How did you learn about ORANGE LHMO® ?
Provide Enrollee details below:
email
text
Online Ad
Google Search
Referred by Friend
Presentation by Agent
Walk-In
Full Name
Use legal name as it appears on valid ID
Use space for M.I. if you do not have one
Complete Delivery Address
ORANGE LHMO® Cards are sent via LBC
House or Unit Number, and Street or Building Name
Street, Subdivision, Village or Barangay
Area, Town or City, and Province
Is your area covered? Emergency Room/ ER and/or Confinement Benefits for Plans that include it are honored in 500+ Hospitals nationwide - click here to see the list. Consultations, APE and Dental benefits (select areas) can only be availed in NCR, Cainta Rizal, Imus Cavite, Calamba & Sta Rosa Laguna, Lipa Batangas, Clark Pampanga, Cebu City - click here to view . Accident Medical Reimbursement benefit for all COMPLETE and BASIC Plans (except PreSchool Plan) covers ALL HOSPITALS NATIONWIDE (not just the 500+ hospitals above)
email Address
Check both Inbox and Spam for our email
Local Mobile Number
09xxxxxxxxx, for example 09228052922
Date of Birth, Month Day Year
Age 15 days to 85 years. Plans have age limits
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Gender
Male
Female
Civil Status
Important for determining legal Beneficiary
Single
Married
Divorced
Single Parent
Widow
Blood Type
Optional.Helpful for Emergencies
Preferred ORANGE LHMO® Plan
Have you viewed the Plans? If not, learn more abo ut our 3 COMPLETE ORANGE LHMO® Plans for Ages 5 to 65 here . For other age groups and lower priced options, you can view the BASIC ORANGE LHMO® Plans here . Consultations, APE and Dental benefits can only be availed at the 15 locations here . Emergency Room/ ER and/or Confinement Benefits for Plans that include it are honored in 500+ Hospitals listed here
Select your ORANGE LHMO® Plan
BASIC ORANGE LHMO® PreSchool Plan P 3,999/year
BASIC ORANGE LHMO® General Plan P 3,999/year
BASIC ORANGE LHMO® Senior Plan P 2,999/year
Agent Code or Referral Code or Offer Code
Optional Are you filling out this form in behalf of the Enrollee? If yes, please let us know your name, number, email and relationship to Enrollee (for example, are you the Parent, Employer, Agent, etc.).