TERMS AND CONDITIONS Page No.
Page 1 of 4
TO FACILITATE PAYMENT FOR THE
PAGCOR HEALTHCARE PLAN SERVICE
PROVIDERS
Ekkamai EMS and Health Management Ambulance
Rescue Services
(Name of Service Provider)
Corporate Office
(PAGCOR Branch)
A. PROCESSING REQUIREMENTS FOR SERVICE PROVIDERS
1. Must be willing to provide the following DOCUMENTARY REQUIREMENTS for processing of
bills:
(a) Detailed Statement of Account (SOA) or Statement of Itemized Charges or Charge Slips
(whichever is available), with applicable twenty percent (20%) Senior Citizen (SC)/Person with
Disability (PWD) discount estimate per cost center upon presentation of corresponding ID (SC
ID and unexpired PWD ID); duly signed by the employee/authorized signatory/patient.
(b) Valid/unexpired PAGCOR Letter of Guarantee (LOG)SOA of Accredited Physicians, detailing
role in the case, duly signed by the employee/authorized signatory.
TERMS AND CONDITIONS Page No. Page 2 of 4
TO FACILITATE PAYMENT FOR THE
PAGCOR HEALTHCARE PLAN SERVICE
PROVIDERS
B. SERVICE
1. Must be willing to provide ambulance services for PAGCOR’s employees (a.k.a. PAGCOR’s
patients) within the limit specified in the valid/unexpired LOG issued by PAGCOR and provided
by the PAGCOR patient to Ekkamai EMS and Health Management Ambulance Rescue
Services prior to availment of services.
2.Must be willing to inform PAGCOR and PAGCOR’s patients of the necessary and important
AMBULANCE EMERGENCY SERVICES rules and regulations to be observed while of the
services of Ekkamai EMS and Health Management Ambulance Rescue Services .
3.Must be willing to provide ambulance services for PAGCOR and PAGCOR patients without the
need for a deposit or partial payment EXCEPT for services that are in excess or not covered by
the valid/unexpired PAGCOR LOG.
C. DISCOUNTS
1.Must be willing to deduct the applicable 20% SC/PWD discount upon presentation of
corresponding ID (SC ID and unexpired PWD ID) from the SOA of PAGCOR’s SC/PWD
patients.
D. SETTLEMENT OF BILLS
1. PAGCOR shall pay the Ekkamai EMS and Health Management Ambulance Rescue
Services within thirty (30) calendar days from receipt of billings, provided that all documentary
requirements are attached thereto. Otherwise, the billings shall be returned to Ekkamai EMS
and Health Management Ambulance Services for completion prior to settlement. All bills shall
be VAT inclusive, zero-rated transactions.
2.PAGCOR shall inform of any query on the billings within fifteen (15) days from receipt of the
SOA. Otherwise, the bills sent to Ekkamai EMS and Health Management Ambulance Rescue
Services to PAGCOR will be final and collectible. In case the SOA is contested, reconciliation of
accounts/records shall forthwith be conducted between PAGCOR and Ekkamai EMS and Health
Management Ambulance Services thereafter, PAGCOR shall undertake to pay the reconciled
SOA within thirty (30) days.
TERMS AND CONDITIONS Page No. Page 3 of 4
TO FACILITATE PAYMENT FOR THE
PAGCOR HEALTHCARE PLAN SERVICE
PROVIDERS
Ekkamai EMS and Health Management Ambulance Rescue Services
(Name of Service Provider)
Corporate Office
(PAGCOR Branch)
E. MISCELLANEOUS
1.Must give PAGCOR a copy of new/revised rates prior to its implementation, the same shall
take effect on the date of receipt of revised rates from the Ekkamai EMS and Health
Management Ambulance Services. Otherwise, charges based on the new/revised rates will not
be honored.
2.Must allow the accreditation to commence upon receipt of Certificate of Accreditation, which
shall take effect for a period of two (2) years, and is automatically renewed every year
thereafter, unless modified or revoked earlier by either party upon thirty (30) days prior written
notice to the other.
3.If the foregoing is acceptable to you, please indicate your conformity by accomplishing and
signing the CONFORME portion below and returning three (3) original copies of these Terms
and Conditions to PAGCOR.
TERMS AND CONDITIONS Page No. Page 4 of 4
TO FACILITATE PAYMENT FOR THE
PAGCOR HEALTHCARE PLAN SERVICE
PROVIDERS
ISSUED BY: CONFORME BY:
JANICE A. SARAZA, MD.
Senior Manager, EWD
Health Services & Wellness __________Michael_C. Esteban____________
Department
Printed Name and Signature
IAN LESTER D. BALDOS
_________________President_______________
Assistant Vice President
Designation
Health Services & Wellness
Department
Philippine Amusement and Gaming
Corporation
