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06.06
                                                                                             TABELA INDIVIDUAL
                                   Taxa de                Premium                   Premium I                   Gold                             Gold I                       Maxim
                                   R$ 15,00              Enfermaria                Apartamento              Enfermaria                        Apartamento                   Apartamento
                                    00 a 18                 69,91                      85,64                    90,39                           121,96                        153,79
                                    19 a 23                 89,90                     110,14                   116,89                           157,71                        198,87
                                    24 a 28                110,22                     135,03                   121,69                           164,19                        207,05
           Individual




                                    29 a 33                110,22                     135,03                   125,32                           169,09                        213,22
                                    34 a 38                110,22                     135,03                   134,98                           182,14                        229,68
                                    39 a 43                131,93                     161,63                   156,78                           211,56                        266,77
                                    44 a 48                170,32                     208,66                   221,38                           298,72                        376,68
                                    49 a 53                212,05                     259,78                   284,69                           384,15                        484,42
                                    54 a 58                243,86                     298,75                   317,58                           428,52                        540,37
                                   59 ou +                 410,90                     503,39                   542,17                           731,57                        922,52

                                   Taxa de                Premium                   Premium I                           Gold                     Gold I                       Maxim
                                   R$ 15,00              Enfermaria                Apartamento                       Enfermaria               Apartamento                   Apartamento
                                    00 a 18                 59,41                      72,79                            76,85                   103,69                        130,72
                                    19 a 23                 76,40                      93,61                            99,37                   134,08                        169,03
                                    24 a 28                 93,66                     114,77                           103,45                   139,59                        175,98
          Familiar




                                    29 a 33                 93,66                     114,77                           106,54                   143,75                        181,23
                                    34 a 38                 93,66                     114,77                           114,76                   154,84                        195,22
                                    39 a 43                112,11                     137,38                           133,30                   179,85                        226,74
                                    44 a 48                144,74                     177,36                           188,21                   253,95                        320,16
                                    49 a 53                180,20                     220,81                           242,04                   326,59                        411,73
                                    54 a 58                207,23                     253,93                           270,00                   364,31                        459,28
                                   59 ou +                 349,18                     427,87                           460,94                   621,95                        784,09

                                  ASSINATURA            01 a 05                06 a 10                   11 a 15                  16 a 20              21 a 25                 26 a 31
                                 VENCIMENTO               05                     10                        15                       20                   25                      05

         SERVIÇOS OPCIONAIS                      Coleta Domiciliar (São Paulo e Grande SP)                                                                        R$ 6,00

DECLARAÇAO DE SAÚDE Campos de preenchimento obrigatório:Peso e altura; Questão de "A" a "W" (Utilizando "SIM" ou "NÃO").

                                                                                         10 Dias após a assinatura do contrato, liberação de: Consultas exclusivamente em nossas unidades
NOVO BENEFICIÁRIO E COMPRA DE CARÊNCIA ATÉ 65 ANOS                                       Próprias e os demais itens da letra b do aditivo de carência (CAR-24), serão liberados somente com a
                                                                                         quitação antecipada da 2ª mensalidade.

                               Zona                                CREDENCIADOS                                 PREMIUM           PREMIUM I        GOLD            GOLD I          MAXIM
                                ZC      Hosp. Igesp - Bela Vista                                                    Int               Int          Int/PS          Int/PS           Int/PS
                                ZC      Hosp. Adventista - Liberdade                                              Int/PS            Int/PS         Int/PS          Int/PS           Int/PS
                                ZC      Complexo Hospitalar Paulista - Cerq. César                                Int/PS            Int/PS         Int/PS          Int/PS           Int/PS
                                ZC      Mat. Pró-Matre paulista - Cerq. César                                                                                                         M
                                ZL      Hosp. Da Penha - Penha                                                      Int/PS          Int/PS         Int/PS           Int/PS          Int/PS
REDE CREDENCIADA SÃO PAULO




