MediCard Individual/Family Online Membership

Welcome to the MediCard Online Membership Application, kindly select type of application below.

Type of Application

New Applicant

Renewal

Last Name(Required)

First Name(Required)

Middle Initial :(Required)

Middle Initial

mi

Not Applicable

Email Address(Required)

Mobile Number(Required)

Member ID(Required)

VIP Plan(Required)

Regular Private (200K Coverage per illness)

Regular Private (250K Coverage per illness)

Large Private (300K Coverage per illness)

Suite (500K Coverage per illness)

Plan(Required)

Individual

Family

Amount(Required)

Please make sure you entered the correct amount.

Upload Government ID(Required)

Max. file size: 2 GB.

*Note: Only jpg, png, pdf formats are allowed.

SELECT TYPE OF PLAN

MediCard allows you to choose what's important for you. From basic room to suite accommodation or with our without access to 5 star hospitals. The choice is yours. Simply tick your preferred plan to see how it would benefit you.

VIP Program(Required)

REGULAR PRIVATE W/ 200,000 DDL

REGULAR PRIVATE W/ 250,000 DDL

LARGE PRIVATE

SUITE UP TO 8000

5 Star Hospitals:

AHMC - Asian Hospital and Medical Center, MMC - Makati Medical Center,
SLMC-QC - St. Luke's Medical Center - Quezon City, TMC - The Medical City,
SLMC-Global City - St. Luke's Medical Center - Global City, CSMC - Cardinal Santos Medical Center

PLAN VERIFICATION

You have chosen:

