BLUE ROYALE

A worldwide medical dollar plan that gives you complete freedom of choice for the best medical care

Make the most out of life’s precious moments.

With Pacific Cross, you can enjoy medical coverage that
helps secure your peace of mind, wherever life takes you.

Here For You

The rising costs of hospitalization and medical treatment are one of the pressures you have to deal with in today’s
times. When illness strikes, you undoubtedly want to look for the best ways to secure you and your loved ones.
Pacific Cross can help you financially prepare for life’s uncertainties with the Blue Royale Medical Insurance Plan.

Blue Royale offers one of the most comprehensive range of medical insurance benefits available in the Philippines.
It offers you complete freedom of choice to be treated by whom you please, when you please and where you
please—anywhere in the world! Blue Royale provides an impressive coverage limit of US$ 2,000,000 each year.
You are also assured of swift reimbursement of eligible charges.

BLUE ROYALE A Product of Pacific Cross Insurance, Inc.

• Your choice of hospital, clinic, pharmacy and doctor... WORLDWIDE!

• Maximum coverage of up to US$ 2,000,000
• Swift reimbursement of eligible charges
• Maternity benefit
• Worldwide emergency assistance
• Emergency evacuation services
• Optional Out-Patient coverage for dental and vision
• Transport of mortal remains
• Available under Blue Royale (for infants to 65 years old) and
Blue Royale Premier (66 years old and up)*

*See insert for more information on Blue Royale Premier.

Page 2 of 12
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Frequently Asked Questions
(For New Applicants)

Q: How do I get a Blue Royale Medical Insurance Plan?

A: Contact our Medical Sales office at +63 2 230-8511 or e-mail us at [email protected]. Our Account
Executives will be more than happy to answer your questions or give you a free presentation in person.

Q: How do I pay my Blue Royale Premium?

A: Pacific Cross offers you several convenient ways to pay your premium: You can pay in cash or credit, via bank Bills Payment
Facilities, either annually or semi-annually.

Q: Do I need to undergo a physical examination before I can get a Pacific Cross Insurance plan?
A: No, applicants normally do not need to undergo a physical exam. All you have to do is answer the application form and
medical questionnaire as truthfully as possible. Failure to answer the questions in the declaration in full, concealment, or
misrepresentation of any significant condition will affect your Policy and the payment of your claims.

Q: What is a Pre-Existing Condition?

A: A Pre-Existing Condition is a disability or illness which existed before the commencement of cover. The existence of a Pre-
Existing Condition can be medically determined given its natural history or the manner of development of a disease, which
means you may or may not be aware of its presenting symptoms. Pre-Existing Conditions are also those that are known
to you because you have felt its signs and symptoms regardless if this prompted you to seek for treatment, medication,
advice, or diagnosis. When you answer our Medical Questionnaire, please ensure that you tell us about all your medical
conditions and symptoms happening at any time in the past and/or present, known and/or suspected, whether or not
treatment or professional advice was sought. We will then notify you accordingly of the Company’s decision to insure or
not to insure or to impose special terms.

Q: How soon can I avail of my Blue Royale Benefits?

A: You can avail of your Blue Royale Benefits 30 days after the date shown on your Policy. However, you already have immediate
coverage for accidental injury.

Q: How can Blue Royale take care of me when I am abroad?

A: In the event that you are hospitalized while abroad, our worldwide emergency assistance partner will be there to help
you. Pacific Cross includes coverage for a maximum of 90 days abroad per trip. Coverage is extended beyond 90 days
provided the reason for going abroad is not to seek medical treatment.  The extension of stay overseas must also be due
to an emergency illness or condition (leading to confinement) that arose on or before your 90th day abroad, for which the
continued hospitalization will require you to stay abroad beyond 90 days.

Q: What does “90-day per trip coverage” mean?

A: This means that you can travel an unlimited number of trips outside the Philippines with insurance coverage provided that
each trip does not exceed 90 days. Premium may change for overseas stay of more than 90 days.