                                ZL      Hosp. Aviccena - Belém                                                                                     Int/PS           Int/PS          Int/PS
                                ZL      Hosp. Itaquera - Itaquera                                                      PS             PS             PS               PS              PS
                                ZL      Hosp. Central de Guaianazes - Guaianazes                                   Int/PS/M       Int/PS/M       Int/PS/M         Int/PS/M        Int/PS/M
                                ZL      Hosp. Oito de Maio - Itaim Paulista                                        Int/PS/M       Int/PS/M       Int/PS/M         Int/PS/M        Int/PS/M
                                ZL      Hosp. E Mat. São Miguel - S. Miguel Paulista                               Int/PS/M       Int/PS/M       Int/PS/M         Int/PS/M        Int/PS/M
                                ZL      Day Hospital - Ermelino Matarazzo                                            Int/PS         Int/PS         Int/PS           Int/PS          Int/PS
                                ZL      Hosp. E Mat. Master Clin - São Mateus                                      Int/PS/M       Int/PS/M       Int/PS/M         Int/PS/M        Int/PS/M
                                ZL      Clinicordis - Mooca                                                            PS             PS             PS               PS              PS
                                ZL      CEMA - Oftalmologia                                                            PS             PS             PS               PS              PS
                                ZO      Hosp. Albert Sabin - Lapa                                                                                                   Int/PS          Int/PS
                                ZO      Hosp. Plena - Taipas                                                         Int/PS         Int/PS         Int/PS           Int/PS          Int/PS
                                ZO      Hosp. E Mat. Jardins - Pinheiro                                              Int/PS         Int/PS         Int/PS           Int/PS          Int/PS
                                ZO      Hosp. E PS Portinari - V. Jaraguá                                            Int/PS         Int/PS         Int/PS           Int/PS          Int/PS
                                ZN      Hosp. E Mat. San Paolo (Voluntários) - Santana                             Int/PS/M       Int/PS/M       Int/PS/M         Int/PS/M        Int/PS/M
                                ZN      Hosp. E Mat. Presidente - Tucuruvi                                           Int/PS         Int/PS         Int/PS           Int/PS          Int/PS

                                                             CREDENCIADOS                                       PREMIUM           PREMIUM I        GOLD            GOLD I         MAXIM
                             Ghelfond                                                                              X                  X             X                X              X
Laboratórios




                             Laboratório IGESP                                                                     X                  X             X                X              X
                             Mello                                                                                 X                  X             X                X              X
                             Clin. Diag. Dr. Luiz Scoppeta                                                         X                  X             X                X              X
                             Pathos, Schimillevicth, Ed. Cardiológica                                                                               X                X              X
                             Delboni e Lavoisier                                                                                                                                    X
ZONA                          CREDENCIADOS                    PREMIUM     PREMIUM I    GOLD        GOLD I     MAXIM
                   ATIBAIA                Clínica Ubiratan                                                         PS Adulto   PS Adulto   PS Adulto
                   BAURERI                Hospitalis - Núcleo Hospitalar de Barueri        Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M
                   BRAGANÇA PTA.          HUSF (Hospital Univ. São Francisco)              Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M
                   CAIEIRAS               Clínica Neuro Stelio Leal Pessanha               Consultas   Consultas   Consultas   Consultas   Consultas
                                          Bioclínic                                        Consultas   Consultas   Consultas   Consultas   Consultas
                   CARAPICUIBA
                                          Orion - Clínica de Especialidades                Consultas   Consultas   Consultas   Consultas   Consultas
                   DIADEMA                Hospital Diadema                                 Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M
                                          Hosp. Pró Mater Santo Antônio                        PS          PS          PS          PS          PS
                   F. VASCONCELOS         Clínica Dra. Aracili                             Consultas   Consultas   Consultas   Consultas   Consultas
                                          Oftalmomed                                       Consultas   Consultas   Consultas   Consultas   Consultas
                   FRANCISCO MORATO       CEAM                                             Consultas   Consultas   Consultas   Consultas   Consultas
                                          CEAM                                             Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M
                   FRANCO DA ROCHA
                                          Orion - Clínica de Especialidades                Consultas   Consultas   Consultas   Consultas   Consultas
                                          Hospital Stella Maris                            Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M
                                          Hospital Bom Clima                                 Int/PS      Int/PS      Int/PS      Int/PS      Int/PS
                   GUARULHOS
                                          Hospital Saúde Guarulhos                           Int/PS      Int/PS      Int/PS      Int/PS      Int/PS
                                          Hospital Carlos Chagas                                                                             Int/PS
GRANDE SÃO PAULO




