I. OUT PATIENT 2.

2. Present the admitting slip together with the Maxicare Card and at least one (1)  Electrocardiogram (ECG) for members 35 years old and above or as
valid ID to the admitting section to acquire a Letter of Eligibility (LOE). prescribed by the physician FREQUENTLY ASKED QUESTIONS (FAQs)
 All medically necessary out-patient consultations and out-patient procedures 3. Proceed to the reserved room/operating room.  Pap’s Smear for members 35 years old and above or as prescribed by the
are covered subject to MBL. 4. A Letter of Authorization (LOA) will be issued by Maxicare upon hospital’s physician How do I know if a certain diagnostic procedure requested by an accredited doctor is
confirmation of the member’s confinement. covered under my program?
 Eye laser therapy for retinal hole, retinal tear, retinal detachment and
5. Upon discharge, file Philhealth and settle the non-coverable charges. Note: Kindly schedule the Annual Check Up two (2) weeks prior to your preferred For inquiries on your benefit coverage, you can call our call center hotlines (02)582-
glaucoma as prescribed by an Accredited Physician/Specialist is covered up to
Php10,000/eye/member/year. Eye correction procedures such as Lasik, PRK date. For inquiries, please call the Maxicare Customer Care Annual Check Up Team at 1900 and (02) 798-7777. Our Call Center Specialist will ask for your medical details to
and the like are not covered. III. EMERGENCY CARE (02) 553-8820. assess the coverage of your availment based on your Maxicare program.
 Electro-cauterization of skin lesions such as plantar warts, flat warts, VII. DENTAL CARE What do you mean by confinement or hospitalization?
periungal warts, filiform warts and molluscum contagiosum, in any part of the A. IN AN ACCREDITED HOSPITAL A person is said to be confined or hospitalized if he is admitted in a hospital as a
body, as prescribed by an Accredited Physician/Specialist, is covered up to  Oral consultation/examination registered bed patient for at least twelve (12) hours.
Php1,000/member/year.  Doctor’s services, x-rays, laboratory and diagnostic examinations, and other  Oral prophylaxis (twice a year) What do you mean by latest modality?
 Sclerotherapy for varicose veins as prescribed by an Accredited medical services related to the emergency treatment of the patient are covered  Simple tooth extraction A medical procedure is defined as:
Physician/Specialist, to be availed through an Accredited Vascular Surgeon, is subject to MBL.  Temporary filling (unlimited) 1. Available only to one or two tertiary medical care facilities
covered up to Php5,000/leg/member/year. Medicines and cosmetic-related  Ambulance service from an accredited hospital/clinic to another accredited  Simple repair and adjustment of dentures
2. Requires specialized skills from specialized personnel and:
hospital/clinic is covered subject to MBL. 3. Is sanctioned and recognized as a significant medical update and part of the
procedures are not covered.  Re-cementation of jacket crowns, bridges, inlay and onlay
 standard clinical practice guidelines by the corresponding clinical and academic society
Allergy testing / allergy screening and other related examinations as  Palliative treatment of simple mouth sores and blisters
prescribed by an Accredited Physician/Specialist is covered subject to MBL. B. IN A NON-ACCREDITED HOSPITAL or association responsible for certifying practicing specialist physicians
 Desensitization of hyper-sensitive teeth (up to two teeth) Is it true that EENT, Neurologists and Urologists issued a memorandum to all HMOs
 Speech therapy for stroke patients is covered as charged subject to MBL on  Permanent fillings (up to two teeth)
reimbursement basis. All consultations shall be part of the limit and shall be  Reimbursable up to 100% of Maxicare rates up to MBL/ availment/member/year. stating that they will charge extra professional fees?
 Gum treatment for cases like inflammation or bleeding
treated as sessions.  Ambulance service from a non-accredited hospital/clinic to an accredited Yes. In order to avoid this, you may coordinate with our Customer Care Department
 Emergency dental treatment prior to each availment so they can make arrangements with doctors who do not
 Tuberculin test is covered subject to MBL. hospital/clinic is reimbursable up to Php2,500/conduction.