Page 3 of 12 Blue Royale Blue Royale

 CORE BENEFITS
Plan A Plan B Plan C
MAXIMUM COVERAGE PER YEAR (aggregate limit per year) US$ 500,000 US$ 1,000,000 US$ 2,000,000

IN-PATIENT BENEFITS

Room and Board

including General Nursing Care

Daily Limit for Philippine confinement US$ 300 US$ 600 US$ 850

Daily Limit for Overseas confinement Private Room Private Room Private Room
up to US$ 1,000 up to US$ 1,500 up to US$ 1,500

Miscellaneous In-Patient Charges As Charged As Charged As Charged

for required diagnostic laboratory tests, prescribed medicines and supplements, blood and
components, anesthesia, surgical appliances and devices, and intra-operative standard
prosthetics (as approved by Pacific Cross)

Professional Fee As Charged As Charged As Charged

Intensive Care Unit, Coronary Care Unit, Telemetry As Charged As Charged As Charged

Operating Theater and Recovery Room As Charged As Charged As Charged

Surgeon’s Fee US$ 30,000 As Charged As Charged

includes pre-surgical assessment and normal post-surgical care while confined in the
treatment country for each disability

Anesthetist’s Fee 40% of Surgeon’s Fee As Charged As Charged

Private Duty Nurse As Charged As Charged As Charged

when certified necessary by the Attending Physician (at home for up to 30 days immediately
after hospitalization)

Procedure Done on an Out-Patient Basis Subject to the limit of In-Patient Benefits

for selected procedures as approved by Pacific Cross

OUT-PATIENT BENEFITS
Major Out-Patient Care As Charged As Charged As Charged
Consultation in Doctor’s Office up to 90 days
covers Professional Fees of general practitioner, Specialist, Chinese medicine practitioner, immediately (with or (with or
Acupuncturist, and herbalist necessary for the treatment of a covered disability after without prior without prior
Physiotherapist or Chiropractor necessary for the treatment of a covered disability hospitalization hospitalization) hospitalization)
Prescribed Medicines and Supplements
covers take home medicines for maintenance drugs and supplements including herbal and (i.e., available
Chinese medicines, vitamins, food supplements, and hormone supplements/replacement only as a Post-
therapy necessary for the treatment of a covered disability Hospitalization
Diagnostics, X-rays and Laboratory Tests necessary for the treatment of a covered disability Follow-Up Care
Surgical Appliances and Devices Benefit via
includes durable medical equipment and corrective devices as prescribed by the Attending Reimbursement)
Physician and approved by Pacific Cross

Page 4 of 12 Blue Royale

 Plan A Plan B Plan C

Supplementary Out-Patient Care Pacific Cross Major Major

covering Out-Patient availments not requiring prior hospitalization or not related to pays 80% Out-Patient Out-Patient
a medical condition where the 90 days Post-Hospitalization Follow-Up Care Benefit is up to a limit Care Care
applicable. Also covers Out-Patient availments incurred beyond 90 days after hospitalization per year of will apply will apply
for a covered condition. Supplementary Out-Patient Care shall be limited to the following US$ 2,500
services and treatments:
Consultation in Doctor’s Office (via
covers Professional Fees of general practitioner, Specialist, Chinese medicine practitioner, Reimbursement
Acupuncturist, and herbalist necessary for the treatment of a covered disability only)
Physiotherapist or Chiropractor
necessary for the treatment of a covered disability
Prescribed Medicines
covers Out-Patient medicines for maintenance drugs procured from a recognized pharmacy,
including herbal and Chinese medicines, hormone supplements/replacement therapy
necessary for the treatment of a covered disability, excluding vitamins and supplements
Diagnostic, X-rays and Laboratory tests
necessary for the treatment of a covered disability

Other Alternative Treatments US$ 1,500 US$ 3,000 US$ 3,000

Homeopathy, Osteopathic Manipulative Therapy (OMT), Bonesetter, Iridology and any
medication prescribed by the mentioned alternative treatments to a limit per year of

Executive Check-Up (ECU) Package* US$ 200 US$ 500 US$ 600
Available to each Insured Person starting on his/her second year with Pacific Cross, provided
that he/she has any of the Blue Royale Plans (A, B, or C) the preceding year and is covered
under Blue Royale Plan A, B, or C upon Policy renewal. The Insured Person must be 20 to 65
years old upon effective date/renewal date. ECU package may be availed of at any hospital
or clinic within the Philippines. One time package availment per year, to a limit of

* ECU availment may be done after full payment of annual premium or after full payment
of both semi-annual premiums.
* Group accounts’ ECU is subject to underwriting guidelines.