VIP PROGRAM
REGULAR PRIVATE VIP PROGRAM

With AHMC, MMC, SLMC, TMC & CSMC

PLAN RATES

	REGULAR PRIVATE	REGULAR PRIVATE	LARGE PRIVATE	SUITE UP TO 8000
Limit for Dreaded Disease	P 200,000	P 250,000	P 300,000	P 500,000
Additional limit for accidents	P 50,000	P 100,000	P 150,000	P 200,000
Pre-existing Conditions Coverage
In-patient & Out-patient	P 5,000	P 10,000	P 15,000	P 20,000
Free Consultation at MediCard owned Clinics from the following primary care physicians & specialists: General Surgeon Pediatrecian General Practitioner Obstetrician Gynecologist Family Medicines Internal Internist Above consults will not be charged to the members' Maximum Benefit Limit.
Members can also avail of the free consultations even for the conditions which are classified under general exclusions or pre-existing conditions which are not covered. On thop of this, members can avail of the discounts on laboratory examinations.	Laboratory examinations up to 30% discount	Laboratory examinations up to 30% discount	Laboratory examinations up to 40% discount	Laboratory examinations up to 50% discount
	Maternity Related laboratory & ultrasound up to 30% discount	Maternity Related laboratory & ultrasound up to 30% discount	Maternity Related laboratory & ultrasound up to 30% discount	Maternity Related laboratory & ultrasound up to 30% discount
Emergency care in non-accredited facility subject to MRV*(MEDICard Relative Value)	dreaded disease limit	dreaded disease limit	dreaded disease limit	dreaded disease limit
Out-patient medicines	P 3,000	P 4,000	P 5,000	P 8,000
Point of Service Benefit
Out-patient consultation	5 consultations at P 250 / consultation	10 consultations at P 300 / consultation	15 consultations at P 350 / consultation	unlimited consultations at P 350 / consultation
Out-patient laboratory/diagnostic	80% up to P 5,000	80% up to P 10,000	80% up to P 12,000	100% up to P 20,000
In-patient: Approved for hospital bills	80% up to P 30,000	80% up to P 50,000	80% up to P 75,000	80% up to P 100,000
Professional fees	70% MRV up to DDL	75% MRV up to DDL	80% MRV up to DDL	100% MRV up to DDL
Executive Check Up at MediCard Clinics	PRIMARY PACKAGE	EXPANDED	EXPANDED Plus choice of: Kidney Functions Liver Functions Thyroid Functions Diabetes Functions	EXPANDED Plus Choice of two(2): Kidney Functions Liver Functions Thyroid Functions Diabetes Functions
Other Benefits:
a) MEDICard Skin & Body	Diamond Peel (3 sessions)	Diamond Peel (3 sessions) or Facial (2 sessions)	Diamond Peel/Facial (5 sessions each)Revitale or Thermolift (2 sessions)	Diamond Peel(10 sessions)/Facial (5 sessions) Revitale or Thermolift (2 sessions)
b) Weight Management / Nutrition Program	Covered at MediCard Lifestyle Center	Covered at MediCard Lifestyle Center	Covered at MediCard Lifestyle Center	Covered at MediCard Lifestyle Center
c) Use of Medicard Lifestyle Center - conference room (maximum 4 hours)	One-time	Twice(2x) a year	Twice (2x) a year	Three (3x) times a year
d) Physical Therapy	Up to ten (10) sessions within the maximum benefit limit per member per year	Up to ten (10) sessions within the maximum benefit limit per member per year	Up to ten (10) sessions within the maximum benefit limit per member per year	Up to ten (10) sessions within the maximum benefit limit per member per year
e) Coverage for slipped disc	P 5,000	P 10,000	P 20,000	P 30,000
f) Dental (Standard plus)	Bi-annual oral prophylaxis	Bi-annual oral prophylaxis Light cure filling (1 surface)	Bi-annual oral prophylaxis Light cure filling (2 surfaces)	Bi-annual oral prophylaxis Light cure filling (5 surfaces) Root canal up to P 5,000
g) Assist America	Covered	Covered	Covered	Covered
h) Lifeline Rescue	Covered	Covered	Covered	Covered
	ANNUAL	ANNUAL	ANNUAL	ANNUAL
Principal member Only	P 25,379	P 30,096	P 45,733	P 66,943
Principal + 1 dependent	P 45,908	P 54,391	P 82,493	P 120,666
Principal + 2 dependents	P 67,649	P 75,224	P 99,287	P 136,697
Principal + 3 dependents	P 88,266	P 94,982	P 115,212	P 151,896
Principal + 4 or more dependents	P 111,131	P 116,839	P 132,875	P 168,756
In excess of 4 dependents (per dependents)	P 22,517	P 23,542	P 25,841	P 26,566
i) PREMIUM FOR 61-65 YEARS OLD:
	ANNUAL	ANNUAL	ANNUAL	ANNUAL
Principal Member Only	P 32,993	P 39,125	P 71,344	P 104,432

MEMBERSHIP ELIGIBILITY

PRINCIPAL MEMBER

Company or self-employed individual 18 years old up to age 60.

DEPENDENTS

For Married Principal Member

The legal spouse at least 18 years old up to age 60
Legitimate and/or legally adopted children above 30 days up to 21 years of age unmarried and unemployed and living under the same roof as the principal member

For Single Principal Member

Parents up to age 60, unemployed and dependent upon the principal member
Brothers and sisters above 30 days up to 21 years of age who are not gainfully employed, unmarried and are living under the same roof as the principal member

Enrollees age 41 and above are required to undergo and pay a minimal fee of P 650.00 medical evaluation at any MediCard free-standing clinic (please see list here: https://www.medicardphils.com/offices-and-clinics/).

The choice of enrolling dependents must follow a hierarchy. This means that the spouse first must be enrolled followed by the eldest child, second child and so on for married personnel. For single personnel, the parents must be enrolled first followed by eldest brother/sister and so on.

Note:

Non-PhilHealth/Medicare members (e.g. parents below 60 and unemployed, etc.) shall pay the corresponding portion during confinement.
Medical, surgical, hospital and professional services expenses NOT EXPLICITLY COVERED under this Agreement, member must settle all billings upon discharge from the hospital. If MediCard will advance the payment, member shall pay MEDICard within seven (7) days of receiving of statement of account with an administration fee of 15%. If not settled within seven (7) days, a penalty of 2% per month of the amount owing until the debt is satisfied. MEDICard has the option to suspend the ID card of the member(s) involved until settlement.
Above rates are inclusive of VAT.