Note: The ambulance service provided herein shall be available regardless of the  Oral incision and drainage charge extra fees.
location within the Philippines. What do I do if lose my Maxicare ID card?
You have to fill out the Maxicare Member & Card Maintenance Form and submit to
AVAILMENT PROCEDURE C. OUTSIDE THE PHILIPPINES Dental Provider: Maxicare Dental Hub the Maxicare Head Office together with Php 200 as payment. Your new ID card will be
Contact Number: (02) 582-1966/1986 issued within seven (7) working days from the date the required documents are
1. Acquire Letter of Authorization (LOA) by presenting your Maxicare Card together  100% of actual cost is reimbursable up to MBL/availment/member/year. forwarded to the Maxicare Head Office, provided that all requirements are complete.
with at least one (1) valid ID through the following: Are your hotlines available even during midnight?
Note: Kindly schedule an appointment with the preferred dentist prior to availment. Our Call Center operates 24/7 and is manned by our Call Center Specialists who are
D. IN AREAS WITHOUT ACCREDITED HOSPITALS
a. PCC/Helpdesk For inquiries, please call the contact details indicated above. highly trained to assist you in any of your medical concerns.
b. Maxicare Coordinator of any accredited hospital  Reimbursable subject to MBL. Are you open on weekends?
c. Maxicare Member Gateway REIMBURSEMENT GUIDELINES Our Primary Care Centers and Maxicare Coordinators’ clinics are open from Monday to
Saturday. Our coordinators’ contact details and clinic schedules are listed in the
2. Present Letter of Authorization (LOA)/referral slip to Maxicare-accredited 1. Reimbursements must be filed within 30 days from the date of availment or date website’s Accredited Providers page (www.maxicare.com.ph).
doctor/specialist. AVAILMENT PROCEDURE of discharge. Otherwise, the reimbursement will be forfeited. For the complete lists of FAQs, kindly refer to the booklet provided.
3. Avail of consultation. 2. Not all procedures may be reimbursed (i.e. consultations are not reimbursable).
4. If laboratory exams are required, go back to Step 1. 1. Go to the Emergency Room of the nearest hospital. 3. Reimbursements are only allowed for emergency cases availed at non accredited
2. Present Maxicare Card together with at least one (1) valid ID. hospitals/clinics.
Note: Letter of Eligibility (LOE) will also be provided prior to consultation. 3. Avail of treatment at the Emergency Room. 4. Members filing for reimbursements must submit the complete documents as
4. If for confinement: follows:
II. IN PATIENT
a. Avail of entitled room plan.
b. Notify Maxicare within the next twenty-four (24) hours for EXCLUSION CONDITIONS
assistance. a. Filled-out Claims Reimbursement Form
PRINCIPALS b. Medical Certificate indicating the diagnosis and procedure(s) done (if any)
c. File Philhealth and settle non-coverable charges. 1. Services obtained for non-emergency conditions from physicians and hospitals in
c. Original BIR-registered Official Receipt(s) / Sales Invoice with TIN
d. Statement of Account (summary of hospital bill charges) any of the following circumstances: a) non-affiliated physicians in non-affiliated
ROOM AND Note: For availments in a non-accredited hospital, members can file for hospitals; b) non-affiliated physicians in affiliated hospitals; c) affiliated physicians
MBL e. Charge slips or detailed itemized breakdown of charges (charges per item paid)
PLAN TYPE BOARD TYPE reimbursement by securing pertinent documents (refer to the complete list under the
f. Police report for cases of assault or vehicular accidents in non-affiliated hospitals or other non-affiliated healthcare facility
Reimbursement Guidelines portion) and sending them to the Maxicare Head Office 2. Additional hospital charges and physician’s profesional fees resulting from: a)
PLATINUM within thirty (30) days from the date of discharge. g. Operative report for surgical cases
DEPENDENTS OF EXECUTIVE (LARGE 200,000 h. Clinical Abstract / History room upgrading beyond member’s allowable time during emergency care; b)
i. Certification of non-availability of medicines from hospital pharmacy and original extensión of hospital stay despite reléase of discharge order from member’s
PRIVATE) IV. PRE-EXISTING CONDITIONS
prescriptions signed by the attending physician (for IP medicines bought outside the hospital) attending physician; c) fees of the assistant surgeons/resident doctors who
PLATINUM assisted the attending physician in the process of rendering the medical services
EXTENDED DEPENDENTS OF