EMERGENCY BENEFITS

Emergency Out-Patient Treatment As Charged As Charged As Charged

for treatment of emergency cases/conditions not leading to confinement provided by the
Out-Patient department of a hospital or a licensed doctor in his clinic for a covered disability

Emergency Dental Services As Charged As Charged As Charged

due to a covered accident

Emergency Local Ambulance Service As Charged As Charged As Charged

from place of occurrence to the nearest hospital facility or from hospital to hospital using
land transportation service. If local land transportation facility is not available, other
transportation facilities are allowed subject to the approval of Pacific Cross.

Emergency Overseas Coverage Included Included Included

overseas cover is for an unlimited number of trips outside the Philippines, provided that
each trip does not exceed 90 days except if Treatment Area Limitation (TAL) discount option
is selected.

Worldwide Emergency Assistance Included Included Included

Pacific Cross, through our designated assistance provider, will provide the assistance and
advice (24 hours a day, 7 days a week) for free but the client will be responsible for any third
party charges incurred as a result of such advice or assistance unless otherwise specified
elsewhere in the Policy. Insured Person must be traveling 100 miles (or 150 kilometers) or
more from his primary and legal address or in another country which is not his Country of
Residence for less than 91 days unless otherwise endorsed in the Policy.

Page 5 of 12 Blue Royale

 Plan A Plan B Plan C

Services* include but are not limited to the following:

• Emergency Medical Evacuation: Evacuation under appropriate medical supervision to the nearest
medical facility
• Medical Repatriation: Repatriation under medical supervision to the Insured Person’s legal
residence or to a medical or rehabilitation facility near the Insured Person’s residence
• Return of Mortal Remains: The return of mortal remains will be arranged and paid for.
• Compassionate Visit: When an Insured Person is traveling alone and will be hospitalized for more
than 7 consecutive days, an economy, round-trip, common carrier transportation will be provided
to a family member or a friend to accompany the Insured Person.
• Care of Minor Child(ren): One-way economy common carrier transportation will be provided to
the place of residence of minor child(ren) when they are left unattended as a result of medical
emergency or death of an Insured Person.

*Availment of services through our designated assistance provider, limit per year of As Charged and on top of the
Maximum Coverage Limit

*Availment of services not through our designated assistance provider, limit per year of As Charged and part of the
Maximum Coverage Limit
The actual cost will be paid via reimbursement by the Company subject to the limits specified which
will form part of the Maximum Coverage Limit of the plan provided that such assistance is a result of
a covered illness, accidental injury or death occurring during the Period of Insurance.

ORGAN TRANSPLANT US$ 100,000 US$ 200,000 US$ 200,000

fees for kidney, heart, liver, lungs, and bone marrow transplants (as approved by Pacific
Cross) including follow-up treatment and sequelae. Coverage is subject to the inner limits
of In-Patient, Emergency Out-Patient and Out-Patient Benefits under an aggregate limit
per year of

MENTAL AND NERVOUS DISORDERS US$ 5,000 US$ 10,000 US$ 10,000
covering biologically based mental illness and degenerative brain disorder as defined in
the Policy. Coverage is subject to the inner limits of In-Patient, Emergency Out-Patient and
Out-Patient Benefits under an aggregate limit of US$ 5,000 per year with a lifetime limit of

AIDS/HIV US$ 25,000 US$ 100,000 US$ 100,000

benefit will apply after 5 years of continuous coverage under the Blue Royale Policy and any
renewal thereof. It will be subject to the inner limits of In-Patient, Emergency Out-Patient
and Out-Patient Benefits under a combined lifetime limit of

CONGENITAL CONDITIONS US$ 1,000 US$ 2,000 US$ 2,000

for the treatment of congenital, heredo-familial, developmental abnormalities, birth defect.
Benefit will apply after 5 years of continuous coverage under the Blue Royale Policy and any
renewal thereof. It will be subject to the inner limits of In-Patient, Emergency Out-Patient and
Out-Patient Benefits under an aggregate limit of US$ 1,000 per year with a lifetime limit of

