MAXICARE HEALTHCARE PROGRAM

“Our commitment to good health and peace of mind…”

Is your purse ready when you get
sick?
FACT:

Despite recent economic gains, the government’s

budget for health care is still far from the international
standards set by the World Health Organization
(WHO). The DOH budget in 2007 was 1.1 percent of
the national budget, and 1.6 percent in 2006. The
DOH budget only ranked seventh among the budgets
for government agencies.
 You’ll never know when you’ll get
sick.
Here, we give you the top reasons why we recommend or clients to get an HMO

1.         It is costly to get sick. With the high prices of medicines these days and the Professional fees of doctors
do not come cheap too; they range from P250 to P1,000 per visit. And if hospitalization is required, the bill
can run up to the millions for prolonged illnesses. It is not surprising, thus, for people to go broke over
medical bills. Lifetime savings may be wiped out after one prolonged hospital stay.

2.       The government provides a health insurance to Filipinos through the Philippine Health Insurance Corp.
(Philhealth). Members can avail of coverage for medicines, hospitalization and doctor¢s fees according to
the schedules set by Philhealth. However, Philhealth coverage is not enough and covers to about 20-40%
of your hospital fees.  Members have to turn to their savings to cover all health costs.

3.       For an annual fee, HMOs can insure a person and cover preventive health care costs (check-ups,
laboratory fees) and hospitalization. The HMO has a list of accredited hospitals and health centers which
one can go to for health care. Should a person require further examination by a specialist, the HMO will
refer him to a physician accredited with them.

4.       With HMOs you don’t need to shell out cash at the hospital or doctor¢s office. The HMO takes care of
all that as long as your account is current. There is no need to scrounge around for money in the event that
a deposit has to be made to the hospital prior to admission.
What your MAXICARE CARD can
do you for YOU?
Your MAXICARE card will give you free and
unlimited access to over 300 hospitals and clinics
nationwide. Simply present your card and avail of
your benefits.

Whether it’s an emergency, confinement,

consultation or annual check up, you’d be assured
you are holding on to something, a protection not
just for you but a financial protection for your
parents, wife, kids, children AND peace of mind
 Years of Service, Extent of
Expertise
20 years of SOLID
Healthcare Expertise

1ST HMO to implement the “HOSPITAL-BASED Program”

More than 300,000 Cardholders nationwide

HMO of Choice

Best Employers in Asia/Philippines

Top 2,000 Companies in the Country
Best Employers in
Asia/Philippines
Banking & Finance Industry
Business Processing –
Outsourcing/ Contact Centers
Manufacturing Industry
Food & Retail Industry
A few of the Clients we SERVE..
Vast Network of Providers

308 Accredited Hospitals

and Clinics nationwide
(60% are Tertiary Hospitals)

Over 6,000 Top-

Caliber Accredited
Doctors (Consultants,
Fellows & Diplomates)

All Maxicare Centers

on-line with the Head
Office
 Can be used in over 300 hospitals
and clinics nationwide including:
• Alabang Medical Center
• Asian Hospital
• Capitol Medical Center
• Cardinal Santos Medical Center
• Chinese General Hospital
• De Los Santos Medical Center
• FEU-Nicanor Reyes Hospital
• Las Pinas City Medical Center
• Las Pinas Doctors Medical Center
• Makati Medical Center
• Manila Doctors Hospital
• Perpetual Help Medical Center
• St. Lukes Medical Center
• The New Medical City
• University of Santo Tomas Hospital
• University of the East-Ramon Magsaysay Medical Center

And many other top & recognized hospitals in Luzon, Visayas & Mindanao
 Extensive Customer Care Network

24/7 Call Center Primary Care Centers

(MMC, SLMC, N-TMC)

Customer Care Cebu

Division
Iloilo
Bacolod
Davao
Roving Team
General Santos

Centers in Key Cities

Corporate-Based
 THE MAXICARE
INTELLIGENT CARD
Maxicare Swipe Card
• Real-time validation of membership during
availments
• Real-time record of availments which can
be viewed via the web
• Swipe facility using more than 600 POS
units of Equitable PCIBank nationwide
•Cards need not be replaced
on a yearly basis
 MAXICARE TYPES OF
MEMBERSHIP
Type Size Age Eligibility Dependents Eligibility MEMBERSHIP FEES

Individual 1 applicant 2-60 years old, Not Applicable According to Plan of Choice, according to age
renewable up to 65
Family At least 2. Principal must be 18 to Dependent must follow Per Person, According to Plan of Choice, according to age
1 principal and 60 years old. hierarchy/order. If
at least 1 single, mother > father
dependent > eldest to youngest
sibling If married,
spouse > eldest child
>youngest child

