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MAXICARE HEALTHCARE CORPORATION

Premium quality healthcare is deserved by every individual.


MAXICARE, an industry leader with 30 years of solid healthcare expertise,
has been a trusted name among top corporations and individuals.

Happy to assist you!


Juliet Ching
0917.8359547
02.8404.5829
I. IN-PATIENT BENEFITS molluscum contagiosum, in any part of the body
prescribed by an Affiliated Physician/Specialist is up
• Room and Board Accommodation to P1,000/member/year.
• Use of Operating Room, Intensive Care Unit 3. Sclerotherapy for varicose veins (except medicines
(ICU), Isolation Room (if prescribed by an and for cosmetic purposes) as prescribed by an
attending affiliated physician) and Recovery Affiliated Physician, to be availed through affiliated
vascular surgeons is up to P5,000/leg/member/year
Rooms
4. Allergy Testing/ allergy screening and other related
• Professional Fees of Attending Physicians, examinations prescribed by an Affiliated Physician
Surgeons, Anesthesiologist and Cardio is up to P2,500/member/year.
pulmonary clearance before surgery and 5. Speech therapy for stroke patients only. Covered
cardiac monitoring during surgery as charged up to 10,000/member/year on
reimbursement basis.
• Standard nursing services
Note: Consultations shall be part of the limit
• Medicines for in-patient use 6. Tuberculin test is up to P600/member/year
• Blood product transfusions and intravenous
fluids, including blood screening and cross ● Diagnostic / Therapeutic Procedures with
matching Specific Limits
• X-ray, laboratory examinations, diagnostic tests
1. All diagnostic / therapeutic procedures
and therapeutic procedures incidental to
medically necessary for treatment - 100% of
confinement actual cost subject to MBL
• Dressings, conventional casts (plaster of Paris) 2. Arthrocentesis - up to six (6) sessions subject
and sutures to MBL
• Anesthesia and its administration 3. Continuous Positive Airway Pressure (CPAP)
• Oxygen and its administration titration for sleep study - up to
P60,000/member/year (shared limit for OP
• Standard admission kit and IP)
• All other items directly related in the medical 4. Dialysis - up to twelve (12) sessions subject
management of the patient, as deemed to MBL
medically necessary by the attending affiliated 5. Non-oral chemotherapy (for cancer treatment
physician only) - up to twelve (12) sessions subject to
MBL
6. Oral chemotherapy (for cancer treatment
NOTE: Required to file Philhealth. Non-Philhealth
only)- up to P60,000/member/year (shared
members will pay for the Philhealth portion. limit for OP and IP)
7. Physical therapy / Occupational therapy
SALIENT FEATURES excluding subspecialties such as cardiac
PLAN TYPE R&B MBL rehabilitation, pulmonary rehabilitation and the
like - shared limit of up to twelve (12)
Platinum Plus Large Private Php 250,000 sessions/member/year subject to MBL
Note: Therapy of one (1) body area shall be
Platinum Regular Private Php 200,000 considered as one (1) session
8. Therapeutic Radiology:
a. Brachytherapy - up to twelve (12)
Gold Regular Private Php 150,000
sessions subject to MBL
b. Cobalt - up to twelve (12) sessions
Silver Semi-Private Php 100,000 subject to MBL
c. Linear Accelerator Therapy - up to
twelve (12) sessions subject to MBL
R&B – Room and Board Accommodation (room d. Radioactive Cesium - up to twelve
category) (12) sessions subject to MBL
MBL – Maximum Benefit Limit (limit per illness per e. Radioactive Iodine - up to twelve (12)
year) sessions subject to MBL
9. Transurethral Microwave Therapy of
II. OUT-PATIENT BENEFITS Prostate - covered up to 25,000/member/year
(shared limit for OP and IP)
All outpatient consultations and outpatient procedures 10 . Stapled Hemorrhoidectomy - covered up to
(as long as it is Medically Necessary). P10,000/member/year (shared limit for OP
and IP)
1. Eye laser therapy only for retinal tear, retinal 11 . 4D Ultrasound except for maternity-related
hole, retinal detachment and glaucoma
cases - covered up to P5,000/member/year
prescribed by an Affiliated Physician/Specialist is up
to P10,000/eye/member/year. Eye correction such (shared limit for OP and IP)
as Lasik, PRK and the like are not covered.
2. Electrocauterization of skin lesions such as plantar
warts, flat warts, periungual warts, filiform warts, and
12 . Esophageal Manometry - Covered up to affiliated Hospital to an affiliated Hospital (on
P5,000/member/year (shared limit for OP reimbursement basis).
and IP)
13 . Intensified Modulated Radiotherapy - covered Note: it is very important that you call the Maxicare
up to P10,000/member/year (shared limit for Hotline within 24 hours in order for Customer Care to
OP and IP) arrange a transfer from the non-affiliated hospital to the
14 . Botox which is not cosmetic in nature nor for affiliated hospital.
beautification purpose - covered up to
P5,000/member/year (shared limit for OP
and IP) IV. PREVENTIVE CARE
15 . Positron Emission Tomography (PET) Scan -
covered up to P5,000/member/year (shared • Passive and active vaccines for treatment of
limit for OP and IP) tetanus and animal bites shall be covered up to
16 . CT Pulmonary Angiography - covered up to Php18,000 per member per year
P5,000/member/year (shared limit for OP • Periodic monitoring of health problems
and IP) • Health education and counseling on diets and
17 . Other Modalities - covered up to exercise
P5,000/member/year (shared limit for OP • Health habits & family planning counseling
and IP)