MATERNITY BENEFIT Not Available US$ 5,000 US$ 6,000

all inclusive limit per pregnancy for pre-natal and post-natal care, normal delivery, surgical
delivery, miscarriage, threatened and therapeutic abortion, complications of pregnancy
including re-hospitalization and nursery for the newborn up to 7 days including infant
formula, room-in cost and newborn screening (excluding Pediatrician’s Professional Fee,
screening and treatment for congenital conditions and vaccinations). Benefits are subject to
waiting periods as fully indicated in the Policy (12 months for post-natal care, normal, and
surgical delivery; 90 days for miscarriage, threatened and therapeutic abortions)

HOSPICE CARE US$ 5,000 US$ 5,000 US$ 5,000

following the Attending Physician’s diagnosis that a covered condition under the Policy is
terminal, such that a patient is expected to live 6 months or less because there is no available
treatment which will be effective in aiding recovery, this benefit will cover the cost of pain
management, services and accommodation should the patient decide (as prescribed by the
Attending Physician) to stay in an In-Patient hospice facility or institution duly constituted
and registered to provide a centralized program of palliative and supportive services to
dying persons in the form of physical, psychological, social and spiritual care. The indicated
amount is a lifetime limit whether stay in an In-Patient hospice facility is continuous or not.

BURIAL EXPENSES BENEFIT DUE TO ACCIDENT US$ 500 US$ 1,000 US$ 1,000
reimbursement of burial expenses if the Insured Person dies during the Period of Insurance
due to an Accident covered by the Policy, up to a limit of

Page 6 of 12 Blue Royale

 Plan A Plan B Plan C

VALUE ADDED BENEFITS

Pacific Cross Health Care Card Included (IP & ER only) Included Included
treatment at all Pacific Cross accredited medical facilities in the Philippines, up to plan limits
with no-cash-outlay

Sports Coverage Included Included Included

for recreational sports including skiing and scuba; excluding contact sports (subject to
Policy limits)

Free Child Coverage Included Included Included

free coverage for a newborn of a female Insured as early as the infant's 15th day up to the female
Insured's Policy renewal. Effective date of the infant's coverage is upon submission of application
form and is subject to 30 Days Qualifying Period. In-Patient/Hospitalization Benefits will be provided
to the newborn.

Antivenom, Rabies and Tetanus Post-Exposure Prophylaxis As Charged As Charged As Charged

coverage for injections of specified vaccines and necessary immunoglobulin after exposure to
pathogen(s) to prevent infection from occurring

OPTIONAL BENEFITS
Plan A Plan B Plan C
PERSONAL ACCIDENT BENEFIT Coverage is available as an option;
includes coverage for death, dismemberment, as well as total and from US$ 100,000 to US$ 500,000.
permanent disablement caused directly and solely by accident Rates for Class 1 (Standard Risk)
Occupation = US$ 1.32 per US$ 1,000
Covers new clients age 16 to 60.
Renewable until age 65.

VISION BENEFIT not available US$ 700 US$ 700

pays 80% of eye exams and prescription lenses* via reimbursement, available for (Included in
annual limit of groups of Core Benefits)
*prescribed contact lens, eyeglass lens/frames as prescribed by either 21 members or
an Optometrist or Ophthalmologist more

DENTAL BENEFIT 1st Year: US$ 1,000 1st Year: US$ 1,000 1 ndYear: US$ 1,000
st

pays 80% of charges via reimbursement, annual limit of 2nd Year Onwards: 2nd Year Onwards: 2 Year Onwards:
US$ 2,000
US$ 2,000 US$ 2,000
(Included in
Core Benefits)

The following dental benefits are covered from the 1st year onwards:
Dentures (as a result of accident only), Routine Oral Examination (not to exceed 2 per
year), Oral Prophylaxis (not to exceed 2 per year), Fluoride Treatment (1 treatment per
year), Amalgam Filling (per surface), Anterior Fillings (per surface), Root Canal Fillings,
Simple Extraction, Pits & Fissure Sealant (1 treatment per year only), Dental X-rays and
Diagnostics, Medications necessary and directly related to the dental treatment (i.e.,
pain reliever, antibiotics, disinfectant and antiseptic)

