CRITERIA

Access To Clinics and Hospitals

Medical Services ( Non- emergency)
Professional Fees ( Both consultations and confinements )
Emergency Cases
OUT-PATIENT BENEFIT
Consultations (during regular clinic hours)
Specialist's Fee
Pre &
Eye Post-natal
Laser consultations
treatment for glaucoma, retinal tear, retinal hole and
retinal detachment prescribed by an Accredited Physician/specialist
warts, periungual warts, filiform warts and molluscum
excluding Lasik, PRK and the like
contagiosum, in any part of the body, including facial warts, except
Speech Therapy
Respiratory Therapy
Laboratory Exams & other Diagnostic Procedures
Minor Surgeries not requiring confinement
IN-PATIENT (PHILHEALTH INCLUSIVE)
Room and Board Accommodation
Standard Admission Kit
Use of operating room and recovery room facilities
ICU Confinement
Professional fee of attending physician
Specialist's Fee
Surgeon's Fee
Anesthesiologist's fee
Administered medicines
Oxygen and its administrations
Blood transfusions and intravenous fluids
Laboratory tests, x-rays and other diagnostic tests
Dressings,
All plaster
other items casts,related
directly and sutures
in the medical management of the
patient as deemed medically necessary by the attending Accredited
PRE-EXISTING CONDITIONS FOR PRINCIPALS & DEPENDENTS
Physician and/or coordinator
(DREADED & NON-DREADED)
SPECIAL PROCEDURES
All diagnostic/therapeutic procedures medically necessary for
treatment
Arthrocentesis
Dialysis
Non-oral Chemotherapy (for cancer treatment only)
Oral Chemotherapy (for cancer treatment only)
Physical therapy/Occupational therapy excluding subspecialties
Therapeutic Radiology: Linear Accelerator Radiotherapy, Cobalt
such as cardiac rehabilitation, pulmonary rehabilitation and the like
therapy, Brachytherapy, Radioactive Iodine, Radioactive Cesium,
Gamma Knife Microwave
Transurethral Surgery Therapy of Prostate
Stapled Hemorrholdectomy
Mammotome
3D Ultrasound except for Maternity-related cases
Photodynamic Therapy
Genotyping
Single Incision Laparoscopy Surgery (SILS)
Stereotactic Breast Biopsy
Stereotactic Radiation Therapy/Stereotactic Radiosurgery, Cyber
Knife, Gamma Knife
EMERGENCY CASES
In Accredited Facilities
In Non-Accredited Facilities
In a Foreign Territory / Country
Ambulance Service per conduction (non-accredited networks)
Professionalfees
Specialist’s fee(s)
perofconsult
attending
withphysician(s)
cardiologist, E.E.N.T.,
endocrinologist, urologist, neurologist, oncologist
Emergency Room Fees
Medicines used for immediate relief & during treatment
Whole blood/human blood product transfusions
Oxygen/I.V. fluids
Laboratory, or
Out-Patient x-ray and otherServices
Ambulatory diagnostic procedures
Professional Fees
Procedure / Treatment
CONDITIONS WITH SPECIFIC LIMITATIONS
Initial treatment within 24 hours from time of bite of Animal bites
(Under ER treatment
Suceeding and OP only)
after 24 hours from time of bite of Animal
bites
Vaccines for treatment of tetanus and animal bites (includimg
Scoliosis including necessary procedures, except physical therapy
administration fee but excluding ER Fees)
sessions, whether congenital, pre-existing, developmental or
Congenital Conditions except physical therapy sessions &
acquired
developmental disorders
Hepa-B except vaccines and screening
Motor Vehicular Accidents
Unprovoked Assault, including domestic violence, whether initiated
by the Stenosis,
Spinal member or by a known
Spondylosis andorSlipped
unknown third
Disc party
(and all other
conditions medically related to the above mentioned conditions)
Adult Hernia
Coronary Angiogram and Coronary Artery Bypass Graft
Benign Prostatic Hypertrophy
Cardiac Valvular / Rheumatic Heart Disease
Congenital Hernia
ANNUAL PHYSICAL EXAMINATIONS
Physical Examination
Chest X-ray
Stool Examination
Routine Urinalysis
Complete Blood Count
Electrocardium (ECG) for 35 y/o and above
Pap smear for females 35 y/o and above
DENTAL CARE
Dental Examination & Consultation
Emergency Dental Treatment
Oral Prophylaxis
Simple Tooth Extraction
Restorative & Prosthodontic Treatment Leveling
Temporary fillings (Unlimited)
Desensitization of Hypersensitive Teeth
Simple adjustment of dentures
Re-cementation of loose crowns, inlays & on-lays
Permanent Filling – Lightcure / Amalgam
FINANCIAL ASSISTANCE BENEFIT
Group Life Insurance Coverage (Natural Cause or Accident)
Accidental Death and Disablement
Living (Terminal Illness) Benefit for Employees Up to 65 Years Old
SPECIAL CONCESSIONS
Work-Related Illnesses / accidents
Philhealth
Bill Back Arrangement
Deleted Member Refund Provision
Room Upgrade Provision
OUT-OF-NETWORK coverage
MEMBERSHIP ELIGIBILITY
Principal
Dependents
MEMBERSHIP PARTICIPATION FOR DEPENDENTS
MAXICARE ACCREDITED NETWORK ONLY

INCLUSIVE BENEFITS
MAXICARE ACCREDITED NETWORK ONLY

INCLUSIVE BENEFITS

INCLUSIVE BENEFITS
MAXICARE ACCREDITED NETWORK ONLY
INCLUSIVE BENEFITS
MAXICARE

INCLUSIVE BENEFITS
MAXICARE
 MAXICARE

MAXICARE (Maxicare Dental Hub Only)

MAXICARE

MAXICARE

MAXICARE