V. ANNUAL CHECK-UP (ACU)


III. EMERGENCY CARE
Basic 5 Routine; Clinic-based: (Applicable to Platinum
Affiliated Hospital
o Doctor’s services Plus, Platinum, Gold and Silver Plan Type)
o Emergency Room fees 1. History and Physical Exam
o Medicines used for immediate relief and 2. CBC (Complete Blood Count)
during treatment 3. Routine Urinalysis
o Oxygen, intravenous fluids and blood 4. Routine Fecalysis
products o Dressings, conventional casts 5. Chest X-ray (PA and Lateral)
(plaster of Paris) and sutures
o Initial treatment of animal bites shall be The ACU however, may only be availed within the
covered for the first twenty-four (24) hours contract period after (1) payment of at least six (6) month
from the time of bite subject to MBL (except
worth of membership, and (2) must be a member of at
cost of vaccines).
o X-rays, laboratory, diagnostic examinations least six (6) months starting from the effectivity date.
and other medical services related to the Members must notify Maxicare’s Customer Care
emergency treatment of the patient Department (CCD) at least one (1) month prior to the
preferred schedule. Any request for rescheduling or
Non-Affiliated Hospitals change of venue must be in writing and shall be allowed
• Within the Philippines only once provided request was forwarded to CCD at
Maxicare shall reimburse up to 80% of the actual least one (1) week prior to the original ACU schedule.
hospital bills and 80% of the professional fees Otherwise, ACU
based on Maxicare rates incurred during the first entitlement shall be forfeited.
twenty-four (24) hours of treatment up to Php 30,000
per availment per member.

• Areas without affiliated hospitals within the


Philippines
Maxicare shall reimburse 100% of the total
hospital bills and Professional fees based on
Maxicare rates

• Outside the Philippines


Maxicare shall reimburse 100% actual costs up to
Php30,000 per availment per member.
Ambulance Service
Maxicare will cover road ambulance service for transfers
from an affiliated hospital to another affiliated hospital up
to MBL and Php2,500 per conduction if it is from a non-
VI. DENTAL CARE (OPTIONAL) VII. VALUE ADDED FEATURES

Exclusive for Dental Hub Provider Only MAXICARE’S INTERNATIONAL ASSISTANCE


PROGRAM
1. Oral Consultation/ Examination
2. Once a year Oral Prophylaxis Maxicare has partnered with Insurance Company of
3. Simple Tooth Extraction Assist America Asia Limited.
4. Unlimited Temporary Fillings, as needed Benefits:
5. Simple Repair and Adjustment of Dentures Medical Emergency Assistance
6. Recementation of Jacket Crowns, Bridges, ● Emergency Medical Evacuation
Inlay and Onlay ● Emergency Medical Repatriation
7. Palliative Treatment of Simple Mouth Sores ● Medical Referral
and Blisters ● Medical Monitoring
8. Desensitization of Hypersensitive Teeth – up to ● Prescription Assistance
2 Teeth per year ● Foreign Hospital Admission Assistance
9. Permanent Fillings – up to 2 Teeth per year ● Return of Mortal Remains
10. Gum Treatment for Cases Like Inflammation or
Bleeding Non-Medical Emergency Assistance
11. Emergency Dental Treatment ● Compassionate Visit
12. Oral Incision and drainage ● Care of Minor Children
● Emergency Message Transmission
Note: Dental Benefit is optional for an additional fee of ● Lost Luggage or Document Assistance
Annual fee: P387, Semi-annual: P209 ● Legal and Interpreter Referrals
● Pre-Trip Information
● Mobile App Services

