ORANGE LHMO® - The 4-in-1 Preventive Healthcare, Emergency Medical Care, Confinement, and Casualty Assistance Card. Best value in Health Card in the Philippines

Let's get started! Please fill up the form below for a personalized ORANGE LHMO® PremiumPlus Plan proposal via email. It only takes seconds! You can also Order online from our Lazada Store - just click here

One and only one simple form to fill up for each person. It's that simple.

NOTE: If you are signing for a Company or Organization, please inform us so you can submit in XLS or CSV format instead of using the form below.

Have you chosen your Plan? Choose from our 3 COMPLETE ORANGE LHMO® Plans for Ages 5 to 65 here. For other age groups and lower priced options but with less benefits, you can view the BASIC ORANGE LHMO® Plans here .

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	First Name M.I. Last Name
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
Gender
Civil Status Important for determining legal Beneficiary
Blood Type Optional.Helpful for Emergencies
Preferred ORANGE LHMO® Plan Have you viewed the Plans? If not, learn more about 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
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.).
	By clicking "Submit" below, I hereby grant permission to process the Personal Data above and receive proposal(s) for relevant Medical Benefits, Health Care, Health Services, Health Insurance, Life and Non-Life Coverage.