An Innovative Micro Health Insurance Program named

I.C.E Card Presentation

The Partnership

The I.C.E Card is the result of a unique collaboration between WESTERN GUARANTY and trusted Managed Care Provider GOLDMED, to extend “Peace-of-Mind” health care to millions of Filipinos at home and abroad.

I.C.E Card is a game changing program designed to meet the risk-protection needs of every Filipino with a cost-effective health insurance to cover certain eventualities.

I.C.E Card Presentation

Access To Service

Through GOLDMED, a premier medical and managed-care facilitator in the country, insured members shall have a worry-free and responsive access to more than 340 accredited hospitals and medical practitioners nationwide, with NO CASH OUTLAY!

I.C.E Card Presentation

WESTERN GUARANTY presents:

PROGRAM FEATURES

I.C.E Card Presentation

Emergency Conditions

dreA life threatening or accidental injury or a sudden and

unexpected onset of a condition which at the time of occurrence

reasonably appears to have the potential of causing immediate

disability or death which requires the immediate alleviation of

pain or discomfort. These illnesses or injuries require urgent

medical/surgical care which the member secures immediately

after the onset or as soon as the care may be made available

but in any case within 24 hours after the onset. Heart attacks,

cardiovascular diseases, poisoning, loss of consciousness or

respiration, convulsions are examples of emergency conditions.

I.C.E Card Presentation

Card Type I.C.E CARD

EMERGENCY Medical Coverage Limit** Php.20,000

Accidental Death Php.100,000

Cash Assistance for Accidental Death Php.20,000

Cash Assistance for Fire & Earthquakes Php.10,000

NOTE: NO CASH OUTLAY

Program Summary

Plans for I.C.E Card

I.C.E Card Presentation

I.C.E Card - Front

I.C.E Card Presentation

I.C.E Card - Rear

I.C.E Card Presentation

Program Details

Card is valid for One (1) year upon activation

Membership Eligibility: 5 years old to 65 years old

Maximum of Three (3) cards purchases for a period of One (1) year, but only One (1) card may be used at a time.

The card is on a “One-Time Availment” basis – limited to one time availment on a per card basis, regardless if treatment cost exceeds the covered limit, or not.

SMS Enrollment – 3 days activation upon registration

Access to over 340 Accredited Hospitals nationwide

Emergency Cases leading to confinement are covered

Program coverage is on top of PhilHealth (filing is required)

I.C.E Card Presentation

Emergency Care Benefits

Ambulance service to transport a non-ambulatory patient the nearest medical facility covered up to Php.5,000 (inclusive of coverage limit)

Emergency room fees

Professional services of accredited physicians, surgeons, and specialists

Medicines used for immediate relief and treatment

Intravenous (IV) fluids and whole blood and human blood products

Dressings, plastic casts, sutures and other supplies

X-ray, laboratory examinations and diagnostic procedures

Anti-tetanus equine serum (ATS), tetanus toxoid, anti-rabies injection, and anti-venom vaccine for immediate treatment covered up to Php.10,000 (inclusive of coverage limit)

I.C.E Card Presentation

Emergency Care (Non-Accredited)

All other benefits coverable under an Accredited Hospital shall be made available for Non-Accredited, through reimbursement

Note: In case of emergency confinement in a Non-Accredited Hospital of GOLDMED and/or foreign territory, reimbursement shall be 80% of all eligible expenses up to coverage limit (subject to Relative Value Unit)

I.C.E Card Presentation

REGISTRATION AND AVAILMENT PROCESS

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Registration & Activation

Member must purchase the card at designated sales channels

Scratch the 1168 (Medilink) card number portion of the card

Activate by texting: GOLDMED-ICE[16-digit PIN Number]#[Activation Code]#[First

Name]#[Middle Initial]#[Last Name]#[Birthday mmddyyy]#[Gender M or F]#[Civil Status M or S]

SEND to SMART (0999) 888-6565

GLOBE (0917) 777-6565 Card will be activated after Seventy-Two (72) hours

Member will receive notification for successful SMS membership enrollment otherwise follow SMS instruction for invalid registration.