PLAN VERIFICATION

You have chosen:

VIP PROGRAM
REGULAR PRIVATE VIP PROGRAM

With AHMC, MMC, SLMC, TMC & CSMC

PLAN RATES

	REGULAR PRIVATE	REGULAR PRIVATE	LARGE PRIVATE	SUITE UP TO 8000
Limit for Dreaded Disease	P 200,000	P 250,000	P 300,000	P 500,000
Additional limit for accidents	P 50,000	P 100,000	P 150,000	P 200,000
Pre-existing Conditions Coverage
In-patient & Out-patient	P 5,000	P 10,000	P 15,000	P 20,000
Free Consultation at MediCard owned Clinics from the following primary care physicians & specialists: General Surgeon Pediatrecian General Practitioner Obstetrician Gynecologist Family Medicines Internal Internist Above consults will not be charged to the members' Maximum Benefit Limit.
Members can also avail of the free consultations even for the conditions which are classified under general exclusions or pre-existing conditions which are not covered. On thop of this, members can avail of the discounts on laboratory examinations.	Laboratory examinations up to 30% discount	Laboratory examinations up to 30% discount	Laboratory examinations up to 40% discount	Laboratory examinations up to 50% discount
	Maternity Related laboratory & ultrasound up to 30% discount	Maternity Related laboratory & ultrasound up to 30% discount	Maternity Related laboratory & ultrasound up to 30% discount	Maternity Related laboratory & ultrasound up to 30% discount
Emergency care in non-accredited facility subject to MRV*(MEDICard Relative Value)	dreaded disease limit	dreaded disease limit	dreaded disease limit	dreaded disease limit
Out-patient medicines	P 3,000	P 4,000	P 5,000	P 8,000
Point of Service Benefit
Out-patient consultation	5 consultations at P 250 / consultation	10 consultations at P 300 / consultation	15 consultations at P 350 / consultation	unlimited consultations at P 350 / consultation
Out-patient laboratory/diagnostic	80% up to P 5,000	80% up to P 10,000	80% up to P 12,000	100% up to P 20,000
In-patient: Approved for hospital bills	80% up to P 30,000	80% up to P 50,000	80% up to P 75,000	80% up to P 100,000
Professional fees	70% MRV up to DDL	75% MRV up to DDL	80% MRV up to DDL	100% MRV up to DDL
Executive Check Up at MediCard Clinics	PRIMARY PACKAGE	EXPANDED	EXPANDED Plus choice of: Kidney Functions Liver Functions Thyroid Functions Diabetes Functions	EXPANDED Plus Choice of two(2): Kidney Functions Liver Functions Thyroid Functions Diabetes Functions
Other Benefits:
a) MEDICard Skin & Body	Diamond Peel (3 sessions)	Diamond Peel (3 sessions) or Facial (2 sessions)	Diamond Peel/Facial (5 sessions each)Revitale or Thermolift (2 sessions)	Diamond Peel(10 sessions)/Facial (5 sessions) Revitale or Thermolift (2 sessions)
b) Weight Management / Nutrition Program	Covered at MediCard Lifestyle Center	Covered at MediCard Lifestyle Center	Covered at MediCard Lifestyle Center	Covered at MediCard Lifestyle Center
c) Use of Medicard Lifestyle Center - conference room (maximum 4 hours)	One-time	Twice(2x) a year	Twice (2x) a year	Three (3x) times a year
d) Physical Therapy	Up to ten (10) sessions within the maximum benefit limit per member per year	Up to ten (10) sessions within the maximum benefit limit per member per year	Up to ten (10) sessions within the maximum benefit limit per member per year	Up to ten (10) sessions within the maximum benefit limit per member per year
e) Coverage for slipped disc	P 5,000	P 10,000	P 20,000	P 30,000
f) Dental (Standard plus)	Bi-annual oral prophylaxis	Bi-annual oral prophylaxis Light cure filling (1 surface)	Bi-annual oral prophylaxis Light cure filling (2 surfaces)	Bi-annual oral prophylaxis Light cure filling (5 surfaces) Root canal up to P 5,000
g) Assist America	Covered	Covered	Covered	Covered
h) Lifeline Rescue	Covered	Covered	Covered	Covered
	ANNUAL	ANNUAL	ANNUAL	ANNUAL
Principal member Only	P 25,379	P 30,096	P 45,733	P 66,943
Principal + 1 dependent	P 45,908	P 54,391	P 82,493	P 120,666
Principal + 2 dependents	P 67,649	P 75,224	P 99,287	P 136,697
Principal + 3 dependents	P 88,266	P 94,982	P 115,212	P 151,896
Principal + 4 or more dependents	P 111,131	P 116,839	P 132,875	P 168,756
In excess of 4 dependents (per dependents)	P 22,517	P 23,542	P 25,841	P 26,566
i) PREMIUM FOR 61-65 YEARS OLD:
	ANNUAL	ANNUAL	ANNUAL	ANNUAL
Principal Member Only	P 32,993	P 39,125	P 71,344	P 104,432

