 82 297-7151


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Select 2015-01 (Jan) Lowres