Small and Medium Enterprises (SMEs) have continuously increases in population and competitiveness in the industry. The MaxicarePLUS is a healthcare program for this small – to – medium scale businesses, aiming to provide overall health and wellness to its employees within accessible terms and with comprehensive coverage. Thru this program, SMEs with a minimum of 10 principals (and a maximum of 99 enrollees, including qualified dependents) will be able to experience the benefits it offers.

MaxicarePlus is offered in Platinum, Gold, Silver and Bronze programs, consisting of varying Maximum Benefit Limits (MBL), and Room and Board features.

The MaxicarePlus also covers pre – existing dreaded and non – dreaded conditions up to assigned MBL per member. Annual In-Patient and Out-Patient Executive Check – ups are options that are available for this program. Other optional features include: Cancer coverage, Dental coverage, Life with Accidental Death, Dismemberment and Disablement Package, and Wellness Programs amongst others.

Healthcare Benefits

Out-Patient Care

• Consultation
• Treatment of minor injuries such as lacerations, mild burns, sprains and the likes
• Minor surgery not requiring confinement
• Eyes, ears, nose, throat (EENT) treatment
• Eye laser therapy for retinal tear, retinal hole, retinal detachment and glaucoma
• X-ray, laboratory exams, routine and diagnostic procedures as prescribed by an accredited Physician
• Cauterization of warts
• Sclerotherapy for varicose veins
• Allergy-testing, allergy screening and other related examinations
• Speech Therapy (For Stroke patients only)
• Tuberculin Test

In-Patient Care

• Room and board accommodation
• Use of operating room, intensive care unit (ICU), isolation room, recovery room
• Professional Fee/s of the attending Physician/s
• Prescribed drugs and medicines for use in the hospital
• Whole blood / human blood products and IV fluids transfusion
• X-ray, laboratory tests, diagnostic tests and therapeutic procedures incidental to confinement
• Dressings, conventional casts and sutures
• Anesthesia, Oxygen and its administration
• Standard nursing services and admission kit

Emergency Care

• Maxicare – Affiliated Hospitals

1. Doctor’s services
2. Emergency Room fees
3. Medicine used for immediate relief and during treatment
4. Oxygen, IV fluids, whole blood and human blood products
5. Dressings, casts and suture
6. X-ray, laboratory and diagnostic exams, and other medical services related to the emergency treatment of the patient
7. Room upgrade in case of room unavailability
8. Initial treatment of animal bites – covered for the first 24 hours from the time of bite
9. Ambulatory Service from affiliated hospital or clinic to another affiliated one covered up to benefit limit

• Non-Affiliated Hospitals

1. Within the Philippines – Reimbursable up to 80% of total hospital bills and Professional fees, up to Php 30,000.00 per case during the first 24 hours
2. Areas within the Philippines without Maxicare – affiliated hospital – Reimbursable up to 100% of total hospital bills and Professional fees
3. Outside the Philippines – Reimbursable up to 100% of the total hospital bills and Professional fees
4. Ambulatory Services – From non-affiliated hospital or clinic to an affiliated one covered up to Php 2,500 per conduction

Preventive Care

• Passive and active vaccines for treatment of tetanus and animal bites
• Periodic monitoring of health problems
• Health education and counseling on diet or exercise
• Health habits and family planning counseling

Other Benefits (covered up to Benefit Limit)

• Pre-existing dreaded and/or non-dreaded conditions
• (Principals only) Work-related cases
• Diagnostic procedures
• Provoked and unprovoked assault

Optional Benefits

• Benefits for Cancer cases
• Dental coverage
• Life with accidental death and dismemberment
• Wellness programs
• Annual Check-up
• Executive Check-up

General Terms and Conditions

• Account size – Minimum of 10 principals
  • – Maximum of 99 enrollees (combination of principals and dependents)
• Age Eligibility
  • – Principals: 18 to 65 years old
  • – Adult Independents: 18 to 65 years old
  • – Minor Dependents: 15 days to 21 years old
• Submission of Application Form is not required
• Membership fees can be paid on an annual, semi-annual and quaterly basis
• All benefits are subject to Maxicare’s General Exclusions and Conditions for eligible accounts