(LARGE 2000,000  Dreaded conditions are covered up to MBL. shall not be chargeable to the member and/or Maxicare except for hospitals that
MARRIED EXECUTIVE
PRIVATE)  Non-dreaded conditions are covered up to MBL. do not have resident physicians to assist during surgeries, subject to the prior
GOLD 5. Submit the complete reimbursement documents to any of the following mailing approval of Maxicare; d) use of extra bed, tv, electric fan, DVD/VCD, and otehr
DEPENDENTS OF MANAGERIAL (REGULAR 150,000 V. DIAGNOSTIC/THERAPEUTIC PROCEDURES addresses: similar ítems unless such appliances and ítems are necessarily and ordinarily
PRIVATE) included in the member’s room and board accomodation; e)extra food; f) toilet
Luzon: articles like face towel, soap, toothbrush and the like; g) difference in room and
GOLD  All conventional/therapeutic procedures medically necessary for treatment Maxicare Healthcare Corporation
EXTENDED DEPENDENTS OF are covered subject to MBL. board, the incremental rate differences for profesional fees, diagnostic and
(REGULAR 150,000 c/o Claims Reimbursement Receiving Unit
MANAGERIAL  Arthrocentesis is covered subject to MBL for IP and up to six (6) sessions
laboratory examinations, and otehr ancillary medical services brought about by
PRIVATE) Ground Floor, CIBI Center obtaining a room accomodation higher tan the member’s room and board
GOLD subject to MBL for OP 3308 Zapote St., Brgy. Sta. Cruz accomodation limit; h) services of a private or special nurse; i) all other ítems not
DEPENDENTS OF SUPERVISOR (REGULAR 100,000  Continuous Positive Airway Pressure (CPAP) titration for sleep study is Makati City medically necessary in the medical management of the patient;
covered up to Php60,000 shared limit for OP and IP.
PRIVATE) 3. Custodial, domiciliary, convalescent and intermediate care.
 Dialysis is covered subject to MBL for IP and up to twelve (12) sessions Visayas:
GOLD 4. Long-term rehabilitation and psychiatric care and/or psychological illnesses and
EXTENDED DEPENDENTS OF subject to MBL for OP. Maxicare Healthcare Corporation
(REGULAR 100,000 conditions including neurotic and psychotic behavior disorders; anxiety disorders
SUPERVISOR  Non-oral chemotherapy (for cancer treatment only) is covered subject to MBL c/o Claims Reimbursement Receiving Unit
PRIVATE) 5. Treatment for injury and its complications resulting from self-inflicted injuries
for IP and up to twelve (12) sessions subject to MBL for OP. 8th Floor, Apple One-Equicom Tower including infections as a result of tattoos, piercing of the ear or any body part,
GOLD  Oral chemotherapy (for cancer treatment only) is covered up to Php60,000 Mindanao Ave., cor. Biliran Road whether self-inflicted or done by a third party; or attempted suicide or self-
DEPENDENTS OF RANK & FILE (REGULAR 80,000 shared limit for OP and IP. Cebu Business Park, Cebu City destruction, whether sane or insane
PRIVATE)  Physical therapy/occupational therapy excluding sub-specialties such as 6. Developmental disorders including functional disorders of the mind, such as but
GOLD cardiac rehabilitation, pulmonary rehabilitation, and the like are covered Mindanao: not limited to Attention-Deficit Disorder (ADD) / Attention-Deficit Hyperactivity
EXTENDED DEPENDENTS OF subject to MBL for IP and shared limit of up to twelve (15) sessions Maxicare Healthcare Corporation
(REGULAR 80,000 Disorder (ADHD), Autism Spectrum Disorders, Central Auditory Processing
RANK & FILE /Member/year subject to MBL for OP. c/o Claims Department Disorder (CAPD), and Mental Retardation
PRIVATE) rd
Note: Therapy of one (1) body área shall be considered as one (1) session 3 Floor, FTC Tower 7. Treatment of any injury received when there is a) negligence; b) unauthorized use
 Therapeutic Radiology procedures such as Brachytherapy, Cobalt, Linear Mt. Apo St., Davao City of prohibited drugs or regulated drugs; c) alcoholic liquor intake; d) direct or
 Room and Board accommodation are covered subject to members room and Accelerator Therapy, Radioactive Cesium and Radioactive Iodine are covered
board limit. indirect participation in the commission of a crime whether consummated or not;
up to MBL for IP and up to twelve (12) sessions subject to MBL for OP. HEIRARCHY OF DEPENDENTS e) violation of law or ordinance; f) unnecessary exposure to imminent danger,
 All other items directly related to the medical management of the patient, as
deemed medically necessary by the Attending Accredited Physician and/or knowingly or unknowingly or hazard to health, by the member
VI. ANNUAL CHECK-UP Married Employees Note: Maxicare shall be given a copy of the Police or Doctor’s report (the
Maxicare Coordinator are covered subject to MBL.