The following dental benefits are covered from the 2nd year onwards:
Complex Extraction, Surgical (Impacted Wisdom Tooth/Apicoectomy), Periodontal
Surgery, Crowns, Bridges, Compound Inlay/Onlay, Gold Inlay/Onlay, Porcelain Inlay/Onlay

Page 7 of 12 Blue Royale

 Travel +
The benefits below are included. The limits are on a 90 days per trip basis, except for Blue Royale Medical Insurance Policies whose
premiums have been changed for overseas stay of more than 90 days.

TRAVEL BENEFITS LIMITS

Baggage Delay US$ 200

• Lump sum cash benefit for a minimum of 6 hours delay of checked-in baggage
• Additional lump sum cash for a continuous delay of after 48 hours happening in a foreign destination

Loss or Damage to Baggage and Personal Effects US$ 3,000

• Cost of repair of damaged baggage or cost of the damaged or lost baggage, subject to depreciation
• Cost of clothing, prescribed medicines, bags, footwear, and other personal effects up to US$ 150 per
item, pair or set
Not covered: Baggage more than 5 years old

Loss of Laptop US$ 220

• Cost of lost laptop not more than 3 years old is paid up to the limit.
• Laptop that is more than 3 years but less than 6 years old is subject to 50% depreciation but not exceeding
the limit
Not covered: netbook, portable telecom equipment and handheld computer such as tablet and palmtop, other
electronic and technical equipment and accessories; lost laptop more than 6 years old

Theft of Cash US$ 220

• Reimbursement equivalent to the amount of cash that is stolen while being physically carried by Insured,
up to the limit
• Must be reported to the police within 48 hours from its occurrence
• Not applicable for children 15 years old and younger
Not covered: Unknown reason of loss or unexplained disappearance of cash

Loss of Travel Documents US$ 3,000

• Cost of the replacement fee of lost passport including unused visa and re-issuance of travel tickets or cost
of the new return flight tickets of the same class, whichever is applicable
• Reimbursement of travel and unplanned accommodation expenses up to a combined daily limit of
US$ 110 that are incurred during the 2 days after the original date of supposed departure which was
necessarily abandoned
Not covered: Communication and other related incremental charges while obtaining replacement travel documents

Trip Cancellation US$ 4,000

• Reimbursement for the unused and non-refundable portion of travel fare, accommodation expenses,
penalties and other irrecoverable pre-paid charges related to the trip according to the contract with
Insured’s Provider (e.g., hotel, airline), Travel Agency, and/or Tour Operator
• Due to death, life threatening condition, serious illness/injury of the Insured or Immediate Family member
• Due to these circumstances happening to Insured or his Immediate Family who is traveling on the same
itinerary and who is also insured under the Company's Travel Policy: (i) sickness resulting to the doctor's
declaration of patient being unfit to travel for the past 7 days immediately before or on the scheduled
departure date, (ii) sickness resulting to compulsory quarantine or denied boarding or (iii) lost travel
documents
• Due to severe weather conditions, natural catastrophe, unexpected outbreak of strike, riot or civil
commotion, technical failure of aircraft or technical failure or mechanical fault of the airport facility (e.g.,
runway obstruction, airport traffic or congestion)
• Due to sudden acts of terrorism causing an immediate release of the highest travel advisory level of "Do
not travel" at the place of departure or at the planned destination up to an inner limit of US$ 2,000
Limitation: Insured can claim from only 1 of these benefits namely: (i) Flight Delay or (ii) Trip Postponement or
(iii) Trip Cancellation or (iv) Trip Termination for the same occurrence.

Page 8 of 12 Blue Royale

The benefits below are included. The limits are on a 90 days per trip basis, except for Blue Royale Medical Insurance Policies whose
premiums have been changed for overseas stay of more than 90 days.