VII. ADDITIONAL BENEFIT

• Life Insurance coverage with Accidental IX. DREADED DISEASE / CONDITION


Death, Dismemberment & Disablement
up to Php50,000
Any condition that is considered to be chronic,
• Initial Treatment within 24 hours from time of
progressive, life-threatening and which may entail
bite of Animal bites - subject to MBL (except
life long therapy wherein complete cure cannot be
cost of vaccines)
ensured
• Succeeding treatment after 24 hours from time of
bite of Animal bites - subject to MBL (except cost COVERAGE FOR DREADED AND
of vaccines) NON-DREADED CONDITIONS
• Vaccines for treatment of tetanus and animal
bites (including administration fee but excluding 1st year of membership:
ER Fees) - up to P18,000/member/year (shared
limit for OP and IP) • Dreaded and Non-dreaded covered
• Scoliosis including necessary procedures, subject to below limits:
except physical therapy sessions, whether
congenital, pre-existing, developmental or
acquired - Up to P20,000/member/year Plan Type Per illness per
(shared limit for OP and IP) member per year
Note: Physical Therapy sessions shall form part of the
Physical therapy/ Occupational therapy limits Platinum Plus Php 20,000
• Congenital Conditions except physical therapy
sessions and developmental disorders - up to Platinum Php 15,000
P20,000/member/year (shared limit for OP and IP)
Note: Physical Therapy sessions shall form part of the Gold Php 10,000
Physical therapy/ Occupational therapy limits
• Chronic Dermatoses - Consultations only
• Hepatitis B - Not Covered
Silver Php 5,000
• Wellness Program - Not Covered
Subsequent years of membership: k) Chronic Genito-urinary Disorders
• Dreaded conditions not considered l) Chronic Kidney Disease/Failure & its
acquired are covered subject to below complications
limits: m) Chronic Liver Parenchymal Diseases such as
Plan Type Per illness per but not limited to Liver Cirrhosis, Chronic
member per year hepatitis, Non-alcoholic Fatty Liver
Disease/Steatohepatitis (NASH), New growth
Platinum Plus Php 20,000 n) Chronic Pulmonary Diseases such as but not
limited to Bronchial Asthma, Chronic Obstructive
Platinum Php 15,000 Pulmonary Disease (COPD), emphysema, and
other chronic lung disease
Gold Php 10,000 o) Collagen Vascular/Connective
Tissue/Immunologic Disorders such as but not
Silver Php 5,000 limited to Systemic Lupus Erythematosus,
scleroderma, rheumatoid arthritis and its
complications
• Non-dreaded conditions shall be p) Complications of immuno-compromised clinical
covered up to MBL conditions except HIV/AIDS
• Acquired dreaded conditions shall q) Extrapulmonary Tuberculosis including Pott's
be covered up to MBL disease and Multi-Drug Resistance Case (MDR)
case
Such dreaded conditions are as follows, but not r) Multiple Organ Failure
limited to: s) Muscular Dystrophies such as but not limited to
Duchenne, Becker, limb girdle,
a) All malignancies (including indicated facioscapulohumeral, myotonic,
chemotherapy or radiotherapy) oculopharyngeal, distal, and Emery-Dreifuss
b) Arthritis t) Neuro-surgical interventions and/or major
c) Blood Dyscrasias such as but not limited to neurological diseases such as but not limited to
Leukemia, Idiopathic Thrombocytopenic Poliomyelitis/Meningitis/Encephalitis,
Purpura, Lymphoma Demyelinating Neurologic diseases and its
d) Chronic Cardiovascular Diseases and its complications/sequelae and Peripheral Nervous
complications such as but not limited to System Disorders/Diseases; Neurosurgical
Uncontrolled Hypertension of whatever conditions: brain tumors, arteriovenous fistula,
etiology, Aortic Dissection, Abdominal Aortic aneurysm and other
Aneurysm, Myocardial infarction, Cardiac u) Previous craniotomy sequelae
Arrest, Congestive Heart Failure, Cardiac v) Slipped disc
Arrhythmia, Cardiac Tamponade, Coronary w) Spinal Stenosis
Artery Disease, Cardiomyopathies and x) Thyroid Dysfunctions due to disease of thyroid
Valvular Heart Disease except Mitral Valve such as but not limited to Hypothyroidism and
Prolapse, Aortic Dissection, Abdominal Hyperthyroidism
Aortic Aneurysm and Peripheral Vascular y) Any illness other than above which would require
Disease and its complications such as but Critical Care/Intensive Care Unit (ICU)
not limited to Buerger's Disease Confinement
e) Chronic Glomerulonephritis z) All complications resulting from above list of
f) Cataract and Glaucoma conditions
g) Cerebrovascular Diseases such as but not
limited to Stroke, Cerebral, Cerebellar, Such non-dreaded conditions are as follows, but not
Thrombosis, Embolism and Ruptured limited to:
aneurysm and all Intracranial Hemorrhage
and related conditions a) All benign tumors, except those causing
h) Cholecystolithiasis and Choledocholithiasis compression and obstructive symptoms or
i) Chronic Endocrine Disorders and its complications
complications such as but not limited to b) Anal Fistulae
Dyslipidemia, Obesity, Diabetes Mellitus, c) Cervical Polyps (if benign biopsy)
Hormonal Dysfunctions excluding surgical d) Conjunctivitis (except chemical, complicated)
treatment/procedures for obesity. Endometriosis/Controlled Dysfunctional Uterine
j) Chronic Gastrointestinal Diseases such as but Bleeding (except if caused by uterine malignancies)
not limited to Irritable Bowel Syndrome, Crohn's e) Hearing impairment
disease
f) Hemorrhoids iii. Necessary laboratory examinations
g) Uncomplicated Hepatitis A or diagnostic procedures may be
h) Gastritis, Duodenitis or Uncomplicated Gastric /
Duodenal Ulcer requested by the Maxicare primary
i) Inactive Pulmonary Tuberculosis care physician or Coordinator using
j) Migraine the Maxicare Laboratory Request
k) Non-surgical Ear-Nose-Throat conditions such as but Form. Member then proceeds to the
not limited to Sinusitis, Rhinitis, Tonsillopharyngitis,
Laryngitis, Parotitis, Otitis Media, Otitis Externa and laboratory where the tests will be
Surgical performed. Results of the tests may
Ear-Nose-Throat conditions such as but not be followed up with the Maxicare