 Room upgrade in case of room unavailability, for emergency cases leading to (i) legitimate spouse, and (ii) children (eldest to youngest) “Report”), if any. To determine whether or not such treatment is an exclusión
confinement, is covered for the first twenty-four (24) hours. Routine Package for Principals & Dependents under this paragraph, Maxicare may rely on the report, as well as on the
Single Employees evaluation of its own Medical Resource Group provided, however, that if
 Physical Examination (i) parents, and (ii) siblings (eldest to youngest) Maxicare has yet to receive the report or the evaluation of its Medical Resource
 Complete Blood Count (CBC) Group, the member shall shoulder the expense for medical treatment subject to
AVAILMENT PROCEDURE  Urinalysis Single Parent Employees (including widow and widower employees) Maxicare’s reimbursement should it be found, after submission of pertinent
 Fecalysis (i) children (eldest to youngest), (ii) parents, (iii) siblings (eldest to youngest) documentary evidence, that the treatment is not an exclusión under this
1. Secure an admitting slip from a Maxicare-accredited Specialist. paragraph. Reimbursement will be based on Maxicre standard rates.
 Chest x-ray
8. Aesthetic, cosmetic and reconstructive surgery or any consultation or treatment  W CITY CENTER
th th
for any beautification purposes except if necessary to treat a functional defect MAXICARE HELPDESKS Ground Floor, W City Center, 7 Avenue corner 30 Street, Bonifacio Global
due to accidental injury within the initial confinement City, Taguig
9. Oral surgery following accidental injury to teeth for purposes of beautification; The following helpdesks are authorized to issue Letter of Authorization (LOA) Tel No: (02) 908-6957
dental examinations, extractions, fillings, other dental treatment and their  LIPA BATANGAS
complications except to the extent that are medically necessary for repair or CALAMBA MEDICAL CENTER MANILA DOCTORS HOSPITAL Ground Floor, NGC Building, J.P Laurel Highway, Balintawak, Lipa City,
alleviation of damage to the member caused solely by an accident; medical care Maxicare Office, 2nd Floor, Room 220, Manila Doctor's Hospital, Batangas
resulting from any dental-related conditions Calamba Medical Center Tower, 667 UN Ave, Ermita, Manila Tel No: (02) 908-6900 loc. 1199
10. Maternity care and all other conditions (except pre and post natal consultations) Calamba City, Laguna Tel. No.: (02) 524-3011 local 4510
related to and/or resulting from pregnancy and/or delivery which affect the Tel. No. :(049) 544-0084 to 87 local 4204
conditions of the member and the unborn child
11. Circumcision (except for treatment of urological conditions), sex transformation, CAPITOL MEDICAL CENTER UNIVERSITY OF STO. TOMAS Note: All members shall have no access to Healthway Medical Clinics
diagnosis, treatment and procedures related to fertility or infertility, artificial Room 1101, 11th Floor, Room 407, Dr. Patrick Moral's Clinic, **Supervisor and Rank & File has no Access to Asian Hospital & Medical Center
insemination, sterilization or reversal of such and their complications Capitol Medical Center Medical Arts Bldg. UST Compound, and Saint Lukes Medical Center –quezon City.