TRAVEL BENEFITS LIMITS

Trip Termination US$ 4,000
• Reimbursement for the unused and non-refundable portion of travel fare, accommodation expenses,
penalties, and other irrecoverable pre-paid charges related to the trip according to the contract with
Insured’s Provider (e.g., hotel, airline), Travel Agency and/or Tour Operator
• Cost of unplanned accommodation for Insured’s extended overseas stay if medical assistance is necessary
or after hospital discharge
• For the same reasons as that of Trip Cancellation
Limitation: Insured can claim from only 1 of these benefits namely: (i) Flight Delay or (ii) Trip Postponement or
(iii) Trip Cancellation or (iv) Trip Termination for the same occurrence.

Flight Delay US$ 200

• Lump sum cash benefit for a minimum of 6 hours flight delay
• Additional lump sum cash for a continuous delay of after 48 hours happening from a place of departure
that is not the place of origin
• For reasons of severe weather conditions, natural catastrophes, technical failure of aircraft, or technical
failure or mechanical fault of the airport facility (e.g., runway obstruction, airport traffic or congestion)
• Also applicable to late arrival at the airport as a result of the same circumstances affecting the preceding
public conveyance such as bus line, shipping line, or rail transit
Limitations: Insured can claim from only 1 of these benefits namely: (i) Flight Delay or (ii) Trip Postponement or
(iii) Trip Cancellation or (iv) Trip Termination for the same occurrence; Insured can only claim for either Alternative
Means of Transportation or Flight Delay for the same leg of the trip.
Not covered: Delays of chartered flights

Missed Connecting Flight US$ 100

• Lump sum cash benefit per 6 consecutive hours maximum of 96 hours
• For missed onward connecting flight due to the late arrival of incoming flight and no alternative onward
transportation is made available after arriving at the overseas transfer point
• For reasons of severe weather conditions, natural catastrophes, technical failure of aircraft, or technical
failure or mechanical fault of the airport facility (e.g., runway obstruction, airport traffic or congestion),
organized industrial action (e.g., strike), or hijack
Limitation: Insured can claim from only 1 of these benefits namely: (i) Flight Delay or (ii) Trip Postponement or
(iii) Trip Cancellation or (iv) Trip Termination for the same occurrence.

Strikes and Hijacks US$ 200

• Daily allowance per each full day up to 10 days that the travel is delayed from reaching the scheduled
destination for a minimum of 12 hours
• For reasons of organized industrial action, strike, or hijack

Alternative Means of Transportation US$ 400

• Reimbursement for the cost of the new flight and related fare expenses necessarily incurred for the use
of alternative public transportation to allow the Insured to reach the planned destination on time as a
result of carrier cancellation of original flight schedule; no alternative onward transportation is made
available to the Insured after missing the connecting flight; or more than 6 hours waiting time for the
airline’s arrangement for another new or connecting flight
• Due to severe weather conditions, natural catastrophes, technical failure of aircraft, technical failure or
mechanical fault of the airport facility (e.g., runway obstruction, airport traffic or congestion), organized
industrial action (e.g., strike), or hijack
Limitations: Insured can only claim for either Alternative Means of Transportation or Missed Connecting Flight for
the same occurrence; Insured can only claim for either Alternative Means of Transportation or Flight Delay for the
same leg of trip.
Not covered: Delays of chartered flights; any private means of transportation

Page 9 of 12 Blue Royale

 The benefits below are included. The limits are on a 90 days per trip basis, except for Blue Royale Medical Insurance Policies whose
premiums have been changed for overseas stay of more than 90 days.

TRAVEL BENEFITS LIMITS

Trip Postponement US$ 300

• Reimbursement for unused and non-refundable portion of travel fare, accommodation expenses,
penalties and other irrecoverable pre-paid charges related to the trip according to the contract with
Insured’s Provider (e.g., hotel, airline), Travel Agency and/or Tour Operator that has been postponed as
a result of carrier cancellation of original flight schedule or, flight delay with more than 24 hours waiting
time for the airline’s arrangement for another new or connecting flight
• Due to severe weather conditions, natural catastrophes, technical failure of aircraft, technical failure or
mechanical fault of the airport facility (e.g., runway obstruction, airport traffic or congestion)
Limitation: Insured can claim from only 1 of these benefits namely: (i) Flight Delay or (ii) Trip Postponement or
(iii) Trip Cancellation or (iv) Trip Termination for the same occurrence.
Not covered: Delays of chartered flights