MEMBERSHIP ELIGIBILITY

PRINCIPAL MEMBER

Company or self-employed individual 18 years old up to age 60.

DEPENDENTS

For Married Principal Member

The legal spouse at least 18 years old up to age 60
Legitimate and/or legally adopted children above 30 days up to 21 years of age unmarried and unemployed and living under the same roof as the principal member

For Single Principal Member

Parents up to age 60, unemployed and dependent upon the principal member
Brothers and sisters above 30 days up to 21 years of age who are not gainfully employed, unmarried and are living under the same roof as the principal member

Enrollees age 41 and above are required to undergo and pay a minimal fee of P 650.00 medical evaluation at any MediCard free-standing clinic (please see list here: https://www.medicardphils.com/offices-and-clinics/).

The choice of enrolling dependents must follow a hierarchy. This means that the spouse first must be enrolled followed by the eldest child, second child and so on for married personnel. For single personnel, the parents must be enrolled first followed by eldest brother/sister and so on.

Note:

Non-PhilHealth/Medicare members (e.g. parents below 60 and unemployed, etc.) shall pay the corresponding portion during confinement.
Medical, surgical, hospital and professional services expenses NOT EXPLICITLY COVERED under this Agreement, member must settle all billings upon discharge from the hospital. If MediCard will advance the payment, member shall pay MEDICard within seven (7) days of receiving of statement of account with an administration fee of 15%. If not settled within seven (7) days, a penalty of 2% per month of the amount owing until the debt is satisfied. MEDICard has the option to suspend the ID card of the member(s) involved until settlement.
Above rates are inclusive of VAT.

PLAN VERIFICATION

You have chosen:

VIP PROGRAM
LARGE PRIVATE VIP PROGRAM

With AHMC, MMC, SLMC, TMC & CSMC

PLAN RATES

	REGULAR PRIVATE	REGULAR PRIVATE	LARGE PRIVATE	SUITE UP TO 8000
Limit for Dreaded Disease	P 200,000	P 250,000	P 300,000	P 500,000
Additional limit for accidents	P 50,000	P 100,000	P 150,000	P 200,000
Pre-existing Conditions Coverage
In-patient & Out-patient	P 5,000	P 10,000	P 15,000	P 20,000
Free Consultation at MediCard owned Clinics from the following primary care physicians & specialists: General Surgeon Pediatrecian General Practitioner Obstetrician Gynecologist Family Medicines Internal Internist Above consults will not be charged to the members' Maximum Benefit Limit.
Members can also avail of the free consultations even for the conditions which are classified under general exclusions or pre-existing conditions which are not covered. On thop of this, members can avail of the discounts on laboratory examinations.	Laboratory examinations up to 30% discount	Laboratory examinations up to 30% discount	Laboratory examinations up to 40% discount	Laboratory examinations up to 50% discount
	Maternity Related laboratory & ultrasound up to 30% discount	Maternity Related laboratory & ultrasound up to 30% discount	Maternity Related laboratory & ultrasound up to 30% discount	Maternity Related laboratory & ultrasound up to 30% discount
Emergency care in non-accredited facility subject to MRV*(MEDICard Relative Value)	dreaded disease limit	dreaded disease limit	dreaded disease limit	dreaded disease limit
Out-patient medicines	P 3,000	P 4,000	P 5,000	P 8,000
Point of Service Benefit
Out-patient consultation	5 consultations at P 250 / consultation	10 consultations at P 300 / consultation	15 consultations at P 350 / consultation	unlimited consultations at P 350 / consultation
Out-patient laboratory/diagnostic	80% up to P 5,000	80% up to P 10,000	80% up to P 12,000	100% up to P 20,000
In-patient: Approved for hospital bills	80% up to P 30,000	80% up to P 50,000	80% up to P 75,000	80% up to P 100,000
Professional fees	70% MRV up to DDL	75% MRV up to DDL	80% MRV up to DDL	100% MRV up to DDL
Executive Check Up at MediCard Clinics	PRIMARY PACKAGE	EXPANDED	EXPANDED Plus choice of: Kidney Functions Liver Functions Thyroid Functions Diabetes Functions	EXPANDED Plus Choice of two(2): Kidney Functions Liver Functions Thyroid Functions Diabetes Functions
Other Benefits:
a) MEDICard Skin & Body	Diamond Peel (3 sessions)	Diamond Peel (3 sessions) or Facial (2 sessions)	Diamond Peel/Facial (5 sessions each)Revitale or Thermolift (2 sessions)	Diamond Peel(10 sessions)/Facial (5 sessions) Revitale or Thermolift (2 sessions)
b) Weight Management / Nutrition Program	Covered at MediCard Lifestyle Center	Covered at MediCard Lifestyle Center	Covered at MediCard Lifestyle Center	Covered at MediCard Lifestyle Center
c) Use of Medicard Lifestyle Center - conference room (maximum 4 hours)	One-time	Twice(2x) a year	Twice (2x) a year	Three (3x) times a year
d) Physical Therapy	Up to ten (10) sessions within the maximum benefit limit per member per year	Up to ten (10) sessions within the maximum benefit limit per member per year	Up to ten (10) sessions within the maximum benefit limit per member per year	Up to ten (10) sessions within the maximum benefit limit per member per year
e) Coverage for slipped disc	P 5,000	P 10,000	P 20,000	P 30,000
f) Dental (Standard plus)	Bi-annual oral prophylaxis	Bi-annual oral prophylaxis Light cure filling (1 surface)	Bi-annual oral prophylaxis Light cure filling (2 surfaces)	Bi-annual oral prophylaxis Light cure filling (5 surfaces) Root canal up to P 5,000
g) Assist America	Covered	Covered	Covered	Covered
h) Lifeline Rescue	Covered	Covered	Covered	Covered
	ANNUAL	ANNUAL	ANNUAL	ANNUAL
Principal member Only	P 25,379	P 30,096	P 45,733	P 66,943
Principal + 1 dependent	P 45,908	P 54,391	P 82,493	P 120,666
Principal + 2 dependents	P 67,649	P 75,224	P 99,287	P 136,697
Principal + 3 dependents	P 88,266	P 94,982	P 115,212	P 151,896
Principal + 4 or more dependents	P 111,131	P 116,839	P 132,875	P 168,756
In excess of 4 dependents (per dependents)	P 22,517	P 23,542	P 25,841	P 26,566
i) PREMIUM FOR 61-65 YEARS OLD:
	ANNUAL	ANNUAL	ANNUAL	ANNUAL
Principal Member Only	P 32,993	P 39,125	P 71,344	P 104,432

MEMBERSHIP ELIGIBILITY

PRINCIPAL MEMBER

Company or self-employed individual 18 years old up to age 60.

