**READ FIRST** INSTRUCTIONS:
INDIVIDUAL PLAN
only one person can use the card (Only Principal adult or minor only)
ADULT only (18 y/o - 60 y/o):
✔Details should be on principal/payor part (skip 2nd page and sign the 3rd page)
✔If two or more adults will apply then one application form per adult (repeat the online application process)
MINOR only (15 days old - 17 y/o):
✔Details on principal/payor part should be the guardian of minor
✔Details on the dependent part (2nd page) should be the minor
✔Signature on 3rd page should be the principal/payor guardian of minor
✔If two or more minors will apply then one application form per minor (repeat the online application process along with the details of guardian principal/payor per application)
__________________________________________________________________________
FAMILY PLAN
1 or more person can use the card (Principal + Dependent/s immediate family 1st degree only)
SINGLE eligible dependents (either / or):
⦿parents - up to 60 y/o only
⦿siblings - 15 days old to 21 y/o only (eligible only if parents is 60+ y/o,deceased,ofw,hmo member)
✘you cannot mix dependent parents to siblings (vice-versa)
MARRIED eligible dependents (and / or):
⦿spouse - up to 60 y/o only (can skip spouse if 60+ y/o,deceased,ofw,hmo member)
⦿children - 15 days old to 21 y/o only
SINGLE PARENT eligible dependents (either / or):
⦿parents - up to 60 y/o only
⦿children - 15 days old to 21 y/o only
✘you cannot mix dependent parents to children (vice-versa)