Land Vehicle Rental Excess Protection US$ 1,000

Reimburses the excess of the rented land vehicle insurance, in case the rented land vehicle is damaged due to
collision, fire or involvement in fire, external explosion, self-ignition or lightning

ANNUAL PREMIUMS As of 1 August 2018

0-3 4-18 19-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65
PLAN A
Core Benefits $ 1,294 $ 1,354 $ 1,380 $ 1,509 $ 1,624 $ 1,766 $ 2,127 $ 2,254 $ 2,544 $ 2,682 $ 2,872
Dental Benefits 310 634 634 634 634 634 634 634 634 634 634
Travel + 69 69 69 69 69 69 69 69 69 69 69

PLAN B
Core Benefits 1,563 1,656 2,250 2,807 3,080 3,350 3,612 3,836 3,980 4,312 4,954
Dental Benefits 310 634 634 634 634 634 634 634 634 634 634
Vision Benefits* 165 165 165 165 165 165 165 165 165 165 165
Travel + 69 69 69 69 69 69 69 69 69 69 69

PLAN C
Core Benefits** 1,963 2,430 2,802 3,523 3,778 3,973 4,139 4,312 4,440 4,793 5,524
Travel + 69 69 69 69 69 69 69 69 69 69 69

*Vision Benefits under Plan B are only available for groups of 21 members or more who all opt for the benefit (no exception).
**Dental and Vision benefits are already included.

Premiums are inclusive of all applicable taxes.

The Documentary Stamp Tax (DST - US$ 4.00) should be deducted from the Core Benefits Premium before applying any discount and/
or loading (i.e., additional premium). The DST should be added back after all discounts and loadings have been applied, then add the
premium for any applicable optional benefits.

If you are paying on semi-annual mode, please note that 8% surcharge and DST charge will apply. The amounts of your first and second
installment will vary with the former being slightly higher than the latter due to DST.

Page 10 of 12 Blue Royale

DISCOUNT OPTIONS

Plan A Plan B Plan C

US$ 1,000 Deductible Option 15% Discount not available not available
US$ 2,500 Deductible Option 30% Discount 18% Discount 18% Discount
US$ 5,000 Deductible Option 40% Discount 24% Discount 24% Discount
Treatment Area Limitation 25% Discount 25% Discount 25% Discount
Notes for Discount Options:
1. The percentage discounts are not applicable to optional benefits. 3. Treatment Area Limitation excludes treatment in Canada; United
States of America, its dependent territories and the Caribbean
2. Deductibles are computed on a per annum basis and applied to the following: Islands; Japan; People’s Republic of China; Hong Kong and
a. All items stated under In-Patient Benefits Singapore.
b. In-Patient availments for Organ Transplant, Mental and Nervous Disorder,
Congenital Conditions and HIV/AIDS
c. All items stated under Major Out-Patient Care (available as 90 days Post
Hospitalization Follow-Up Care Benefit) of Blue Royale Plan A

SOME THINGS ALL APPLICANTS SHOULD KNOW:

As with all insurance, there are some important points you should know before entering into a contract. In this section,
we identify some key Policy provisions.