Group 5-19 employees Employee must be 18 up At least 75% of the Per Person, According to Plan of Choice, according to age
to 60 years old employees must enroll
at least 1 dependent.
Must follow hierarchy

Corporate 20 employees & Employee must be 18 up to At least 75% of the Uniform Rates for all, Subject to a separate quotation.
up 65 years old employees must enrol at Rates on this presentation do not apply
least 1 dependent. Must
follow hierarchy
 MAXICARE INDIVIDUAL &
FAMILY HEALTHCARE
PROGRAM
PLAN TYPE ROOM & BOARD MAXIMUM ANNUAL CHECK UP
BENEFIT LIMIT

Platinum Plus Large Private 200,000 Overnight Executive Check UP

Platinum Regular Private 150,000 Executive Check Up

Gold Regular Private 100,000 Semi Executive Check Up

Silver Semi Private 60,000 Routine/Basic

1. Age eligibility is 2-60 years old renewable up to 65 years old

2. With over 600 affiliated hospitals & clinics nationwide
3. Maximum Benefit Limit is on a per type of illness/per injury per year
 I. OUTPATIENT CARE
• Medically necessary consultations during regular clinic hours,
except medicines.
• Dermatology Consultations
• Eye, ear, nose and throat (EENT) treatment
• Treatment of minor injuries such as lacerations, mild burns,
sprains and the like
• X-ray, laboratory examinations, routine, diagnostic and
therapeutic procedures prescribed by an accredited doctor
• Minor surgery not requiring confinement
• Physical Therapy/Occupational Therapy up to 12 sessions
• Laser Therapy for retinal detachment and glaucoma prescribed
by an affiliated physician up to P10,000/eye/member/year
• Cauterization of Warts up to P1,000/year / member
• Speech Therapy up to 12 sessions (Stroke Patients)
Out Patient Availment
 II. IN PATIENT CARE
• Room and Board Accommodation
• Use of Operating and Recovery Rooms
• Use of Intensive Care Unit (ICU)
• Professional Fees of attending doctor(s)
• Drugs and medicines for use in the hospital
• Whole blood and human blood products and IV fluids
• X-ray, laboratory examinations and diagnostic tests
• Dressings, casts and sutures
• Anesthesia and its administration
• Oxygen and its administration
• Laparoscopy and Lithotripsy covered up to 100% of the actual cost
• Standard nursing services
• Admission kit including ice cap and wee bag
In-Patient Availment
 III. ANNUAL CHECK UP
* according to plan of choice
Platinum Plus Plan: (Multi-Phasic B)
• CBC (Complete Blood Count)
• Blood Chemistry (FBS, HDL, Cholesterol, Creatine, Albumin, Uric Acid, Alkaline Phosphatase, Potassium, LDL,
triglycerides, SGOT, Globulin, Calcium Phosphatase, Urea, Total Cholesterol, VLDL, SGPT, Total Protein, Total Billrubin)
• Thyroid Function:TSH-IRMA
• Hepatitis Screening: BhsAg, Anti-HBs, Anti-HBc
• Routine Urinalysis
• Routine Fecalysis
• Cardiac Work-up (12-Lead ECG, Treadmill Stress Test)
• Chest x-ray
• Abdominal Work-up (Upper Gastrointestinal series, Ultrasound of liver, Gallbladder & Pancreas, barium Enema,
Proctosigmoidoscopy)
Platinum Plan : (Executive Check-up)
• Physical Examination
• Urinalysis
• Fecalysis
• Chest X-ray
• CBC (Complete Blood Count)
• Blood Chemistry – Potassium, Creatinine, Total Protein, Total Bilirubin, Triglycerides, Calcium, Uric Acid, Albumin, SGOT,
Alkaline, Fasting Blood Sugar, Phosphate
• 12 – Lead Elecrocardiogram
• Ultrasound of the Gallbladder and kidney
• Treadmill Stress Test OR Barium Enema
 III. ANNUAL CHECK UP
* according to plan of choice
Gold Plan : Semi Executive Check Up
• Physical Examination
• Urinalysis
• Fecalysis
• Chest X-ray
• CBC (Complete Blood Count)
• Blood Chemistry (FBS, SGPT, Cholesterol, Creatinine, Uric Acid)
• 12-Lead ECG
• Papsmear
Silver Plan: (Routine)
• Physical Examination
• Urinalysis
• Fecalysis
• Chest X-ray
• CBC (Complete Blood Count)
• 12 – Lead Elecrocardiogram (exclusive for 40 years old & above as an optional package)
• Papsmear (exclusive for 40 years old & above as an optional package)
 IV. PREVENTIVE CARE
• Administration of passive immunization excluding
cost of vaccines
• Periodic Monitoring of health problems
• Health education and counseling on diets and
exercise
• Health Habits and Family Planning counseling
 V. EMERGENCY CARE
A. ACCREDITED HOSPITAL
• Doctor’s services
• Emergency room fees
• Medicines used for immediate relief & during treatment
• Oxygen, intravenous fluids, whole blood & human blood products
• Dressings, casts & sutures
• X-rays, laboratory & diagnostic examinations & other medical services
related to the emergency treatment of the patient.
• Ambulance Service for accredited hospital-to-hospital transfer up to P
2,500./ per conduction (by reimbursement)