I.C.E Card Presentation

Availment

FOR ACCREDITED HOSPITALS:

Member goes to an Accredited Hospital for Emergency treatment

Member presents his GoldMed I.C.E Card together with a valid ID card (government, company or school ID)

FOR NON-ACCREDITED HOSPITALS:

Member settles the bill and secures documents (receipts, Medical Certificate, and other pertinent documents) for reimbursement

Download reimbursement form at www.goldmedhealth.com, and submit within 30 days from availment (failure to file within timeframe shall void reimbursement)

I.C.E Card Presentation

PROGRAM LIMITATIONS AND EXCLUSIONS

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Exclusions

1. Treatments, medications, examinations, or services not approved, authorized or recommended by the PROVIDER designated Coordinator/Assistant Coordinator, except for emergency cases;

2. Professional services obtained from Physicians and Hospitals in any of the following circumstances: (a) Non-Accredited Physicians in Accredited Hospitals, (b) Accredited Physicians in Non- Accredited Hospitals. Emergency availment from a Non-Accredited Physicians in Non-Accredited Hospitals shall fall under the reimbursement process;

3. Vaccines for immunization, medical supplies and services NOT INCIDENT to treatment or diagnosis of covered sickness or injury, unless otherwise specified in this agreement;

4. Outpatient consults, diagnostics, medicines and medical supplies except those administered by the emergency room physician on emergency cases;

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Exclusions

5. Developmental disorders including functional disorders of the mind, alcoholism drug addiction, alcohol intake, anxiety reaction regardless of the cause, any psychiatric case, and accidents that may arise from these conditions;

6. Injuries or illnesses resulting from war (whether declared or undeclared), riots, demonstrations, provoked or unprovoked criminal acts or while in the military, naval, or air force service of any country or international authority. THESE INCLUDE CATASTROPHIC INJURIES DUE TO FORTUITOUS EVENTS;

7. Treatment of injuries sustained as a result of regular engagement in hazardous sports, which includes, but is not limited to, skydiving, motor sports, judo, karate, taekwondo, boxing, wrestling, bungee jumping, scuba diving, snorkeling, horseback riding, polo, mountain climbing, rock climbing, hang gliding, spelunking, ballooning, and gymnastics;

8. Suicide or self-destruction or any attempt at either, while sane or insane;

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Exclusions

9. Aesthetic, cosmetic and reconstructive surgery or any consultation or treatment for any beautification purposes;

10.Professional fees of medico-legal officer who may be called for medico-legal cases;

11. Procurement or use of eyeglasses, special braces, steel implants, wheelchairs or prosthetic appliances such as artificial limbs, hearing aids, crutches, intra-ocular lens, and contact lenses;

12.Treatment and/or diagnostic tests, surgical operation for congenital abnormalities such as congenital neonatal hernia and all kinds of hernia (except for direct hernia), harelip, clubfoot, cerebral palsy, renal diseases such as medullary sponge kidney, pediatric cardiovascular work-up and the like unless if classified as Emergency in nature;

13.Treatment of any disability which may have affected a child in the period prior to the thirtieth (30th) day after birth;

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Exclusions

14.Any treatment for recuperative purposes such as confinement in a sanitarium or convalescent home (e.g. rehabilitation medicines, physical therapy);

15.Hospital charges with respect to special or private nursing services, supplemental foods and medicines like vitamins and minerals (unless prescribed by authorized attending doctor), extra accommodation and non-medical personal appliances such as radio, television, telephone and the like;

16.Sickness or injury arising from aviation or aeronautics use other than as a fare-paying passenger or a licensed aircraft operated by a recognized airline;

17.Pregnancy, childbirth, miscarriage, pregnancy related illnesses, abortion or postnatal care unless otherwise specified in the Agreement;

18.Cardiac catheterization, implantation of pacemaker, open heart surgery, organ transplants, thallium imaging, cineangiography unless otherwise specified in the Agreement;

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Exclusions

19.Sexually transmitted diseases, venereal diseases, AIDS and AIDS-related complex or condition, including Hepatitis B and Hepatitis B screening;

20.Anti-rabies shots unless otherwise specified in the Agreement;

21.Steroid injections unless classified under Emergency care;

22.Dental Surgery;

23.Circumcision, sex transformation, diagnosis and treatment of fertility or infertility, artificial insemination, sterilization or reversal of such;

24.Guillain-Barre Syndrome;

25.Blood screening for donors;

26.Laser eye surgery for treatment of myopia or treatment for error of refraction; and

27.Health check-ups/Annual check-ups/Pre-employment check-ups for other companies, for government requirements, for insurance purposes, or for travel abroad.

I.C.E Card Presentation