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Philamcare Small Group Underwriting Guidelines

 

1. Eligible Groups

   Employer-employee groups of standard occupational risk.

2. Eligible enrollees

   Employee

   • Regular, full-time, actively at work enrollees, 18-59 years old

   Married Employees

   • Dependent Spouse - 59 years old and below and still performing the normal daily activities.

   • Dependent child - 6 months old to 20 years old and must be single and unemployed.

   Single Employees

   • Dependent Parent - 59 years old and below and still performing the normal daily activities.

   • Dependent Siblings - 6 months old to 20 years old and must be single and unemployed.

3. Number of Members

   • Minimum of 5 employees, maximum of 19 employees

4. Participation Requirements

   • One hundred percent (100%) of eligible enrollees for both contributory and non-contributory groups.

   • For contributory groups, the minimum  contribution rate from the Employer is fifty percent (50%).

   • One hundred percent (100%) of employees with eligible dependents, must enroll one hundred percent (100%) of their eligible dependents.

5. Payment Modes

   • Annual, Semi-annual, Quarterly, and Monthly modes

6. Others

   • All enrollees shall fill-up a medical questionnaire, enrollees 51 years old and above will undergo medical examination.

   • All members of the same class should enroll under the same plan.

Pre-existing illnesses, whether known or unknown, disclosed or not, are excluded during the first year of coverage. After 12 months of continuous coverage, the Pre-existing Condition Clause will not apply anymore to illnesses or conditions which only started to develop on the second year of coverage and onwards, except for conditions or illnesses which have been permanently excluded during the first year of coverage.

 

The final interpretation of any specific provision or its applicability is subject to the provisions of the Agreement issued by PhilamCare Health Systems, Inc. and the Master Policy issued by The Philippine American Life and General Insurance Company.

 

Payment of membership fees does not mean approval of the coverage. Application are subject for evaluation and approval.

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