AGENT ACCREDITATION DETAILED PROCEDURES

A. FRANCHISE RESERVATIONS

1. The agent must fill-out the Application for Group/SA Reservation Form from the Marketing Department. The franchise for the company must first be cleared by the Marketing Department Secretary before a Preliminary Survey Report (PSR) Form is submitted.
   
   
2. Having submitted a PSR prior to clearing of franchise is NOT a guarantee that franchise is automatically reserved to the agent.
   
   
3. For accounts with head offices in Visayas and Mindanao, an agent may file his reservation for franchise and PSR thru the Marketing Office in Cebu and Davao respectively. However, for accounts with head offices or branches outside these areas, the Provincial Marketing Offices must first clear the franchise with the Marketing Department at the Head Office before franchise is granted to the agent and before a proposal is issued.
   
   
4. If the franchise is clear, the account is reserved in the agent's name. The agent must then fill-out the Preliminary Survey Report (PSR) Form and submit it to the Marketing Secretary together with the list of the account's employees and their birthdates.
   
   
5. An agent is given a maximum of three (3) working days to submit a PSR from the date the franchise has been granted to him. Otherwise, the reservation for the account's franchise shall be automatically cancelled.Upon submission of the PSR, the Marketing Head must first approve the PSR before a proposal is made. Turn-around time for preparation of proposal is at least three (3) working days from the date of submission of PSRs.
   
   
6. An agent is given a 30-day franchise to work on an account. After 30 days, the franchise will automatically expire without prior notice if no written request for an extension of franchise has been submitted.
   
   
7. Requests for an extension of franchise are subject to the Marketing Department's approval. This will be based on the status of the agent's negotiations with the prospective account.
   The agent will be given another 30 days to work on the account should his request for a franchise extension be approved.
   
   
8. The Marketing Department, however, shall be under no obligation to furnish the reason for the disapproval of a request for a franchise extension.
   
   
9. All the above mentioned policies shall apply to all group and Salary Allotment (SA) accounts. Individual, family accounts and baby group are not included.
   
   
10. No PSR shall be entertained from those who are NOT accredited with PhilamCare. Any agent who wishes to be accredited with PhilamCare must first attend the PhilamCare Product Orientation Seminar and must bring in at least one individual application.
    
    
11. Being a Philamlife agent does not mean automatic accreditation with PhilamCare. He/she must seek accreditation first before he/she could sell PhilamCare to avoid problems on product, procedures, and underwriting concerns.
    
    
12. A Philamlife agent who is accredited with PhilamCare will retain his Philamlife code for all his businesses while a PhilamCare direct agent shall be issued a new code.

B. QUOTATIONS

1. The agent must furnish the Marketing Department with a list of the account's employees, and their birthdates as basis for the computation of the prospective account's rates.
   
   
2. A quotation for a prospective group account is only valid for two (2) months from the date of issuance. If the account has not been closed after two (2) months, membership fees will have to be recomputed.
   
   
3. A mixed plan can only be allowed if coverage shall be classified according to rank, otherwise uniform plan shall apply for all employees.

C. UNDERWRITING GUIDELINES FOR GROUP COVERAGE

1. QUALIFICATIONS FOR GROUP COVERAGE
   
   a. If coverage shall be company paid, 100% of regular employees (or a rank classification) but not lower than 20 regular employees must be enrolled.
   
   b. If payment of membership fees shall be contributory, at least 75% of employees but not lower than 20 regular employees must be enrolled.
   
   c. A group account may enroll their dependents under the same agreement provided at least 75% of the total number of employees shall enroll their dependents.
   
   d. In cases wherein the number of dependents to be enrolled by each employee is limited, enrollment must not be lower than 75% of an employee's total number of eligible dependents. As such, choice of enrolling eligible dependents must follow a hierarchy. This means that the spouse first must be enrolled, then the eldest child, second child and so on, for married employees; whereas the mother first must be enrolled, then the father, followed by eligible brothers or sisters for single employees.
   
