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Application for Renewal of Coverage

Please key-in the 12 characters of the Agreement Number found on your Data Card (Soft ID Card)

Agreement Number: - - - - -
  • IN
  • 99
  • 9999
  • 99
  • 9
  • 9

Notice:

Accounts that have "first renewal members" are required to accomplish and submit an Application for Renewal of Individual Membership form (addressed to the Principal member) together with a duly signed individual and Family Plan form (Summary of Benefits) to expedite the processing of renewal. Accounts not of this nature proceeds directly to evaluation. The aforementioned documents (for fully paid accounts) are scheduled to be sent 2 months (and also be available in this inquiry) prior to the respective renewal month (e.g accounts renewing July are sent in May).

Application for Renewal of Individual Membership

Step :1

Agreement No. : IN-05-0772-02-0-1 ID No. : 00015134
Name : JUAN FRANCISCO B. DELA CRUZ
Effective Date : 12/21/2011 SEX : MALE
Expiry Date: : 12/20/2012 MOP : ANNUAL
Accomodation : PRIVATE MBL : P100,000.00
Program Type : Plan B / ENHANCED M. Type : Principal

This Data Card must be presented with the membership
ID when availing of health care services.


Name : JUAN FRANCISCO B. DELA CRUZ
Hosp. Prog. Type : PLAN B-PREFERRED HOSPITAL
Expiry Date: : (WITHOUT ASIAN HOSPITAL & MEDICAL CENTER)
Pref. Hospital : MAKATI MEDICAL CENTER
Pref Dental : I-CARE DENTAL CLINIC
Coverage : DEN / IN&OUT /
Effective Date : DEN / IN&OUT /

This Data Card must be presented with the membership
ID when availing of health care services.

Unable to access your agreement online. For inquiries, please dial 813-0131 local 8202-05 or email us.

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