DEPENDENTS

For Married Principal Member

The legal spouse at least 18 years old up to age 60
Legitimate and/or legally adopted children above 30 days up to 21 years of age unmarried and unemployed and living under the same roof as the principal member

For Single Principal Member

Parents up to age 60, unemployed and dependent upon the principal member
Brothers and sisters above 30 days up to 21 years of age who are not gainfully employed, unmarried and are living under the same roof as the principal member

Enrollees age 41 and above are required to undergo and pay a minimal fee of P 650.00 medical evaluation at any MediCard free-standing clinic (please see list here: https://www.medicardphils.com/offices-and-clinics/).

The choice of enrolling dependents must follow a hierarchy. This means that the spouse first must be enrolled followed by the eldest child, second child and so on for married personnel. For single personnel, the parents must be enrolled first followed by eldest brother/sister and so on.

Note:

Non-PhilHealth/Medicare members (e.g. parents below 60 and unemployed, etc.) shall pay the corresponding portion during confinement.
Medical, surgical, hospital and professional services expenses NOT EXPLICITLY COVERED under this Agreement, member must settle all billings upon discharge from the hospital. If MediCard will advance the payment, member shall pay MEDICard within seven (7) days of receiving of statement of account with an administration fee of 15%. If not settled within seven (7) days, a penalty of 2% per month of the amount owing until the debt is satisfied. MEDICard has the option to suspend the ID card of the member(s) involved until settlement.
Above rates are inclusive of VAT.

PLAN VERIFICATION

You have chosen:

VIP PROGRAM
SUITE UP TO 8000 VIP PROGRAM

With AHMC, MMC, SLMC, TMC & CSMC

PLAN RATES

	REGULAR PRIVATE	REGULAR PRIVATE	LARGE PRIVATE	SUITE UP TO 8000
Limit for Dreaded Disease	P 200,000	P 250,000	P 300,000	P 500,000
Additional limit for accidents	P 50,000	P 100,000	P 150,000	P 200,000
Pre-existing Conditions Coverage
In-patient & Out-patient	P 5,000	P 10,000	P 15,000	P 20,000
Free Consultation at MediCard owned Clinics from the following primary care physicians & specialists: General Surgeon Pediatrecian General Practitioner Obstetrician Gynecologist Family Medicines Internal Internist Above consults will not be charged to the members' Maximum Benefit Limit.
Members can also avail of the free consultations even for the conditions which are classified under general exclusions or pre-existing conditions which are not covered. On thop of this, members can avail of the discounts on laboratory examinations.	Laboratory examinations up to 30% discount	Laboratory examinations up to 30% discount	Laboratory examinations up to 40% discount	Laboratory examinations up to 50% discount
	Maternity Related laboratory & ultrasound up to 30% discount	Maternity Related laboratory & ultrasound up to 30% discount	Maternity Related laboratory & ultrasound up to 30% discount	Maternity Related laboratory & ultrasound up to 30% discount
Emergency care in non-accredited facility subject to MRV*(MEDICard Relative Value)	dreaded disease limit	dreaded disease limit	dreaded disease limit	dreaded disease limit
Out-patient medicines	P 3,000	P 4,000	P 5,000	P 8,000
Point of Service Benefit
Out-patient consultation	5 consultations at P 250 / consultation	10 consultations at P 300 / consultation	15 consultations at P 350 / consultation	unlimited consultations at P 350 / consultation
Out-patient laboratory/diagnostic	80% up to P 5,000	80% up to P 10,000	80% up to P 12,000	100% up to P 20,000
In-patient: Approved for hospital bills	80% up to P 30,000	80% up to P 50,000	80% up to P 75,000	80% up to P 100,000
Professional fees	70% MRV up to DDL	75% MRV up to DDL	80% MRV up to DDL	100% MRV up to DDL
Executive Check Up at MediCard Clinics	PRIMARY PACKAGE	EXPANDED	EXPANDED Plus choice of: Kidney Functions Liver Functions Thyroid Functions Diabetes Functions	EXPANDED Plus Choice of two(2): Kidney Functions Liver Functions Thyroid Functions Diabetes Functions
Other Benefits:
a) MEDICard Skin & Body	Diamond Peel (3 sessions)	Diamond Peel (3 sessions) or Facial (2 sessions)	Diamond Peel/Facial (5 sessions each)Revitale or Thermolift (2 sessions)	Diamond Peel(10 sessions)/Facial (5 sessions) Revitale or Thermolift (2 sessions)
b) Weight Management / Nutrition Program	Covered at MediCard Lifestyle Center	Covered at MediCard Lifestyle Center	Covered at MediCard Lifestyle Center	Covered at MediCard Lifestyle Center
c) Use of Medicard Lifestyle Center - conference room (maximum 4 hours)	One-time	Twice(2x) a year	Twice (2x) a year	Three (3x) times a year
d) Physical Therapy	Up to ten (10) sessions within the maximum benefit limit per member per year	Up to ten (10) sessions within the maximum benefit limit per member per year	Up to ten (10) sessions within the maximum benefit limit per member per year	Up to ten (10) sessions within the maximum benefit limit per member per year
e) Coverage for slipped disc	P 5,000	P 10,000	P 20,000	P 30,000
f) Dental (Standard plus)	Bi-annual oral prophylaxis	Bi-annual oral prophylaxis Light cure filling (1 surface)	Bi-annual oral prophylaxis Light cure filling (2 surfaces)	Bi-annual oral prophylaxis Light cure filling (5 surfaces) Root canal up to P 5,000
g) Assist America	Covered	Covered	Covered	Covered
h) Lifeline Rescue	Covered	Covered	Covered	Covered
	ANNUAL	ANNUAL	ANNUAL	ANNUAL
Principal member Only	P 25,379	P 30,096	P 45,733	P 66,943
Principal + 1 dependent	P 45,908	P 54,391	P 82,493	P 120,666
Principal + 2 dependents	P 67,649	P 75,224	P 99,287	P 136,697
Principal + 3 dependents	P 88,266	P 94,982	P 115,212	P 151,896
Principal + 4 or more dependents	P 111,131	P 116,839	P 132,875	P 168,756
In excess of 4 dependents (per dependents)	P 22,517	P 23,542	P 25,841	P 26,566
i) PREMIUM FOR 61-65 YEARS OLD:
	ANNUAL	ANNUAL	ANNUAL	ANNUAL
Principal Member Only	P 32,993	P 39,125	P 71,344	P 104,432