B. NON-ACCREDITED HOSPITAL
• Maxicare shall reimburse 80% of the total hospital bills and 80% of the
professional fees up to Php 30,000.

C. OUT SIDE THE PHILIPPINES

• Maxicare shall reimburse 80% of the total hospital bills and 80% of the
professional fees up to Php 30,000.
 Emergency Availment

MAXICARE Proceed to the ER of the Present MAXICARE ID

Member nearest Affiliated Hospital At Emergency Room

Avail treatment at
Emergency Room

Settle charges not covered by

Maxicare at the Billing Section File PhilHealth Avail Room Plan
once the Discharge Order is on or before Notify MAXICARE
issued by the Attending Doctor discharge Within 24hrs.
 Emergency Availment for Non-
Accredited

MAXICARE Proceed to the Emergency Avail treatment at

Member Room of nearest Hospital Emergency Room

Proceed to Room
Notify MAXICARE
Within 24hrs.

Forward all Medical

Documents to
MAXICARE HO within Settle charges all ER fees File PhilHealth
30 from discharge and secure Medical Cert. on or before
for reimbursement Original Receipts, etc. discharge
 VI. DENTAL BENEFIT
*optional

• Annual Oral/Dental Examination & Consultation

• Emergency Dental Treatment
• Annual Oral Prophylaxis
• Simple tooth extractions
• Restorative and Prosthodontic Treatment Planning
• Permanent fillings – 2 areas/year
• Unlimited temporary fillings, as needed
• Desensitization of hypersensitive teeth – 2/year
• Simple adjustment of dentures
• Recementation of loose crowns, Inlays or Onlays
 Dental Availment

Refer to Health Partners

Listing for contact numbers Call preferred dentist Proceed to
of Accredited Dentists to set appointment Dentist’s Clinic
on scheduled
date

Settle charges not Avail of Dental treatment Present MAXICARE

covered by MAXICARE or consultations Card
MAXICARE
Affiliates/Partners

Up to 20% discount on Optical Services

& Purchases
 VII. OTHER FEATURES
• Life Insurance Coverage of P25,000
• Free Emergency Overseas Medical Evacuation
• Congenital Illness up to P20,000
• Scoliosis whether congenital, pre existing or
aquired up to P20,000
 VII. OTHER FEATURES
1 st Y e a r S u b se q u e n t Y e a rs
P r e E x i s ti n gP rNeo En x i s tiPnr ge E x i s t i n Pg r e E x i s ti n g
D re a d e d D r e a d e d N o n D r e a d eD dr e a d e d
P l a n T y p Ce o n d i ti o n s C o n d i ti o nCso n d i ti o n s C o n d i ti o n s
P la t in u m P lu s 2 0 ,0 0 0 2 0 ,0 0 0 2 0 ,0 0 0
P la t in u m 1 5 ,0 0 0 1 5 ,0 0 0 1 5 ,0 0 0
U p t o C a r d L im it
G o ld 1 0 ,0 0 0 1 0 ,0 0 0 1 0 ,0 0 0
S ilve r 5 ,0 0 0 5 ,0 0 0 5 ,0 0 0
A c q u ire d c o n d it io n s a r e c o ve re d u p t o c a rd lim it fro m t h e 1 s t y e a r
 VIII. NON DREADED & DREADED CONDITIONS
NON DREADED CONDITIONS
Hernias
Tumors/Neoplasms
Hemorrhoids
Ear-Nose Throat Conditions Requiring Surgery
Cataracts and Glaucoma
Asthma
Cirrhosis of the Liver
Anal Fistulae
Cholecystisis/Cholelithiasis
Calculi of the Urinary System
Gastic or Duodenal Ulcer
Hallux Valgus
Collagen Conditions
DREADED CONDITIONS
Cerebrovascular Accident(stroke)
Central Nervous System Lesions (poliomyelitis/meningitis/encephalitis/neurosurgical conditions)
Cardiovascular Diseases
Chronic Pulmonary Diseases
Liver Parenchymal Disease
Chronic-Genito Urinary Tract Disorders
Chronic Gastro-Intestinal Tract Diseases
Connective Tissue Disorders / Immunologic Disorders
Chronic Endocrine Disorders and their complications
Malignancies and blood dyscrasis (cancer, leukemia, idiopathic thrombocytopenic purpura
Injuries and subsequent complications from accidents, assaults, frustrated homicide or frustrated murder
Complications of apprent immunocompromise status
Any illness other than the above which would require intensive Care Unit confinements
 General Exclusions