                   ITAPEVI                Oftalmomed                                       Consultas   Consultas   Consultas   Consultas   Consultas
                                          Laboratório Deliberato                            Exames      Exames      Exames      Exames      Exames
                   ITAQUAQUECETUBA        Oftalmomed                                       Consultas   Consultas   Consultas   Consultas   Consultas
                                          Clínica Carla Delepeu                            Consultas   Consultas   Consultas   Consultas   Consultas
                   MAIRIPORÃ              MAM - Mairiporã Assistência Médica                                       Consultas   Consultas   Consultas
                   MAUÁ                   Hospital Imaculada Conceição                     Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M
                                          Hosp. E Mat. Modi Dór                            Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M
                   MOGI DAS CRUZES        Santa Casa de mogi das Cruzes                    Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M    Int/PS/M
                                          Casa de Saúde Mat. Santana                           PS          PS          PS          PS          PS
                                          Gardiencor                                       Consultas   Consultas   Consultas   Consultas   Consultas
                                          Cytolab                                           Exames      Exames      Exames      Exames      Exames
                   POÁ
                                          Lab. Deliberato                                   Exames      Exames      Exames      Exames      Exames
                                          Oftalmomed                                       Consultas   Consultas   Consultas   Consultas   Consultas
                   OSASCO                 Hospital Montreal                                  Int/PS      Int/PS      Int/PS      Int/PS      Int/PS
                                          Hospital Ribeirão Pires                            Int/PS      Int/PS      Int/PS      Int/PS      Int/PS
                   RIBEIRÃO PIRES
                                          Hospital Santa Amália **                             PA          PA          PA          PA          PA
                                          Hospital Coração de Jesus                          Int/PS      Int/PS      Int/PS      Int/PS      Int/PS
                   SANTO ANDRÉ
                                          Hospital São José                                  Int/PS      Int/PS      Int/PS      Int/PS      Int/PS
                                          Hospital São Bernardo                              Int/PS      Int/PS      Int/PS      Int/PS      Int/PS
                   S. B. DO CAMPO
                                          Hospital Ifor                                                              Int/PS      Int/PS      Int/PS
                                          Hospital e Maternidade Central                    Int/PS       Int/PS      Int/PS      Int/PS      Int/PS
                   S. C. DO SUL
                                          Hospital Nossa Sra De Fátima Bef. S. C. do Sul                             Int/PS      Int/PS      Int/PS
                   SUZANO                 Hospital e Maternidade São Sebastião              Int/PS      Int/PS       Int/PS      Int/PS      Int/PS
                                          Bioclinic                                        Consultas   Consultas   Consultas   Consultas   Consultas
                   TABOÃO DA SERRA
                                          Policlínica Taboão                               Consultas   Consultas   Consultas   Consultas   Consultas

                             REGIÃO                        CREDENCIADOS                    PREMIUM     PREMIUM I    GOLD        GOLD I     MAXIM
Laboratórios




                                          Ipac, Syon, Lab. Modelo, Lab. Deliberato            X            X         X            X          X
                                          Lab. Pedro Bonelli, lab. Mello, Slab, Cytolab,
                         GDE. SÃO PAULO                                                       X            X          X           X           X
                                          Tecnolab
                                          Delboni e Lavoisier                                                                                 X