MEMBERSHIP ELIGIBILITY

PRINCIPAL MEMBER

Company or self-employed individual 18 years old up to age 60.

DEPENDENTS

For Married Principal Member

The legal spouse at least 18 years old up to age 60
Legitimate and/or legally adopted children above 30 days up to 21 years of age unmarried and unemployed and living under the same roof as the principal member

For Single Principal Member

Parents up to age 60, unemployed and dependent upon the principal member
Brothers and sisters above 30 days up to 21 years of age who are not gainfully employed, unmarried and are living under the same roof as the principal member

Enrollees age 41 and above are required to undergo and pay a minimal fee of P 650.00 medical evaluation at any MediCard free-standing clinic (please see list here: https://www.medicardphils.com/offices-and-clinics/).

The choice of enrolling dependents must follow a hierarchy. This means that the spouse first must be enrolled followed by the eldest child, second child and so on for married personnel. For single personnel, the parents must be enrolled first followed by eldest brother/sister and so on.

Note:

Non-PhilHealth/Medicare members (e.g. parents below 60 and unemployed, etc.) shall pay the corresponding portion during confinement.
Medical, surgical, hospital and professional services expenses NOT EXPLICITLY COVERED under this Agreement, member must settle all billings upon discharge from the hospital. If MediCard will advance the payment, member shall pay MEDICard within seven (7) days of receiving of statement of account with an administration fee of 15%. If not settled within seven (7) days, a penalty of 2% per month of the amount owing until the debt is satisfied. MEDICard has the option to suspend the ID card of the member(s) involved until settlement.
Above rates are inclusive of VAT.

