• Maxicare Health Insurance


    Health is wealth, as the old adage goes and without health it is impossible to enjoy life’s pleasures. Although money is necessary, without good health and energy, enjoying the benefits of money is not possible. Therefore, taking care of their well being is highly imperative.

    Life is unpredictable and unfortunately so are accidents, health scares and diseases. No matter how much of care a person takes, sometimes, some things and situations cannot be avoided. A person can fall sick at any point of time or meet with an accident and this will in turn have an impact on their bank balance. Plus, it is a pretty good bet that majority of us would require some or the other medical facility at least a few times throughout our life, it is probably a good idea to ensure that certain financial measures are in place in the eventuality of something happening. One of the most convenient and financially viable options available are Health Insurances.

    Overview of Maxicare Healthcare Corporation

    One of the innovators in the Health Maintenance Organization sector, Maxicare was established in 1987 by an acclaimed group of businessmen and doctors so as to provide the best of facilities available in the healthcare sector to all those living in the Philippines. In the span of twenty years, Maxicare has become the No. 1 Health Maintenance Organization in the Philippines by providing state-of-art healthcare programs through its extensive network of medical services and impeccable customer service.

    It is a part of the Equicom Group, a conglomerate that has its reach in the field of computers and software, finances, banking and healthcare among others. Maxicare has tie ups with relations with over 43000 specialists and doctors in over 1000 clinics and hospitals, serving more than a million people across the country from families to corporates.

    Insurance for Individuals and for the family

    Maxicare provides a number of plans for all healthcare needs and requirements along with extensive coverage providing quality healthcare services that customers can procure without any hassles. Health insurance is necessary and opting for the best choice should be customer’s first priority.

    MyMaxicare is a program that has been created especially for families and individuals with the best healthcare facilities in mind. Customers are spoilt for choice and they can choose whichever option is most suited to them. The benefits and features are extensive and are for both outpatient and inpatient, preventive, emergency, dental care and various other necessities that are common and recurring such as accidents, dismemberment and so on.

    This plan also comes with an annual check up as an inclusive plan and can be customized to suit the needs of the customer and according to the board and room accommodation.

    Maxicare can be availed from anywhere. Those who love travelling but are worried about accessing healthcare facilities need not worry about this anymore thanks to Maxicare’s International Emergency Assist program which has partnered up with one of the largest emergency assistance and medical company, International SOS, provides robust healthcare services to all Maxicare customers.

    Most people are reluctant to spend on healthcare services as some see it as unnecessary expenses, and others cannot afford to, but spending on healthcare should be looked at as an investment, especially so by procuring services from healthcare leaders such as Maxicare.

    Procedures to avail healthcare facilities from Maxicare

    Care during Emergency

    In cases of emergencies such as sudden illness, injury, accidents that have the potential to cause serious damage or even death or something that requires an alleviation of discomfort and extreme pain, healthcare facilities are provided. Customers who require immediate assistance or immediate hospitalization, can secure these facilities right after the care is made available but not after 24 hours post onset. Examples of such conditions are cardiovascular diseases, heart attacks, loss of consciousness, convulsions, poisoning accidents. At the onset of such conditions, customers can move to the emergency room of the closest hospital regardless of whether it is accredited or not accredited to Maxicare.

    In case customers go to hospitals that have been accredited by Maxicare, then

    • Post medical treatment and after the patient has been stabilized, he/she is required to provide the Member’s Maxicare Card and another ID for the validation of membership to the ER staff. After this a LOE or Letter of Eligibility will be provided.

    If the patient is admitted in a hospital that is not accredited by Maxicare then,

    • After the treatment, all the required records and receipts must be carefully preserved as they will be required in order to claim reimbursement.
    • After this, a properly filled out Maxicare Claim for Reimbursement Form and Medical Certificate has to be given to the head office of Maxicare through the claims department. This must be done within a maximum period of ten days of the patient’s discharge from the hospital.

    In-Patient Care

    In the case of an emergency wherein a member cannot avail a particular room, then upgrading of the room is available, but only for the immediate higher accommodation. In such cases, there will be no additional charge levied on to the member which is the difference of the rate of the room and the costs on the first day from the actual time of admittance.

    However, if the upgradation of the room has exceeded beyond a certain time then the excess amount shall be paid for by the member and should be settled with the hospital after their discharge.

    Elective Care (In-Patient)

    • Order or recommendation for admission into hospitals whether it is in cases of emergency or elective, must have come from physicians who have been accredited by Maxicare in the hospital where admission of the patient will be made.
    • Once the recommendation or order has been provided, the member must furnish his/her card from Maxicare along with valid identity proofs to the Admitting section of the hospital post which their Maxicare card will be verified and a Letter of Eligibility will be provided. Based on the room limits and benefit that the customer can avail based on the Letter of Eligibility, admission will be facilitated.
    • The customer’s coverage will be assessed by the the customer care team of Maxicare and post this a Letter of Authorization will be provided by the Roving customer care specialist of the hospital where the member has taken admission.
    • Even during an elective admission, customers can avail upgrading of a room. But the difference between fees, room and other costs incurred will have to be paid by the member.
    • Maxicare’s Roving Customer Care specialist will pay a visit to the member within 2 days from the date of admission and formalities regarding the admission, coverage and other requirements.
    • Member has to be prompt in the filling of his Philhealth Sickness Benefit Claim which will then be forwarded to the Philhealth section of the hospital before the member’s discharge. In case the member does not fill in his/her claim then he/she will have to pay the complete Philhealth cost before discharge.

    Elective Care (Out-Patient)

    • Before availment, members have to present their Maxicare membership card along with the required identity proofs containing their photo and signature. Post this, a Letter of Eligibility will be provided after the membership has been validated.
    • Once the member has been diagnosed, medical care will be provided by Maxicare Primary Care Physician at any Maxicare Primary Care Center; Maxicare Retainer Physician at Company Sites; Maxicare Coordinator at any Maxicare-accredited hospital or clinic.

    In case the member requires consultation with other doctors then referral will be provided by Maxicare Retainer Physician, customer care representative or a coordinator.

    Procedure to file reimbursements

    In order to file reimbursement claims, customers need to follow the below steps -

    • Customers will have to download the form for reimbursement and fill in the required information.
    • All the required documents will have to be attached. These documents are -
    • Copy of the clinical abstract that has been duly signed by the physician
    • A copy of the history of admittance from the medical record of the hospital.
    • All hospital bills and receipts (original)
    • Professional fees (original)
    • Statement of account from the hospital (original)
    • Itemized breakdown or charged slips per the cost center (original)
    • In case of surgeries, the operative record and histopathological report is required
    • Other proofs and documents that are required to support the reimbursement.
    • The form will then have to be submitted along with all the documents to Maxicare within a month from the date of discharge.

    Plans available

    Plan Room and Board Accommodation Maximum Benefit Limit per year
    Platinum Plus Large Private 200,000
    Platinum Regular Private 150,000
    Gold Regular Private 100,000
    Silver Semi-Private 60,000

    Customers can choose from any of the plans above that is most suited to them.

    Customers can apply for Maxicare Health insurance online and avail the best of services and facilities at competitive prices. In addition to this, Maxicare also provides health insurance to employees of small and medium enterprises and also employees of major corporates. Maxicare stands as the undisputed leader in the Philippines among all health maintenance organizations.

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