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  • 1. 06.06 TABELA INDIVIDUAL Taxa de Premium Premium I Gold Gold I Maxim R$ 15,00 Enfermaria Apartamento Enfermaria Apartamento Apartamento 00 a 18 69,91 85,64 90,39 121,96 153,79 19 a 23 89,90 110,14 116,89 157,71 198,87 24 a 28 110,22 135,03 121,69 164,19 207,05 Individual 29 a 33 110,22 135,03 125,32 169,09 213,22 34 a 38 110,22 135,03 134,98 182,14 229,68 39 a 43 131,93 161,63 156,78 211,56 266,77 44 a 48 170,32 208,66 221,38 298,72 376,68 49 a 53 212,05 259,78 284,69 384,15 484,42 54 a 58 243,86 298,75 317,58 428,52 540,37 59 ou + 410,90 503,39 542,17 731,57 922,52 Taxa de Premium Premium I Gold Gold I Maxim R$ 15,00 Enfermaria Apartamento Enfermaria Apartamento Apartamento 00 a 18 59,41 72,79 76,85 103,69 130,72 19 a 23 76,40 93,61 99,37 134,08 169,03 24 a 28 93,66 114,77 103,45 139,59 175,98 Familiar 29 a 33 93,66 114,77 106,54 143,75 181,23 34 a 38 93,66 114,77 114,76 154,84 195,22 39 a 43 112,11 137,38 133,30 179,85 226,74 44 a 48 144,74 177,36 188,21 253,95 320,16 49 a 53 180,20 220,81 242,04 326,59 411,73 54 a 58 207,23 253,93 270,00 364,31 459,28 59 ou + 349,18 427,87 460,94 621,95 784,09 ASSINATURA 01 a 05 06 a 10 11 a 15 16 a 20 21 a 25 26 a 31 VENCIMENTO 05 10 15 20 25 05 SERVIÇOS OPCIONAIS Coleta Domiciliar (São Paulo e Grande SP) R$ 6,00 DECLARAÇAO DE SAÚDE Campos de preenchimento obrigatório:Peso e altura; Questão de "A" a "W" (Utilizando "SIM" ou "NÃO"). 10 Dias após a assinatura do contrato, liberação de: Consultas exclusivamente em nossas unidades NOVO BENEFICIÁRIO E COMPRA DE CARÊNCIA ATÉ 65 ANOS Próprias e os demais itens da letra b do aditivo de carência (CAR-24), serão liberados somente com a quitação antecipada da 2ª mensalidade. Zona CREDENCIADOS PREMIUM PREMIUM I GOLD GOLD I MAXIM ZC Hosp. Igesp - Bela Vista Int Int Int/PS Int/PS Int/PS ZC Hosp. Adventista - Liberdade Int/PS Int/PS Int/PS Int/PS Int/PS ZC Complexo Hospitalar Paulista - Cerq. César Int/PS Int/PS Int/PS Int/PS Int/PS ZC Mat. Pró-Matre paulista - Cerq. César M ZL Hosp. Da Penha - Penha Int/PS Int/PS Int/PS Int/PS Int/PS REDE CREDENCIADA SÃO PAULO ZL Hosp. Aviccena - Belém Int/PS Int/PS Int/PS ZL Hosp. Itaquera - Itaquera PS PS PS PS PS ZL Hosp. Central de Guaianazes - Guaianazes Int/PS/M Int/PS/M Int/PS/M Int/PS/M Int/PS/M ZL Hosp. Oito de Maio - Itaim Paulista Int/PS/M Int/PS/M Int/PS/M Int/PS/M Int/PS/M ZL Hosp. E Mat. São Miguel - S. Miguel Paulista Int/PS/M Int/PS/M Int/PS/M Int/PS/M Int/PS/M ZL Day Hospital - Ermelino Matarazzo Int/PS Int/PS Int/PS Int/PS Int/PS ZL Hosp. E Mat. Master Clin - São Mateus Int/PS/M Int/PS/M Int/PS/M Int/PS/M Int/PS/M ZL Clinicordis - Mooca PS PS PS PS PS ZL CEMA - Oftalmologia PS PS PS PS PS ZO Hosp. Albert Sabin - Lapa Int/PS Int/PS ZO Hosp. Plena - Taipas Int/PS Int/PS Int/PS Int/PS Int/PS ZO Hosp. E Mat. Jardins - Pinheiro Int/PS Int/PS Int/PS Int/PS Int/PS ZO Hosp. E PS Portinari - V. Jaraguá Int/PS Int/PS Int/PS Int/PS Int/PS ZN Hosp. E Mat. San Paolo (Voluntários) - Santana Int/PS/M Int/PS/M Int/PS/M Int/PS/M Int/PS/M ZN Hosp. E Mat. Presidente - Tucuruvi Int/PS Int/PS Int/PS Int/PS Int/PS CREDENCIADOS PREMIUM PREMIUM I GOLD GOLD I MAXIM Ghelfond X X X X X Laboratórios Laboratório IGESP X X X X X Mello X X X X X Clin. Diag. Dr. Luiz Scoppeta X X X X X Pathos, Schimillevicth, Ed. Cardiológica X X X Delboni e Lavoisier X
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