limited to Tonsillectomy, Nasal Polypectomy, primary care physician or
Tympanoplasty, Sialolithotomy, Sialodochoplasty. Coordinator.
l) Non-Toxic Goiter (if uncomplicated Note: Referral Slips and Laboratory Slips* are
m) Ovarian cysts Uncomplicated Cholecystitis, necessary in order for the doctor to know that Maxicare
Cholelithiasis is to be billed for the procedure. For queries and
n) Uncomplicated Hernias (Congenital Hernia will have assistance, please call Maxicare Hotline at (02) 8582-
coverage as listed in the Congenital Clause)
o) Uncomplicated Hypertension 1900.
p) Uncomplicated Urinary Tract Infection,
Stones/Calculi 2. IN-PATIENT SERVICES
q) Urinary Incontinence
a) Upon recommendation of the Maxicare primary
X. AVAILMENT PROCEDURES care physician or Coordinator, the Member may
be admitted to the hospital either on emergency
or Elective Confinement.
1. OUT-PATIENT/NON-EMERGENCY SERVICES
b) For proper monitoring and notification of
a) Any out-patient or non-emergency confinement by Maxicare, the Member must
services are accommodated by the present the Maxicare ID Card to the hospital’s
Maxicare primary care physician at any admitting section immediately upon admission.
Likewise, said section must be notified by the
Maxicare Primary Care Center (PCC).
Maxicare Coordinator of room-and-board
Please refer to the list and location of entitlement for proper room accommodation.
Maxicare PCCs and helpdesks on the 1. Room upgrading during an Elective
inside back cover. Confinement is allowed. However,
the difference in the room-and-
b) If any of the PCCs is inaccessible to the board, doctor’s Professional Fees
Member, he may proceed to any and incremental costs incurred shall
Maxicare Affiliated Hospital/Medical be charged to and settled by the
Clinic and must go through the Maxicare Member upon discharge.
Coordinator. 2. In an emergency confinement
i. Prior to availment, Member shall where room entitlement may not be
present his Maxicare ID Card and, available, room upgrading is
another valid identification card (e.g., allowed subject to the conditions
company ID, SSS ID, driver’s
license, or other ID cards bearing c) Once confinement is monitored, Maxicare
photo and signature) for verification. prepares the LOA, which contains Maxicare’s
For cases when the Maxicare ID extent of coverage on availment. This is issued
card is not available, the Maxicare by the Maxicare representative to the hospital
Certification can be honored. where the Member is admitted.
ii. The Maxicare Coordinator shall
diagnose the Member for any d) All provisions indicated in the LOA shall be
ailment. Appropriate medical discussed by the Maxicare representative with
treatment will then be given or the Member on the first or second day of
confinement may be recommended, confinement. This informs the Member of any
if necessary. If a medical case charges that will not be shouldered by Maxicare,
requires treatment or consultation as well as other requirements pertinent to the
with another specialist, the Maxicare availment. The Member must indicate his
primary care physician or conforme to the LOA provisions by signing the
Coordinator may refer accordingly. same.
Note: For queries and assistance, call
Maxicare Hotline: (02) 8582-1900.
3. EMERGENCY CARE SERVICES
A life threatening or accidental injury or a sudden and • Individual Membership Requirements:
unexpected onset of a condition which at the time of 1. Application form
the occurrence reasonably appears to have the 2. 1 Valid ID/Copy of Birth Certificate
potential of causing immediate disability or death, or 3. Photocopy of ACR (Alien Certificate of
which Residency) if nationality is foreign
requires the immediate alleviation of pain or • Family Membership Requirements
discomfort. Couples only:
1. Application form
2. Copy of marriage certificate
a. Affiliated Hospitals 3. Photocopy of ACR (Alien Certificate of
i. Once confinement is determined, the
Residency) if nationality is foreign
Member must notify MAXICARE HEAD
With child dependent:
OFFICE, through the customer care 1. Application form
department, WITHIN 24 HOURS so that 2. Copy of birth certificate (each child)
proper assistance is promptly rendered. 3. Photocopy of ACR (Alien Certificate of Residency)
b. Non-Affiliated Hospitals if nationality is foreign
i. After treatment at the emergency room, all Note: Maxicare may request for additional
necessary receipts and clinical records requirements when deemed necessary
must be secured by the Member for
processing of claim for reimbursement. HIERARCHY OF ENROLLMENT:
ii. The Maxicare claim for reimbursement form, • Unless there is a valid reason for the
medical certificate and all pertinent non enrollment of certain dependents
documents must be promptly (i.e. currently enrolled in another HMO,
accomplished and submitted to Maxicare abroad, separated, deceased, etc.),
Head Office within thirty (30) days upon the date applicants should enroll their
of discharge. dependents in the priority specified
above.
XI. ENROLLMENT PROCESS AND • Sufficient documentation shall be
GUIDELINES requested by Maxicare from the
applicant to validate the non-eligibility of
1. Fill out the IF application form completely. the dependent (i.e. photocopy of HMO
2. Dependent’s plan must be the same plan as the card, certificate of employment from
principal or one plan lower.
company abroad, death certificate, etc.)
3. Forward the accomplished application form and other
requirements needed (if applicable) to the Account
Officer for processing. REQUIREMENTS FOR ALIEN RESIDENTS/
4. Once the application has been approved, the FOREIGN NATIONALS:
Statement of Account shall be sent to your billing
address for settlement. Payments (cash or check) 1. Photocopy of ACR (Alien Certificate of
may be made at the Maxicare Head Office or at any Residency) ID
Banco de Oro branches via bills payments. 2. Certificate of employment (if applicable)
5. Members will receive a Maxicare ID card as proof of
membership. XIII. EXCLUSIONS AND LIMITATIONS