   
2. WAIVER OF PRE-EXISTING CONDITION CLAUSE
   
   a. Pre-existing condition clause shall apply to all accounts with less than 100 enrollees.
   
   b. Pre-existing condition clause shall be waived for accounts with 100 or more enrollees ONLY if said number represents at least 75% of the account's total workforce.
   
   c. Merging two (2) or more companies or groups which are not in any way affiliated or connected with each other in order to avoid the application of the pre-existing condition clause and/or possible exclusions for certain individuals is not allowed. If there are two or more companies to be covered under one agreement, a certification or any business document must be submitted as proof of their affiliation, otherwise contract shall not be processed.
   
   
3. REQUIREMENTS FOR PREPARATION OF AGREEMENT
   
   The following information and/or documents must be submitted for purposes of contract preparation:
   
   a. Confirmation letter from the company that would signify their acceptance of our proposal and their decision to enroll with PhilamCare -- stipulating their chosen plan, mode of payment and company signatory.
   
   b. Subject to the above-mentioned qualifications for group coverage, accounts with 20 to 99 enrollees must submit individual application forms. On the other hand, accounts with 100 or more enrollees, wherein the pre-existing condition clause has been waived, must submit a master list of all their employees together with their birthdates and plan assignments. Duly accomplished group enrollment cards can follow.
   
   c. For takeover accounts with less than 100 enrollees, an official list of enrollees previously covered by the other HMO must also be submitted. Waiver of the pre-existing condition clause for such accounts may be considered on a case-to-case basis, but only for those enrollees who have been continuously covered for at least one (1) year by the account's former HMO.
   
   d. Individual and families cannot be enrolled as additional members of a group account if they are not in any way connected to or employed by the account. A group agreement change report form and group enrollment card or individual application must be submitted for any additional enrollee. These forms must be duly signed by the contract signatory or company's authorized representative to be considered valid.
   
   
4. EFFECTIVE DATE OF COVERAGE
   
   a. Effective date of coverage shall be the date in which the Agreement was signed by the account. The account shall be given a maximum of two (2) weeks from the effectivity of the Agreement to remit its first payment. If payment has not been forwarded by then, benefits shall be suspended with the exception of any pre-approved arrangements made.
   
   b. No retroactive application of effective dates of coverage shall be allowed. If a group account insists on effecting the agreement prior to its signing, then the client must pay in advance the Statement of Account issued to them with the exception of any pre-approved arrangements made.

D. TRANSFER OF ACCOUNTS/CHANGE OF AGENTS

1. Requests for transfer of accounts must come from the client. Requests filed by agents, however, may be honored provided the client concerned signifies his/her conforme to the request.
2. If the status of the existing agent handling the account is active, a conforme letter regarding the request for transfer will be sent to him. If the agent agrees to the transfer, then the request will be granted. If the agent disagrees, then he must first settle with his client whatever issues there are behind the request for a change of agent before the account is retained under his services.
3. If the agent fails to communicate with the Marketing Department within 30 days from the date in which conforme letter was issued, PhilamCare shall take it to mean that the agent has no objection to the request. Thus, the account shall be automatically transferred to the new agent as requested by the client.
4. An agent whose account has been retained under his services inspite of a request for a change of agent must be able to fully render his services to the account concerned. If the client contacts PhilamCare again or insists on changing his agent upon renewal, PhilamCare shall have no recourse but to automatically transfer the account to the new agent.
5. For accounts that are transferred, commissions from the effectivity date of transfer will be credited to the new agent. Effectivity date of transfer shall be the due date nearest to the date of receipt of the request for transfer.
6. In cases wherein the present agent handling an account has an inactive status with PhilamCare or in cases wherein an account has officially hired the services of an in-house broker through whom they are to course all their transactions, requests for a change of servicing agent shall be automatically granted. This is provided the new agent or in-house broker is accredited and has an active status with PhilamCare.
7. All the above-mentioned policies shall apply to all requests for transfer of accounts, whether individual or group.

Please be informed that PhilamCare has Marketing Officers who are tasked to exclusively solicit accounts for PhilamCare under the same policies and procedures. In Visayas and Mindanao, Marketing Officers are also tasked to provide assistance on product orientation and training of agents. However, they are not expected to always accompany agents or close an account for an agent. The Regional Marketing Head shall discern the support needed by the sales agency force in the closure and coverage of an account.