What is the procedure for Maxicare claims reimbursement?

STEP 1: Upon discharge, the member should secure all reimbursement documents that will be filed
to Maxicare.

Requirements:

• Completely fill-out Claims Reimbursement Form along with the other requirements that are
indicated in the form.Original BIR registered Official Receipt(s)/Sales Invoice with TIN
• Charge Slips or detailed itemized/breakdown of charges (charges per item page if the State
of Account does not include an itemized breakdown of charges)
• Hospital’s Billing Statement or Statement of Account.
• Clinical Abstract, Admitting History and Medical Certificate.
• Histopath/ Surgical Report (if surgical operation was done).
• Police Report in case of an accident and medico legal cases.

Note: Deadline for submission of reimbursement is 60 calendar days from the date of availment
date.

STEP 2: Kindly submit the requirements via Member Gateway

https://membergateway.maxicare.com.ph/ within 60 calendar days from the date of availment.
Our turnaround time (TAT) for the processing is 30 days upon receipt of complete requirements.
Please be advised that claims reimbursement will still be subject for evaluation. If approved, you
will be receiving an email notification from our disbursement team regarding the approved amount
credited to your Maxicare card. If disapproved, on the other hand, you will receive an email
notification from our claims team.

Further, please submit the original hard copies of the reimbursement documents (this is a BIR
requirement) within 30-days via Accenture Benefit dropbox as non-compliance will result in billing
the reimbursement amount to your company.

Luzon:
Maxicare Healthcare Corporation
c/o Claims Reimbursement Receiving Unit
Ground Floor CIBI Center
3308 Zapote St. Brgy. Sta. Cruz, Makati City

Visayas:
Maxicare Healthcare Corporation
c/o Claims Reimbursement Receiving Unit
8th Floor Apple One - Equicom Tower
Mindanao Avenue cor Biliran Road
Cebu Business Park, Cebu City 6000

Mindanao:
Maxicare Healthcare Corporation
c/o Claims Department
3rd Floor FTC Tower, Mt. Apo Street
Davao City
STEP 3: HRSS Benefits Administration submits the documents to Maxicare Head Office.

STEP 4: Maxicare will evaluate and validate the reimbursement documents. Once approved, the
reimbursement will be directly credited to the principal member’s membership card within 30
calendar days from the receipt date of reimbursement documents. Otherwise, Maxicare will release
a notice of disapproval or request for additional documents through the members email indicated
in the reimbursement form.

● All claims must be filed in the Maxicare Head Office within the 60 calendar days period.
● Documents and attachments must all be the original copies. If the original copies are not
available, Certified True Copy will suffice as long as it was issued by the hospital.
● Members may file via Member Gateway https://membergateway.maxicare.com.ph/ within
60 calendar days period.
● If documents are submitted via Member Gateway, original documents should still be
submitted to Maxicare via Accenture Benefit Drop Box within 30 days.

How to claim approved reimbursed via Maxihealth+ App - eWallet:

● eWallet is now available in the MaxiHealth+ application. Members can transfer their
approved reimbursement amount from the Maxihealth+ app to their personal bank account
- free of charge. Once the amount is credited to your Maxicare card, you need to top up
your e-Wallet (Maxicare card to Maxhihealth app e-wallet). Once a successful top up is
done, that is the only time you may use Instapay to send the money to your E-Wallet/Bank
account. However, for bank/e-Wallet transfers using instapay, please check with your bank
first if they are able to receive funds via InstaPay prior to processing the transfer. The
MaxiHealth+ app is downloadable via google play and app store. For more details, please
visit https://maxihealthapp.maxicare.com.ph/.