Who may be enrolled into the Maxicare Program Notwithstanding any provisions to the contrary, the
and what are the requirements? following shall not be covered except otherwise
specified in Agreement:
• The age eligibility for principal and 1. Services obtained for non-emergency conditions
dependents are from 15 days old to 60
from Physicians and Hospitals in any of the
years and 5 months of age.
following circumstances:
• Eligible dependents are as follows (in
a. Non-affiliated physicians in non-affiliated
order):
✓ For single enrollees: Mother, Father, hospitals or clinics;
then Siblings 21 years and 5 months b. Non-affiliated physicians in affiliated
old and below, according to age. hospitals or clinics;
✓ For married enrollees: Spouse, then c. Affiliated physicians in non-affiliated
Children 21 years and 5 months old hospitals or other non-affiliated
and below, according to age. healthcare facilities.
2. Additional hospital charges and physician’s
professional fees resulting from:
a. Room-upgrading beyond member’s allowable time
during emergency care;
b. Extension of hospital stay despite commission of a crime whether consummated or
release of discharge order from member’s not
attending physician; e. Violation of a law or ordinance
f. Unnecessary exposure to imminent danger,
c. Fees of the assistant surgeons/ resident knowingly or unknowingly or hazard to health, by
doctors who assisted the Attending Physician the member.
in the process of rendering the above-
Note: Maxicare shall be given a copy the police or
mentioned services shall not be chargeable to
doctor's report (the “Report”), if any. To determine
the Member and/or Maxicare except for
whether or not such treatment is an exclusion under
hospitals that do not have resident physicians this paragraph, Maxicare may rely on the Report, as
to assist during surgeries subject to the prior well as on the evaluation of its own medical resource
approval of Maxicare group provided, however, that if Maxicare has yet to
d. Use of extra bed, TV, electric fan, DVD/VCD, receive the Report or the evaluation of its medical
and other similar items unless such resource group, the Member shall shoulder the
appliances and items are expenses for medical treatment subject to
necessarily and ordinarily included in Maxicare’s reimbursement should it be found, after
the Member’s Room & Board submission of pertinent documentary evidence, that
Accommodation; the treatment is not an exclusion under this
e. Extra food; paragraph. Reimbursement will be based on
f. Toilet articles like face towel, soap, toothbrush Maxicare standard rates and will be based on the
and the like; terms and conditions of this Agreement.
g. Difference in room and board, the
incremental rate differences for professional 8. Aesthetic, cosmetic and reconstructive surgery or
fees, diagnostic and laboratory any consultation or treatment for any beautification
examinations, and other ancillary medical purposes except if necessary to treat a functional
services brought about by obtaining a room defect due to accidental injury within the initial
accommodation higher than the Member’s confinement.
Room and Board Accommodation limit; 9. Oral surgery following accidental injury to teeth for
h. Services of a private or a special nurse; purposes of beautification. Dental examinations,
i. All other items not medically necessary in the extractions, fillings, other dental
medical management of the patient treatment and their complications to the extent
3. Custodial, domiciliary, convalescent and that are medically necessary for repair or
intermediate care. alleviation of damage to the m e m b e r caused
4. Long-term rehabilitation and psychiatric care solely by an accident. Medical care resulting from
and/or psychological illnesses and conditions any dental related conditions.
including neurotic and psychotic behavior 10. Maternity care and all other conditions, including
disorders; anxiety disorders. pre- and post-natal consultations, related to
5. Treatment for injury and its complications and/or resulting from pregnancy and/or delivery
which affect the conditions of the principal
resulting from self-inflicted injuries including
member and the unborn child.
infections as a result of tattoos, piercing of the ear
11. Circumcision (except for treatment of urological
or in any body part, whether self-inflicted or done
conditions), sex transformation, diagnosis,
by a third party or attempted suicide or self-
treatment and procedures related to fertility or
destruction, whether sane or insane.
infertility, artificial insemination, sterilization or
6. Developmental disorders including functional
disorders of the mind, such as but not limited to reversal of such procedures and their
Attention-Deficit Disorder complications.
(ADD)/Attention-Deficit Hyperactivity Disorder 12. Experimental medical procedures and its
(ADHD), Autism Spectrum Disorders, Bipolar complications.
Disorders, Central Auditory Processing Disorder 13. Acupuncture and cryotherapy and o t h e r
(CAPD), Cerebral Palsy, Down Syndrome, forms of therapies, and its complications.
Neural Tube Defects, and Mental Retardation. 14. All expenses incurred in the process of
7. Treatment of any injury received when there is: organ donation and transplantation if the
member is the donor of such donation or
a. Negligence
transplantation, and its complications.
b. Unauthorized use of prohibited drugs or
regulated drugs
c. Alcoholic liquor intake
d. Direct or indirect participation in the
15. Routine physical examinations required for epidemic or pandemic by the Department of
obtaining or continuing employment, Health, World Health Organization or any
requirement in school, insurance, recognized health authority.
government licensing, health permit and 28. Hepatitis B and screening and vaccines for all types
other similar purposes. of Hepatitis.
16. Purchase or lease of durable medical 29. Benefits covered by PhilHealth and all other
equipment, oxygen dispensing equipment, and government funded healthcare entitlements
oxygen, except during in-patient care. as provided for by law.
17. Corrective appliances, prosthetics and 30. Speech therapy for developmental and
orthotics such as but not limited to eye glasses congenital diseases.
and contact lenses, hearing aids, pacemaker, 31. Weight reduction programs, surgical operation or
artificial limbs, valves, procedure for treatment of obesity, including gastric
knee-tibial insert for total knee arthroplasty, stapling or balloon procedures and liposuction
vascular grafts, titanium thread, myringotomy 32. Cost of vaccines and immunization
tube, intravascular catheters, vascular stents, including its administration.
bone screws/plates, pins, wires, balloons, 33. Cost of medico-legal cases.
orthopedic internal fixator/fixation systems, 34. Routine medical examination or check up or medical
orthopedic external fixator/fixation systems, examination for employment or medical examination
intraocular lens, braces, crutches, for travel.
herniorrhaphy mesh or mesh used for 35. Intravenous Immunoglobulin (IVIG).
herniorrhaphy. 36. Treatment of work-related injuries of high-risk
18. Take-home medicine and outpatient medicine occupations such as but not limited to construction
except workers, miners, loggers and drillers.
a. Chemotherapy m e d i c i n e ( except f o r 37. Cost of the medical services and Professional Fees
c a n c e r treatment in excess of the MBL.
b. Medicine a d m i n i s t e r e d d u ring a n emergency 38. Guillain-Barre Syndrome
treatment. 39. Multiple sclerosis, epilepsy and seizures.
19. Congenital, genetic and heredity disease and their 40. Routine, diagnostic, therapeutic and other
complications (except for hernias) affecting functions procedures of the same or similar nature not
of individuals.
otherwise specified in this Agreement
20. All physical deformities prior to enrollment.
21. Treatment of injuries/illnesses caused 41. Open heart surgeries, angioplasties, valvuloplasty,
directly or indirectly by engaging in any permanent pacemaker, balloon valvuloplasty,
professional sport or hazardous activity percutaneous intra-aortic balloon counter pulsation
such as but not limited to scuba diving, and balloon atrial septostomy.
surfing, water skiing, mountain climbing, 42. All cases of assault whether provoked or unprovoked,
rock climbing, mountaineering, whether initiated by the Member or by a known or
parachuting, airsoft, drag racing, unknown third party.
paintballing, wakeboarding and bungee 43. Home service.
jumping, except for activities under 44. Laser procedures or treatments.
company-sponsored sports activities. 45. Neurologic degenerative diseases such as but not
22. Injuries resulting from direct participation in limited to Alzheimer’s disease, Parkinson’s disease,
riots, strikes, and other civil disturbances. amyotrophic lateral sclerosis
23. Treatment of injuries or illnesses resulting from 46. All screening tests.
war or any combat-related activities while in
military service.
24. Sexually transmitted diseases, genital warts,
AIDS and AIDS related diseases.
25. Pre-existing Conditions
a. Dreaded
b. Non-dreaded
Note: Please refer to the Dreaded and
Non-dreaded above provision
26. Treatment for Chronic Dermatoses, except
Scabies.
27. Infectious diseases (i.e. Avian Flu,
Meningococcemia, etc.) that are declared
OTHER PROVISIONS:

ENHANCED ACTIVATION POLICY

For Individual and Family

OR Issuance Effectivity will be after


Date 7th calendar days

**Effective on October 25, 2021

LAPSATION

If a member fails to pay a membership fee on its


due date, his or her membership shall be
considered lapsed effective the day after the due
date. A member whose membership has lapsed
will not be entitled to any Benefit during the period
that his membership is on a lapsed status, except
in connection with illness or injury that
supervened prior to such lapsation and for which
the member had at that time made the necessary
claim for the benefits under this Agreement.

REACTIVATION

A Member whose coverage has lapsed may apply


to reactivate his or her coverage within fifteen (15)
days from end of Grace Period by (a) submitting a
written request for reactivation; (b) paying the
Membership fee due with arrears, including the
penalty charge of five hundred pesos (Php500) per
Member; (c) for modes of payment other than
annual, paying in advance the Membership fee due
for the next period.
Suspension of benefits under this Agreement shall
be in force until such time the Member shall have
paid in full all fees required in reactivation of his or
her coverage and within thirty (30) days from the
effective date of reactivation.
After forty-five (45) days from the due date and all
fees required in reactivation of coverage is not yet
paid and settled, Maxicare reserves the right to
disapprove reactivation. However, Member may
re-apply subject to approval of the Maxicare
Underwriting Department.

***May change without prior notice***


2024 INDIVIDUAL MEMBERSHIP FEES
PLATINUM PLUS PLATINUM
Large Pvt Reg Pvt
AGE BRACKET 250,000 MBL AGE BRACKET 200,000 MBL
MODE OF PAYMENT MODE OF PAYMENT
SEMI-
ANNUAL SEMI-ANNUAL ANNUAL ANNUAL
15 days old -5
y.o. 68,955 37,236 15 days old -5 y.o. 40,422 21,828
6-10 y.o. 56,459 30,488 6-10 y.o. 32,382 17,486
11-15 y.o. 46,526 25,124 11-15 y.o. 26,062 14,073
16-20 y.o. 45,069 24,337 16-20 y.o. 24,068 12,997
21-25 y.o. 44,814 24,200 21-25 y.o. 25,109 13,559
26-30 y.o. 46,526 25,124 26-30 y.o. 27,764 14,993
31-35 y.o. 55,755 30,108 31-35 y.o. 32,908 17,770
36-40 y.o. 70,098 37,853 36-40 y.o. 43,354 23,411
41-45 y.o. 89,036 48,079 41-45 y.o. 58,946 31,831
46-50 y.o. 106,059 57,272 46-50 y.o. 79,548 42,956
51-55 y.o. 119,664 64,619 51-55 y.o. 96,949 52,352
56-60 y.o. 132,136 71,353 56-60 y.o. 109,786 59,284
GOLD SILVER
Reg Pvt Semi-Pvt

AGE BRACKET 150,000 MBL AGE BRACKET 100,000 MBL


MODE OF PAYMENT MODE OF PAYMENT
SEMI-
ANNUAL SEMI-ANNUAL ANNUAL ANNUAL
15 days old -5
y.o. 35,784 19,323 15 days old -5 y.o. 26,517 14,319
6-10 y.o. 28,014 15,128 6-10 y.o. 22,094 11,931
11-15 y.o. 23,049 12,446 11-15 y.o. 18,697 10,096
16-20 y.o. 22,056 11,910 16-20 y.o. 17,785 9,604
21-25 y.o. 21,546 11,635 21-25 y.o. 17,785 9,604
26-30 y.o. 25,278 13,650 26-30 y.o. 20,233 10,926
31-35 y.o. 30,485 16,462 31-35 y.o. 21,794 11,769
36-40 y.o. 40,013 21,607 36-40 y.o. 26,539 14,331
41-45 y.o. 51,238 27,669 41-45 y.o. 39,785 21,484
46-50 y.o. 61,423 33,168 46-50 y.o. 47,625 25,718
51-55 y.o. 64,249 34,694 51-55 y.o. 47,638 25,725
56-60 y.o. 74,914 40,454 56-60 y.o. 52,925 28,580

NOTES:
• Above rates are inclusive of 12% VAT
• With access to all affiliated hospitals and clinics EXCEPT Healthway Clinics
• Status quo benefits and arrangements including the following:
a. ACU/ECU type: ACU Basic 5 only (applicable to ALL plan types)
b. Philhealth provision: Required to file Philhealth. Non-Philhealth members will pay for the Philhealth
portion.
c. Riders: Built-in on Rates
• International Assistance Program
• Group Life Insurance with Accidental Death, Dismemberment & Disablement (ADD&D)
up to Php 50,000

Separate
e Fee
e
Rider 2023 Rates

Annual Semi-Annual

Standard Dental Benefit 387 209


2024 FAMILY MEMBERSHIP FEES
PLATINUM PLUS PLATINUM
Large Pvt Reg Pvt
AGE BRACKET 250,000 MBL AGE BRACKET 200,000 MBL
MODE OF PAYMENT MODE OF PAYMENT
SEMI-
ANNUAL SEMI-ANNUAL ANNUAL ANNUAL
15 days old -5
y.o. 56,386 30,448 15 days old -5 y.o. 36,727 19,833
6-10 y.o. 46,142 24,917 6-10 y.o. 29,505 15,933
11-15 y.o. 40,196 21,706 11-15 y.o. 23,929 12,922
16-20 y.o. 36,672 19,803 16-20 y.o. 21,897 11,824
21-25 y.o. 37,033 19,998 21-25 y.o. 23,404 12,638
26-30 y.o. 38,784 20,943 26-30 y.o. 25,784 13,923
31-35 y.o. 43,864 23,687 31-35 y.o. 31,028 16,755
36-40 y.o. 50,061 27,033 36-40 y.o. 39,227 21,183
41-45 y.o. 64,810 34,997 41-45 y.o. 50,971 27,524
46-50 y.o. 86,954 46,955 46-50 y.o. 68,148 36,800
51-55 y.o. 102,218 55,198 51-55 y.o. 83,139 44,895
56-60 y.o. 117,436 63,415 56-60 y.o. 97,832 52,829
GOLD SILVER
Reg Pvt Semi-Pvt

