MyMaxicare

A specialized program created for individuals and families, tailored – fit to their budget and what is best for you and your family.

Salient Features

Healthcare Benefits

In-Patient Care

• Room and Board Accommodation
• Use of Operating Room, Intensive Care Unit (ICU), Isolation Room and Recovery Room
• Professional fees of attending Physicians, Surgeons, Anesthesiologist and Cardio-pulmonary Specialist (for clearance before surgery and cardiac monitoring during surgery)
• Standard nursing services
• Medicines for In-patient care
• Blood product transfusions and intravenous (IV) fluids
• X-ray, laboratory examinations, diagnostic tests and therapeutic procedures incidental to confinement
• Dressings, conventional casts (plaster of Paris) and sutures

Out-Patient Care

• Consultations
• Treatment of Minor Injuries
• X-ray, laboratory examinations, routine, diagnostic and therapeutic procedures
• Minor surgery not requiring confinement
• Eye laser therapy for retinal tear / hole / detachment and glaucoma
• Cauterization of warts
• Sclerotherapy (for varicose veins)
• Speech Therapy (For Stroke patients only)
• Allergy Testing
• Tuberculin Test

Preventive Care

Passive and active vaccines for treatment of tetanus and animal bites

Emergency Care

• Affiliated Hospital

1. Doctor’s Services
2. Emergency Room Fees
3. Medicines used for immediate relief and during treatment
4. Oxygen, intravenous (IV) fluids and blood products
5. Dressings, conventional casts (plaster of Paris) and sutures
6. X-rays, laboratory, diagnostic examinations and other medical services related to the emergency treatment of the patient

• Non-Affiliated Hospital

1. Within the Philippines – Reimbursement up to 80% of the actual hospital bills and 80% of the Professional fees (based on Maxicare rates) incurred during the first twenty-four (24) hours of treatment up to Php 30,000.00 / availment / member.
2. Areas without accredited hospitals within the Philippines – Reimbursement of 100% of the total hospital bills and Professional fees (based on Maxicare rates)
3. Outside the Philippines – Maxicare shall reimburse 100% actual costs up to Php 30,000.00 / availment / member
4. Ambulance Service up to Php 2,500.00 per conduction

Additional Benefits

• Life coverage with Accidental Death & Dismemberment
• Scoliosis treatment
• Congenital illness
• Consultations for Chronic Dermatoses up to Benefit Limit
• Transurethral Microwave Therapy of Prostate

Annual Check-Up (ACU) – Applicable to all plan types

Clinic-based Annual Check-Up, consist of five (5) basic routines:

1. History and Physical Exam
2. Complete Blood Count (CBC)
3. Routine Urinalysis
4. Routine Fecalysis
5. Chest X-ray (PA and Lateral)

Dental Care (Optional)

• Annual Oral / Dental Examination and Consultation
• Emergency Dental Treatment
• Annual Oral Prophylaxis
• Simple Tooth Extractions
• Restorative and Prosthodontic Treatment Planning
• Permanent fillings
• Unlimited temporary fillings, as needed
• Desensitization of hypersensitive teeth twice a year
• Simple adjustment of dentures
• Recementation of loose crowns, inlays or onlays
• Dental nutrition and Dietary counseling
• Dental Health Education

Maxicare’s International Assist Program

• 24-hour Telephone Medical Advice
• Emergency Medical Evacuation
• Emergency Medical Repatrition
• Repatrition of Mortal Remains

Dreaded Disease Condition

This corresponds to any condition that is considered to be chronic, progressive, life-threatening and which may entail lifelong therapy. This also refers to conditions where complete cure cannot be ensured.

Coverage for Dreaded and Non-Dreaded Conditions

General Terms and Conditions

Age Eligibility (for both Principals and Eligible Dependents): 15 days old to 60 years old

Eligible Dependents are as follows (in order):

• For Single Principal Enrollees: Mother, Father, Siblings (21 years and 5 months old and below, according to age)
• For Married Principal Enrollees: Spouse, Children (21 years and 5 months old and below, according to age)

Requirements:

• Individual Membership
  • – Filled – up Application Form
  • – Medical Requirements, applicable only for enrollees aged 49 years and 6 months old and above
  • – Photocopy of Alien Certificate of Residency (ACR) if a Foreign national
• Family Membership (Couples only)
  • – Filled – up Application Form
  • – Copy of Marriage Certificate
  • – Medical Requirements, applicable only for enrollees aged 49 years and 6 months old above
  • – Photocopy of Alien Certificate of Residency (ACR) if a Foreign national
• (With Child Dependent)
  • – Filled – up Application Form
  • – Copy of Birth Certificate (per Child)
  • – Medical Requirements, applicable only for enrollees aged 49 years and 6 months old above
  • – Photocopy of Alien Certificate of Residency (ACR) if a Foreign national

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 members