1. Your coverage begins 30 days after the date shown on your 4. Certain conditions are permanently excluded from being
Policy. However, you already have immediate coverage covered. These conditions include:
for accidental injury. • Cosmetic surgery or related complications, contact
lenses, hearing aids and prescriptions thereof, except
2. A Pre-Existing Condition is a disability or illness which those that may be required for reconstructive surgery
existed before the commencement of cover. The existence • Suicide, attempted suicide, or intentional self-inflicted
of a Pre-Existing Condition can be medically determined injury
given its natural history or the manner of development • Pre-Existing Conditions unless such have been declared
of a disease, which means you may or may not be aware and approved by the Company
of its presenting symptoms. Pre-Existing Conditions are • Sexually Transmitted Diseases (STDs)
also those that are known to you because you have felt • All contraceptive methods of birth control; screening
its signs and symptoms regardless if this prompted you and/or treatment pertaining to infertility
to seek for treatment, medication, advice, or diagnosis. • Pregnancy related expense and screening, childbirth
(including surgical delivery), miscarriage and abortion,
When you answer our Medical Questionnaire, please including their complications, pre-natal or post-natal
ensure that you tell us about all your medical conditions care as well as nursing care for the newborn unless
and symptoms happening at any time in the past and/ provided in the schedule of benefits
or present, known and/or suspected, whether or not • Weight treatment, management, and its complications
treatment or professional advice was sought. We will • Confinement wholly for routine medical examinations
then notify you accordingly of the Company’s decision or check-ups
to insure or not to insure, or to impose special terms.
5. Your contract is guaranteed renewable up to age 100.
3. While your Policy is issued in the Philippines, it provides However, we reserve the right to adjust your premium and
coverage when you are overseas for an unlimited number other Policy conditions upon written advice 45 days prior
of trips. However, please note that the maximum period to each renewal.
of cover is for 90 days per trip only. Beyond that, your
plan will be subject to additional premium. If you reside 6. Your contract contains a provision on the Insured Person's
overseas, please advise us as your premium may need to right to Free-Look Period.
be adjusted.
7. For full details, please refer to the Policy.

Page 11 of 12 Blue Royale

 Our Companies
Pacific Cross Insurance, Inc. and
Pacific Cross Health Care, Inc.

Pacific Cross is EXCELLENCE.

We are committed to bringing
nothing but the best to our clients.
Our decisions are based on an intricate
understanding of our clients’ needs,
demands and expectations. We strive to
create and innovate programs that will
best serve our customers.

Pacific Cross is STABILITY.

We are one of the leading and most Get in touch with us today!
financially stable companies in the Call +63 2 230-8511
industry today. Our Premiums Earned in
recent years put us in the top 10 non-life
E-mail [email protected]
insurance companies in the Philippines.
HEAD OFFICE
Pacific Cross Center, 8000 Makati Avenue, 1200 Makati City,
Pacific Cross is EXPERIENCE. Metro Manila, Philippines
We draw from more than 65 years Tel. No.: +63 2 230-8511 Fax No.: +63 2 325-0638
of experience in the insurance industry. E-mail: [email protected]
Our actions are guided by a deep insight
brought about by the knowledge we have PACIFIC CROSS 8 ROCKWELL
gained through the years. MEDICAL SALES CENTER
Unit 8B, 8th Floor, 8 Rockwell Building Hidalgo Drive, Makati City,
Metro Manila, Philippines
Pacific Cross is CUSTOMER SERVICE.
Tel. No.: +63 2 230-8511 Fax No.: +63 2 230-8991
We are rooted in a commitment to E-mail: [email protected]
ever improving customer service. We
aim to be continuously progressive and CEBU
professional. Our commendable track Units 201-202, Avagar Building, No. 09, Escario corner Molave Street,
record and competent support staff Lahug, Cebu City, Philippines
ensure that you are given immediate and Tel. Nos.: +63 32 233-5812, +63 32 233-5816, +63 32 416-4468
excellent service at all times. Fax No.: +63 32 233-5814 E-mail: [email protected]

CLARK
Pacific Cross is a Unit 2, Pavilion Mall, Philexcel Business Park,
PARTNERSHIP OF TRUST. Clark Freeport Zone, Philippines
We build and value enduring Tel. Nos.: +63 45 499-5424, +63 45 499-5428
relationships. We consistently prove that E-mail: [email protected]
we are worthy of the highest confidence
— by our strict standards, the integrity of DAVAO
2nd Floor, Left Wing, Door No. 6, Matina Town Square,
our promises and the results we deliver.
MacArthur Highway, Matina, Davao City, Philippines
In the event of a crisis, we assure you that Tel. No.: +63 82 297-7314 Telefax: +63 82 297-7151
Pacific Cross will be your friend and ally. E-mail: [email protected]

www.pacificcross.com.ph V04.19_TAL&FN

We also have Agency Offices in:

Luzon: Baguio | Batangas | Cavite | Laguna | Legazpi | Naga | Olongapo | Palawan | Pampanga
VisMin: Bacolod | Bohol | Butuan | Cagayan de Oro | Dumaguete | General Santos | Iloilo | Tacloban