1. Self Inflicted Injuries and Injuries from Member’s Own

Misconduct:
•Treatment of injuries or illnesses resulting from war or any
combat-related activities while in military service.
• Functional disorders of the mind, alcoholism and drug addiction
or abuse.
• Treatment of any injuries resulted from the Member’s own
misconduct:
–gross negligence
–vicious or immoral habits
– direct or indirect participation in the commission of a crime
whether consummated or not
– violation of a law or ordinance
– unnecessary exposure to imminent danger or hazard to
health
 General Exclusions

2. Government funded healthcare entitlements &

Personal medical requirements:
• All other government funded health-care entitlements
as provided for by law.
• Routine physical examinations required for obtaining or
continuing employment, requirement in school, insurance
or government licensing

3. For Purposes of Beautification:

• Cosmetic surgery, reconstructive surgery to treat a
functional defect due to accidental injury within the initial
confinement
• Oral surgery following accidental injury to teeth for
purposes of beautification
 General Exclusions

4. Chronic Dermatoses:
Psorasis / Skin Asthma / Chronic Dermatoses

5. Unlawful Acts & Hazardous Sports:

• Treatment of injuries/illnesses the direct and immediate
cause of which is the engagement and participation of the
Member in any (a) hazardous sport or activity i.e. scuba
diving, mountain climbing, parachuting et. al. and (b)
riots, strikes, and other civil disturbances.
 General Exclusions

6. Any Additional or Extra Charges:

• Additional charges resulting from room upgrading, or
additional personal comfort items not included in the room
& board accommodation ( T.V., telephone, etc.)
• Purchase or lease of durable medical equipment, oxygen
dispensing equipment, and oxygen except during covered
in-patient care.
• Corrective appliances, artificial aids, prosthetic
appliances
• Take home medicine
• Services obtained from Non-Accredited Physicians and
Hospitals or other provider of care, except under
emergency care.
 General Exclusions

7. Other Non-Insurable Conditions:

• Custodial, domiciliary, convalescent and intermediate
care.
• Long-term rehabilitation and Psychiatric care.
• Other dental treatment not provided under the program
except to the extent that are medically necessary for
repair or alleviation of damage to the member caused
solely by an accident.
• Maternity and all maternity related conditions except for
pre and post natal consultations and maternity assistance
• Circumcision, sex transformation, diagnosis and
treatment of fertility or infertility, artificial insemination,
sterilization or reversal of such.
 General Exclusions