12. Experimental medical procedures Scout Magbanua St. Cor Forbes Street, Sampaloc, Manila
13. Acupuncture, chirotherapy and other forms of therapies and its complications Scout Magnabua Quezon City Tel. No.: (02) 731-3001 local 2508
14. All expenses incurred in the process of organ donation and transplantation if the Tel. No.: (02) 372-3825 local 5101
Member is the donor of such donation or transplantation, and its complications
15. Routine physical examinations required for obtaining or continuing employment, CARDINAL SANTOS MEDICAL CENTER VICTOR POTENCIANO
requirement in school, insurance/travel or government licensing, health permit Ground Floor Lobby, Main Hospital MEDICAL CENTER MYHEALTH CLINICS
and other similar purposes Building, Cardinal Santos Ground Floor, Doctor’s Building
16. Purchase or lease of any medical equipment, oxygen-dispensing equipment, and Medical Center Wilson St., Victor Potenciano Medical These are Maxicare-affiliated clinics located at selected malls in Metro Manila, making
oxygen except during covered in-patient care Greenhills San Juan City Center, EDSA, Mandaluyong City them easily accesible.
17. Corrective appliances, prosthetics and orthotics sucha s but not limited to eye Tel. No.: (02) 5069948 Tel. No.: (02) 464-9999 local 231
glasses and contact lenses, hearing aids, pacemaker, artificial limbs, valves, knee-  SM NORTH EDSA
nd
tabial insert for total knee arthroplasty, vascular grafts, titanium thread, TMC SOUTH LUZON CEBU HELPDESK 2 Level, SM North Edsa
myringotomy tuve, intravascular catheters, vascular stents, bone screw/plates, 2nd floor, The Medical City 4F, Robinsons Cybergate Mall Quezon City
HEALTHCARE PROGRAM
pins, wires, balloons, orthopedic internal fixator/fixation systems, orthopedic South Luzon, United Boulevard, Cebu City Tel. No.: (02) 441-4106
external fixator or fixation systems, intraocular lens, braces, crutches Greenfield City, Sta. Rosa, Laguna Tel. No.: (032) 402-7901 loc. 9110
18. Take-home medicine and out-patient medicine except a) anti-neoplastic  EDSA SHANGRI-LA
chemotherapy medicine (except for cancer treatment); b) medicine administered DAVAO HELPDESK APPLE ONE CEBU Level 1, Shangri-La Plaza
during an emergency treatment 3F, FTC Tower, Mt. Apo St. Apple One Building Shaw Blvd., Mandaluyong City
19. Congenital, genetic and hereditary diseases and their complications (except for Davao City Mindanao Ave. cor. Biliran Road Tel. No.: (02) 570-4325
hernias) Tel. No.: (032) 322-1900 loc. 9205 Cebu Business Park, Cebu City SUMMARY OF HEALTHCARE PROGRAM
20. All physical deformities prior to enrollment  FESTIVAL SUPERMALL
21. Treatment of injuries/illnesses caused directly or indirectly be engaging in any GEN. SAN HELPDESK BACOLOD HELPDESK Level 2, Festival Supermall
profesional sport or hazardous activity such as but not limited to scuba diving, Rm. 206, 2F, Santanna Building Unit 108, VLI Medical Plaza Bldg. Filinvest, Alabang
surfing, wáter skiing, mountain climbing, rock climbing, mountaineering, Santiago Blvd., Gen. San City Ipil St., Capitol Business Center, Bacolod Tel. No.: (02) 809-4388/850-4855
parachuting, airsoft, drag racing, paintballing, wakeboarding and bunjee jumping, Tel. No.: (034) 433-3044/434-9230 Tel. No.: (083) 552 5662
except for activities under compnay-sponsored sports activities.  ROBINSONS CYBERGATE CEBU FOR
rd
22. Injuries resulting from direct participation in riots, strikes, and other civil CDO HELPDESK ASIAN HOSPITAL & MEDICAL CENTER 3 Level, Robinsons Cybergate
disturbances Door 1, G/F, Silverdale Bldg. Upper Ground Floor, Tower 2 Fuente Osmena, Cebu City
23. Treatment of injuries or illnesses resulting from war or any combat-related Capistrano St. cor. Mabini Asian Hospital & Medical Center Tel. No: (032) 268-8502 to 03
activities while in military service Cagayan De Oro City 2205 Civic Drive, FCC Alabang, Muntinlupa
24. Sexually transmitted diseases, genital warts, AIDS and AIDS-related diseases Tel. No.: (088) 856-4143 Tel. No.: (02) 836-7493  FILOMENA BUILDING
