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HMO > SME / Corporate > Mplus > Application
Proposal Information Sheet (answer gform)
Client Information Sheet (download)
Broker of Record (download)
Signature Bearing Government Issued Valid ID with 3 specimen signatures of the authorized signatory
Masterlist (download)
Essential initial details (additional information must be completed prior to issuance)
Birth Dates (format: Jan 01, 2001)
Position / Occupation
Maximum Benefit Limit and Room and Board (refer to the illustrative proposal)
Dependents (if applicable)
Heirarchy Rule (if a dependent bypassed the heirarchy rule, please provide either proof of coverage for the bypassed dependent or a death certificate)
Married
Legal Spouse who is not more than 65 years old
Natural born or legally adopted children age 15 days to 21 years old
Single
Common law spouse
Must provide affidavit of co-habitation
Each individual is required to submit a Certificate of No Marriage (CENOMAR)
Same sex partner
Must provide affidavit of co-habitation
Each individual is required to submit a Certificate of No Marriage (CENOMAR)
Parent who is not more than 65 years old
Sibling age 15 days to 21 years old
Single Parent
Common law spouse
Must provide affidavit of co-habitation
Each individual is required to submit a Certificate of No Marriage (CENOMAR)
Same sex partner
Must provide affidavit of co-habitation
Each individual is required to submit a Certificate of No Marriage (CENOMAR)
Natural born or legally adopted children age 15 days to 21 years old
Participation Requirement
Non-contributory (Employer / company will shoulder full payment) - 100% of eligible employees shoud be enrolled
Contributory (Employee / member will pay portion of the fee) - at least 75% of the total number of employees
For applicants with existing HMO provider
Schedule of Benefits
Utilization Report
Sole Proprietorships:
DTI Certificate of Registration
BIR 2303
Photocopy of valid Government issued ID with signature of authorized signatory/owner. On the photocopy of the ID, the agent should declare that he/she has seen the original copy.
If signatory is not the CEO / President (Notarized Appointment Letter, or Special Power of Attorney)
Partnership
SEC Certificate of Registration
Articles of Partnership
Partnership Resolution
BIR 2303
Valid ID of the Signatory
If signatory is not the CEO / President (Notarized Appointment Letter, or Special Power of Attorney)
Corporations under Domestic Laws
SEC Certificate of Registration
Articles of Incorporation
General Information Sheet
BIR 2303
Valid ID of the signatory
If signatory is not the CEO / President (Board Resolution duly certified by the Corporate Secretary, or Notarized Appointment Letter, or Special Power of Attorney)
Philippine Economic Zone Authority (PEZA) Registered Entities
SEC Certificate of Registration
Articles of Incorporation
General Information Sheet
BIR 2303
Valid ID of the signatory
If signatory is not the CEO / President (Board Resolution duly certified by the Corporate Secretary, or Notarized Appointment Letter, or Special Power of Attorney)
Latest PEZA Certificate
VAT Zero Certificate
Non-Government Organization or Cooperatives or Religious Groups
Cooperative Development Authority (if applicable)
SEC Certificate of Registration
Articles of Incorporation
BIR 2303
NGO Questionnaire (request from AO)
Valid ID of the signatory
If signatory is not the CEO / President (Board Resolution duly certified by the Corporate Secretary, or Notarized Appointment Letter, or Special Power of Attorney)
Employees / Members
Latest BIR 1604 / Alphalist (stamped received by BIR); or
Philhealth Members Data Form; or
SSS Contribution List with screenshot of proof of payment
Board Members
Latest General Information Sheet (GIS) and/or Articles of Incorporation (AOI)
Consultants
BIR 2307
Foreign Nationals (Expats)
Alien Employment Permit issued by the DOLE; or
Photocopy of Alien Certificate of Registration ACR-I Card issued by Bureau of Immigration
BIR 2307
Send your proof of payment
TO: businessdevelopment@idealifeph.com
CC: kevin.delossantos@idealifeph.com; admin@idealifeph.com
Proof of payment must show the following:
Amount
Reference Number
Time and Date of Transaction
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