• All expenses incurred in the process of organ donation

and transplantation, unless the Member thereof is the
recipient of such donation or transplantation.
• All physical deformities prior to enrollment
• Experimental medical procedures, acupuncture and
speech therapy
• Sexually transmitted diseases, AIDS and AIDS related
diseases
• Hepatitis B screening and all diagnostic examinations for
Members who have pre-existing Hepa B.
 INDIVIDUAL MEMBERSHIP FEES
Platinum Plus Platinum
Php 200,000 Php 150,000
Age Group Large Private Regular Private
Annual Semi-Annual Quarterly Annual Semi-Annual Quarterly
2- 5 36,604 19,766 10,249 21,272 11,487 5,956
6 - 10 30,541 16,492 8,551 17,372 9,381 4,864
11 - 15 25,721 13,889 7,202 14,304 7,724 4,005
16 - 20 25,015 13,508 7,004 13,337 7,202 3,734
21 - 25 24,891 13,441 6,969 13,841 7,474 3,875
26 - 30 25,721 13,889 7,202 15,130 8,170 4,236
31 - 35 30,199 16,307 8,456 17,627 9,519 4,936
36 - 40 37,159 20,066 10,405 22,695 12,255 6,355
41 - 45 46,349 25,028 12,978 30,260 16,340 8,473
46 - 50 54,609 29,489 15,291 40,258 21,739 11,272
51 - 55 61,210 33,053 17,139 48,701 26,299 13,636
56 - 60 67,262 36,321 18,833 54,930 29,662 15,380
61 - 65 * 75,242 40,631 21,068 61,978 33,468 17,354
Gold Silver
Php 100,000 Php 60,000
Age Group Regular Private Semi-Private
Annual Semi-Annual Quarterly Annual Semi-Annual Quarterly
2- 5 17,372 9,381 4,864 12,866 6,948 3,602
6 - 10 13,600 7,344 3,808 10,720 5,789 3,002
11 - 15 11,191 6,043 3,133 9,073 4,899 2,540
16 - 20 10,709 5,783 2,999 8,630 4,660 2,416
21 - 25 10,462 5,649 2,929 8,630 4,660 2,416
26 - 30 12,272 6,627 3,436 9,818 5,302 2,749
31 - 35 14,800 7,992 4,144 10,575 5,711 2,961
36 - 40 19,423 10,488 5,438 12,877 6,954 3,606
41 - 45 24,870 13,430 6,964 19,305 10,425 5,405
46 - 50 29,812 16,098 8,347 23,110 12,479 6,471
51 - 55 34,648 18,710 9,701 25,684 13,869 7,192
56 - 60 40,398 21,815 11,311 28,534 15,408 7,990
61 - 65 * 43,962 23,739 12,309 29,756 16,068 8,332
 FAMILY MEMBERSHIP FEES
PlatinumPlus Platinum
Php 200,000 Php 150,000
Age Group Large Private Regular Private
Annual Semi-Annual Quarterly Annual Semi-Annual Quarterly
2- 5 30,505 16,473 8,541 19,480 10,519 5,454
6 - 10 25,534 13,788 7,150 15,974 8,626 4,473
11 - 15 22,648 12,230 6,341 13,270 7,166 3,716
16 - 20 20,939 11,307 5,863 12,283 6,633 3,439
21 - 25 21,114 11,402 5,912 13,014 7,028 3,644
26 - 30 21,963 11,860 6,150 14,170 7,652 3,968
31 - 35 24,429 13,192 6,840 16,714 9,026 4,680
36 - 40 27,437 14,816 7,682 20,692 11,174 5,794
41 - 45 34,593 18,680 9,686 26,392 14,252 7,390
46 - 50 45,339 24,483 12,695 34,727 18,753 9,724
51 - 55 52,744 28,482 14,768 42,000 22,680 11,760
56 - 60 60,131 32,471 16,837 49,131 26,531 13,757
61 - 65 * 67,952 36,694 19,027 55,617 30,033 15,573
Gold Silver
Php 100,000 Php 60,000
Age Group Regular Private Semi-Private
Annual Semi-Annual Quarterly Annual Semi-Annual Quarterly
2- 5 14,341 7,744 4,015 11,278 6,090 3,158
6 - 10 11,561 6,243 3,237 9,188 4,962 2,573
11 - 15 9,534 5,148 2,670 7,886 4,258 2,208
16 - 20 8,518 4,600 2,385 7,494 4,047 2,098
21 - 25 8,398 4,535 2,351 7,469 4,033 2,091
26 - 30 9,884 5,337 2,768 8,285 4,474 2,320
31 - 35 11,539 6,231 3,231 8,975 4,847 2,513
36 - 40 14,621 7,895 4,094 10,689 5,772 2,993
41 - 45 18,219 9,838 5,101 15,396 8,314 4,311
46 - 50 23,203 12,530 6,497 19,183 10,359 5,371
51 - 55 27,073 14,619 7,580 21,410 11,561 5,995
56 - 60 31,340 16,924 8,775 23,776 12,839 6,657
61 - 65 * 34,492 18,626 9,658 24,947 13,471 6,985
 MEMBERSHIP REQUIREMENTS
1. Application Form
2. For Family Applications
If the principal is single
• If enrolling the PARENTS, pls attach a photocopy of the principal’s birth
certificate
• If enrolling the SIBLINGS as well, pls attach a photocopy of the sibling’s birth
certificate
If the principal is married
• If enrolling the SPOUSE, pls attach a photocopy of the marriage contract
• If enrolling the CHILDREN as well, pls attach a photocopy of the child’s birth
certificate

1. For new applicants whether the principal or dependent aged 50-60 yrs old, please
submit the following:
a) 12 Lead ECG / Electrocardiogram
b) Chest Xray
c) FBS / Fasting Blood Sugar
d) Total Cholesterol
e) HDL-C (High Density Lipoprotein)
f) LDL-C (Low Density Lipoprotein)

• Group Corporate Programs also available.

• Fees are inclusive of VAT
• No application & processing fees.
• Dental Fee of P650 not yet included.
… and may you
always be in the
pink of health!