AGE BRACKET 150,000 MBL AGE BRACKET 100,000 MBL


MODE OF PAYMENT MODE OF PAYMENT
SEMI-
ANNUAL SEMI-ANNUAL ANNUAL ANNUAL
15 days old -5
y.o. 29,542 15,953 15 days old -5 y.o. 23,243 12,551
6-10 y.o. 23,810 12,857 6-10 y.o. 18,935 10,225
11-15 y.o. 19,634 10,602 11-15 y.o. 16,255 8,778
16-20 y.o. 17,540 9,472 16-20 y.o. 15,445 8,340
21-25 y.o. 17,292 9,338 21-25 y.o. 15,392 8,312
26-30 y.o. 20,356 10,992 26-30 y.o. 17,076 9,221
31-35 y.o. 23,766 12,834 31-35 y.o. 18,497 9,988
36-40 y.o. 30,119 16,264 36-40 y.o. 22,028 11,895
41-45 y.o. 37,531 20,267 41-45 y.o. 31,730 17,134
46-50 y.o. 47,804 25,814 46-50 y.o. 39,535 21,349
51-55 y.o. 50,202 27,109 51-55 y.o. 39,711 21,444
56-60 y.o. 58,113 31,381 56-60 y.o. 44,098 23,813

NOTES:
• Above rates are inclusive of 12% VAT
• With access to all affiliated hospitals and clinics EXCEPT Healthway Clinics
• Status quo benefits and arrangements including the following:
a. ACU/ECU type: ACU Basic 5 only (applicable to ALL plan types)
b. Philhealth provision: Required to file Philhealth. Non-Philhealth members will pay for the Philhealth
portion.
c. Riders: Built-in on Rates
• International Assistance Program
• Group Life Insurance with Accidental Death, Dismemberment & Disablement (ADD&D)
up to Php 50,000

Separate
e Fee
e
Rider 2023 Rates

Annual Semi-Annual

Standard Dental Benefit 387 209


MAXICARE PRIMARY CARE CENTERS were put CEBU BUSINESS PARK
together with your convenience in mind. These are well- Lot 5, Block 6, Mindanao Avenue, Cebu Business Park,
appointed to give the cardholders access to quality health Ayala, Barangay Luz, Cebu City
care close enough to where they work or live. Each center Tel No: (032) 260-9067 local 7402
has its staff of Customer
Service Assistants, Primary Care Physicians CEBU SKY RISE
(specialists in some centers on certain days) and Block 8, Lot 3 Cebu IT Park Subdivision, Barangay
additional services like urinalysis and CBC. Because Apas, Cebu City
our centers are located close to major hospitals, our Contact No: (032) 260 9069
Email: pcc.cebuskyrise@maxicare.com.ph
Customer Service Assistants are able to facilitate easy
access to quality diagnostics, specialist consultation
CLARK
and hospitalization when you need it.
SM Clark, Manuel A. Roxas Highway, Clark Freeport,
MAXICARE PRIMARY CARE CENTERS AND Pampanga, Angeles City
MYHEALTH CLINICS Contact No: (045) 8599 8392
Email: pcc.clark@maxicare.com.ph
ABREEZA MALL DAVAO
G/F, Space 1C-1D, Abreeza Corporate Center, DOUBLE DRAGON
J.P Laurel Avenue Bajada, Davao City Ground Floor, Double Dragon Meridian Park. EDSA
Email: pcc.davao@maxicare.com.ph Exit corner Macapagal Avenue, Pasay City Contact
No: 7908-6967, local 6966 and 6967
ALABANG NORTHGATE Email: pcc.doubledragonmp@maxicare.com.ph
G/F Southkey Hub, Indo-China Drive, Northgate
Cyberzone Filinvest, Alabang, Muntinlupa City ETON CENTRIS
Contact No: (02) 79086960 Commercial Space 2, Cyberpod 5 Eton Centris, Edsa
Corner Quezon Ave. Brgy. Pinahan, Quezon City Tel No:
Email: pcc.alabang@maxicare.com.ph
Contact No: (02) 7908 6925

AYALA NORTH EXCHANGE


2ND Flr. Ayala North Exchange, Ayala Avenue Makati City FAIRVIEW
Contact No: (02) 7908 6902 Unit 1&2 AD Center (beside PNB), Regalado
Email: Ave, Fairview QC
pcc.ayalanorthexchange@maxicare.com.ph Contact No: (02) 7798-7739