FOR APPLICANT

Family Name:(Required)

First Name:(Required)

Middle Initial:(Required)

Middle Initial (None):(Required)

mi3

Not Applicable

Birthdate:(Required)

Sex:(Required)

Nationality:(Required)

Civil Status:(Required)

Height:(Required)

Weight (lbs):(Required)

Email:(Required)

Mobile Number:(Required)

Place Of Birth:(Required)

PRESENT ADDRESS (UNIT/BLDG.,NUMBER,STREET,SUBDIVISION,BARANGAY):(Required)

City:(Required)

Province:(Required)

Permanent Address is Same As Present

Same As Present

PERMANENT ADDRESS (UNIT/BLDG.,NUMBER,STREET,SUBDIVISION,BARANGAY):(Required)

City (Permanent Address)(Required)

Province (Permanent Address)(Required)

PERMANENT ADDRESS (UNIT/BLDG.,NUMBER,STREET,SUBDIVISION,BARANGAY)

City

Province

SSS:

TIN:

Occupation:(Required)

Group/Corporate Name:(Required)

Nature of Work:(Required)

Type of Plan:(Required)

Government ID (Applicant)(Required)

Max. file size: 2 GB.

*Note: Only jpg,png,pdf formats are allowed.

Communications will be sent through your given email, mobile number, or address. Should you need to update any information or contact details, please get in touch with us via email to: mgabat@medicardphils.com and copy furnish: kfvillanueva@medicardphils.com.

No. of Dependents(Required)

PERSONAL INFORMATION (DEPENDENT 1)

Family Name (1):(Required)

First Name (1):(Required)

Middle Initial (1)

Type 'NONE' if not applicable

Birthdate (1)(Required)

Sex (1)(Required)

Nationality (1)(Required)

Civil Status (1)(Required)

Email (1)(Required)

Mobile Number (1)(Required)

Relationship to Principal/Payor (1)(Required)

Government ID (1)(Required)

Max. file size: 2 GB.

Note: A birth certificate is required for dependents aged 18 years and below.

PERSONAL INFORMATION (DEPENDENT 2)

Family Name (2):(Required)

First Name (2):(Required)

Middle Initial (2)

Type 'NONE' if not applicable

Birthdate (2)(Required)

Sex (2)(Required)

Nationality (2)(Required)

Civil Status (2)(Required)

Email (2)(Required)

Mobile Number (2)(Required)

Relationship to Principal/Payor (2)(Required)

Government ID (2)(Required)

Max. file size: 2 GB.

Note: A birth certificate is required for dependents aged 18 years and below.

PERSONAL INFORMATION (DEPENDENT 3)

Family Name (3):(Required)

First Name (3):(Required)

Middle Initial (3)

Type 'NONE' if not applicable

Birthdate (3)(Required)

Sex (3)(Required)

Nationality (3)(Required)

Civil Status (3)(Required)

Email (3)(Required)

Mobile Number (3)(Required)

Relationship to Principal/Payor (3)(Required)

Government ID (3)(Required)

Max. file size: 2 GB.

Note: A birth certificate is required for dependents aged 18 years and below.

PERSONAL INFORMATION (DEPENDENT 4)

Family Name (4):(Required)

First Name (4):(Required)

Middle Initial (4)

Type 'NONE' if not applicable

Birthdate (4)(Required)

Sex (4)(Required)

Nationality (4)(Required)

Civil Status (4)(Required)

Email (4)(Required)

Mobile Number (4)(Required)

Relationship to Principal/Payor (4)(Required)

Government ID (4)(Required)

Max. file size: 2 GB.

Note: A birth certificate is required for dependents aged 18 years and below.

VIP Plan Online Application Form

MediCard Individual/Family Online Membership

SELECT TYPE OF PLAN

FOR APPLICANT

PERSONAL INFORMATION (DEPENDENT 1)

PERSONAL INFORMATION (DEPENDENT 2)

PERSONAL INFORMATION (DEPENDENT 3)

PERSONAL INFORMATION (DEPENDENT 4)

MEDICAL INFORMATION (PRINCIPAL)