25. Treatment for chronic dermatoses (except consultations) 104 Ground Floor, Filomena Bldg.
Amorsolo St., Legaspi Village
MEGAWIDE CONSTRUCTION CORPORATION
26. Infectious diseases (i.e. Avian Flu, Meninggococcemia, etc.) that are declared
Makati City January 01, 2019 - December 31, 2019
epidemic or pandemic by the Department of Health, World Health Organization,
or any recognized health authority. Tel. No.: (02) 812-3726
27. Pre-existing Hepatitis B and screening and vaccines for all types of Hepatitis
28. Benefits covered by Philhealth and all other government-funded healthcare
entitlements as provided for by law
29. Speech therapy for developmental and congenital diseases
DEPENDENTS
30. Weight reduction programs, surgical operation or procedure for treatment of
MAXICARE PRIMARY CARE CENTERS (Executive and Managers)
obesity, including gastric stapling or balloon procedures and liposuction
31. Cost of medico-legal cases
These are Maxicare-owned healthcare facilities/clinics that have its own staff of
32. Routine medical examination or check up or medical examination for employment
customer service representatives and primary care physicians, who administer
or travel
healthcare assistance to Maxicare members only.
33. Intravenous Immunoglobulin (IVIG)
MAXICARE HEALTHCARE CORPORATION
34. Treatment of work-related injuries of high-risk occipation such as but not limited
to construction workers, miners, loggers and drillers.  MAKATI MEDICAL CENTER Maxicare Tower
rd
3 Floor Tower One Makati Medical Center, Amorsolo St., 203 Salcedo Street,
35. Cost of medical services and profesional fees in excess of the MBL
Makati City Legaspi Village, Makati City
Tel. No: (02) 893-6064/ 893-9820/ (02) 888-8999 Customer Care Hotline: (02) 582-1900/(02) 798-7777
IMPORTANT: This is only a summary of your healthcare benefits. All provisions in the
contract shall prevail during actual availment. loc. 2109 & 2110

 ST. LUKE’S MEDICAL CENTER – QUEZON CITY

Room 1501, North Tower, Cathedral Heights, QC
Tel. No: (02) 723-5329/ (02) 723-0101 loc. 5151

 ST. LUKE’S MEDICAL CENTER – GLOBAL CITY

24/7 CUSTOMER CARE HOTLINES Room 325, Medical Arts Building, Rizal Drive cor. 15th Ave. and 32nd Ave. Fort
(02) 405-6294 Bonifacio Global City
(02) 236-6294
(02) 582-1900  THE NEW MEDICAL CITY
(02) 798-7777 MGR04, Ground Floor, Medical Arts Tower I, Ortigas Avenue, Pasig
Tel No: (02) 635-6789 loc. 5073/ (02) 706-1526/(02) 706-5080
24/7 MOBILE NUMBER
(0918) 907-2652  CHINESE GENERAL HOSPITAL
(0917) 594-2680 th
10 Floor Medical Arts and Parking Building,
Chinese General Hospital, Sta. Cruz, Manila
Tel. No: (02) 567-6286 to 87

PROVINCIAL TOLL FREE NUMBER  CENTURIA

1-800-10-582- 1900 (PLDT) Unit 933, Centuria Medical Makati, Century City, Kalayaan Avenue cor
1-800-8-582-1900 (GLOBE) Salamanca Street, Brgy. Poblacion, Makati City
Tel No: (02) 793-8652
SMS INQUIRY SERVICE
(0918) 889-6294