BACOLOD IMUS
G/F LOPUES MANDALAGAN Building, Lacson St., Metro MPC Building, Imus, Cavite
Mandalagan, Bacolod City Contact No: (046) 419-8017
Contact No: (034) 458 6715 Email: pcc.imus@maxicare.com.ph
Email: pcc.bacolod@maxicare.com.ph
ILOILO
BAGUIO Retail 4, Three Techno Place, Iloilo Business Park
G/F Patria de Baguio, Porta Vaga Mall, Session Road, Megaworld ILO, Mandurriao, IloIlo City, IloIlo Contact
Baguio City No: (033) 323 9254
Contact No: (074) 661 8833 Email: pcc.iloilo@maxicare.com.ph
Email: pcc.baguio@maxicare.com.ph
SOLENAD LAGUNA
G/F Solenad 2, Nuvali, Sta. Rosa, Laguna Contact
BRIDGETOWNE
2FM Exxa Tower C-5 Road, Barangay Ugong Norte, Libis No: (049) 559 8008
Quezon City Email: pcc.laguna@maxicare.com.ph
Contact No: 8908-6959
Email: pcc.bridgetowne@maxicare.com.ph VV SOLIVEN
GF-SOL1 (Centro Del Sol), VV Soliven Shopping
Complex, EDSA Greenhills, San Juan City Contact
CAGAYAN DE ORO
No: (02) 7798 7788, (02)7798 7739
G/F Primavera City Citta Verde, Pueblo De Oro, Upper
Carmen, Cagayan De Oro Email: pcc.vvsoliven@maxicare.com.ph
Contact No: (088) 864 8804
W CITY CENTER
Email: pcc.cdo@maxicare.com.ph
Ground Floor, W City Center, 7 th Avenue cor. 30th St.,
Bonifacio Global City, Taguig
Contact Nos: 8908-6957
Email: pcc.bgc@maxicare.com.ph
MY HEALTH CLINIC – TAGUIG CITY GENERAL SANTOS
2nd Floor, Venice Grand Canal Mall, McKinley General Santos Doctors’ Hospital Engineering Office
Hills, Taguig City Ground Floor near 1B Station National Highway,
Tel Nos: (+632)8784-6930 General Santos City
Clinic Hours: Open 24 hours daily Tel. Nos: (083) 8553-3963

MY HEALTH CLINIC- SHANGRILA ILOILO


Unit 146, Level 1 Shangri La Plaza 2nd Floor, M22 AJL Annex Bldg.
Mall, Mandaluyong City cor. Ibarra & General Luna Sts., Iloilo City
Tel. Nos.: (02) 8570-4325 loc. 206 Tel. No: (033) 8337-1051
Clinic Hours: 7am- 8pm Monday- Sunday

MY HEALTH CLINIC- NORTH EDSA


2nd Floor, North Link Bldg., F, SM City North HELPDESK
Edsa North Avenue, Quezon City
Tel. Nos.: (02) 8441-4106 loc. 206 VICTOR POTENCIANO MEDICAL CENTER
Clinic Hours: 7am-9pm, Monday-Sunday Ground Floor, Doctor’s Building Victor Potenciano
Medical Center, EDSA, Mandaluyong City
MY HEALTH CLINIC- FESTIVAL MALL Tel. No.: (02) 8464-9999 local 231
21 Style Blvd, Festival Mall, Alabang, Muntinlupa
City Tel. Nos.: (02) 8850-4855 loc.102; Telefax MANILA DOCTORS HOSPITAL
(02)8 809- 4388 Room 220, Manila Doctor's Hospital, 667 UN Ave,
Clinic Hours: 7am-8pm Monday to Saturday Ermita, Manila
Tel. No.: (02) 8524-3011 local 4510
MY HEALTH CLINIC- ROBINSON’S CYBERGATE
3rd Floor, Room 305-306, Robinson’s Cybergate Mall, CEBU HELPDESK
Fuente Osmeña Street, Cebu City 4F, Robinsons Cybergate Mall Cebu City
Tel. Nos.: (032) 8268-8502 loc. 204 or 205 Tel. No.: (032) 8402-7901 loc. 9110
Clinic Hours: 7am-7pm Monday to Saturday
APPLE ONE CEBU
Apple One Building Mindanao Ave. cor. Biliran Road
Cebu Business Park, Cebu City
REGIONAL CUSTOMER CARE CENTERS
BACOLOD HELPDESK
BACOLOD Unit 108, VLI Medical Plaza Bldg. Ipil St., Capitol
Rm. 215 North Point Building Business Center, Bacolod
B.S. Aquino Drive, Bacolod City Tel. No.: (083) 8552 5662
Tel. Nos: (034) 8433-3044 | (034) 8434-9230
CAGAYAN DE ORO ASIAN HOSPITAL & MEDICAL CENTER
2/F Unit 215, De Leon Bldg. Upper Ground Floor, Tower 2 Asian Hospital & Medical
Yacapin St. Cor Velez St., Cagayan De Oro Center 2205 Civic Drive, FCC Alabang, Muntinlupa Tel.
(08822) 71-47-25 | 71-47-26 No.: (02)8836-7493

DAVAO CAPITOL MEDICAL CENTER


2nd Floor Room 17 Jocar Complex Room 1101, 11th Floor, Capitol Medical Center Scout
C. de Guzman Steet, Davao City Magbanua St. Cor. Scout Magbanua Quezon City Tel.
(082) 8227-2941 | 8300-5553 No.: (02) 8372 3825 local 5101

*For Providers’ Directory, please refer to List of


Accredited Hospitals & Clinics at www.maxicare.com.ph
Your Easy Guide to Maxicare’s SMS Inquiry Service (0918-889-MAXI)
1) To request list of accredited providers per area

a. Hospital Key in: prov <space> hos


<space> location Examples: prov hos makati
prov hos bacolod

b. Clinic Key in: prov <space> clinic <space> location


Examples: prov clinic makati prov clinic Ortigas

2) To request list of accredited doctors per specialization per hospital


Key in: doc <space> hospital name
<slash> specialization
Examples: doc makati med/gastro doc
riverside/cardio

3) To request doctor’s schedule and contact number per


hospital
Key in: sked<day> <space> hospital name <slash> doctor’s surname
Key words for each day: mon, tue, w e d , thu, fri, sat, sun
Examples: skedmon medical city/flandes skedsat makati med/genuino

Sales Dept: 8908 6900 locals 1155 /1141/1267


Maxicare Hotline: 8908-6900
Product Inquiry Hotline: (02) 8798-7770
International Assist Hotline: (02) 8811 2521 or (+63917) 562-2100 Customer Care
Department: 8582-1900
Toll Free No. for Provincial Inquiries (PLDT Line): 1-800-10-582-1900 SMS Inquiry:
0918-889-MAXI
www.maxicare.com.ph

Happy to assist you!


Juliet Ching
0917.8359547
02.8404.5829

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