2. MAXICARE HEALTHCARE CORPORATION
is the leading HMO in the industry
has 25 years of solid healthcare expertise
has over 700,000 cardholders nationwide
is included in the Top 1000 Companies in
the Philippines for 2010*
*Maxicare ranked at 394.
6. OUR ROSTER OF CLIENTS
MANUFACTURING INDUSTRY
BUSINESS PROCESS OUTSOURCE INDUSTRY
7. OUR ROSTER OF CLIENTS
And a few more known brands and clients we serve....
8. OTHER PREPAID PRODUCTS
It is the first prepaid Inpatient Benefit Card
specifically designed to provide a one-time coverage
of up to P25,000 on the following confirmed coverable
diseases:
Dengue
Malaria
Cholera
Typhoid and Paratyphoid
Gastroenteritis
Pneumonia
Open both for Maxicare existing members and non-
members aged 2-60 years old.
Selling Price: P1599 and P2199
9. OTHER PREPAID PRODUCTS
Provides a one – time coverage on
illnesses or injuries arising during
emergency.
Open both for Maxicare existing members
and non-members, aged 15 days old to 65
years old.
Selling Price: P788 and P988
10. Access to our Vast Network of Providers
More than 1,000 Accredited
Hospitals and Clinics nationwide
(65% are Tertiary Hospitals)
More than 27,000 Top Caliber
Accredited Doctors
(Consultants, Fellows and Diplomates)
All Maxicare Centers are on-line
with the Head Office
11. Maxicare Intelligent Card
Real-time validation of membership during
availments thru our swipe facilities in more
than 1,300 POS units nationwide;
Immediate activation & de-activation of
membership within 24 hours;
Replacement need not be done on a yearly
basis*;
12. The Maxicare Card is now capable of receiving reimbursements
thru electronic cash credits.
Members may now enjoy cashless payment of
Maxicare reimbursements through electronic card
credits withdrawable via Bancnet, Expressnet,
Megalink and EqB ATMs.
Funds credited to the card may be used for
purchases made at any POS merchants of Bancnet,
Megalink or Expressnet nationwide.
13. Access to Maxicare Primary Care
Center
Primary Care Center (PCC) is a healthcare facility which has its staff of Customer Service
Representatives and Primary Care Physicians
ADVANTAGES:
Easy access to Internal Medicine Specialists
Unlimited number of FREE consultations
Strategically & conveniently located at
major hospitals in Metro Manila.
14. The Maxicare Primary Care Center
Filomena Building
G/F Filomena Building
Amorsolo Street
Legaspi Village, Makati City
Monday to Friday: 7AM – 6PM
Saturday: 7AM - 4PM
15. The Maxicare Primary Care Center
Makati Medical Center
1st Floor Tower One, Makati Medical
Center, Amorsolo St. Makati City
Monday to Friday: 7AM – 7PM
Saturday: 8AM - 4PM
16. The Maxicare Primary Care Center
Quezon City
15/F Room 1501, North Tower, Cathedral Heights, QC
Monday to Friday: 7AM – 6PM
Saturday: 7AM - 4PM
Global City
Room 325 Medical Arts Building, Rizal Drive Cor. 15th
Ave. & 32nd Ave. Fort Bonifacio Global City
17. The Maxicare Primary Care Center
MGR04 (Out-Patient), Ground floor,
Medical Arts
Tower 1, The New Medical City
Ortigas Ave., Pasig City
12/F (In-Patient) Tower A
Monday to Friday: 7AM – 6PM
Saturday: 7AM - 4PM
18. The Maxicare Primary Care Center
Chinese General Hospital
10th Floor Mediacal Arts and Parking
Building, Sta Cruz, Manila
Monday to Friday: 8am-5pm
Saturday: 8am-4pm.
19. The Maxicare Primary Care Center
Asian Hospital & Medical Center
Lower ground floor, Asian Hospital
and Medical Center, 2205 Civic Drive,
FCC, Alabang, Muntinlupa
Monday to Friday: 8am-5pm
Saturday: 7am-5pm.
20. Access to My Health Clinics
MyHealth provides additional clinic network to Maxicare.
As an affiliate company,
My Health offers its state-of-the-art facilities and competent line of
doctors and specialists to Maxicare members.
21. SM City North Edsa Festival Supermall
2nd Level Building F, SM City A-3 Level 2 Style Boulevard,
North Edsa, North Avenue, Festival Supermall, Filinvest
Quezon City Corporate City
Tel #: 441-4106 Tel #: 850-4855
7AM to 9PM Waltermart Calamba 7AM to 8PM
Level 2 Waltermart Center
Calamba,Bgy. Real Calamba
City, Laguna
Edsa Shangri La Tel (049) 502-7130 to 32
Robinsons Cybergate
Unit 146, Level 1, Shangrila Plaza
EDSA corner Shaw CEBU
Blvd., Mandaluyong City
Tel #: 570-4325 3rd Level, Robinsons Cybergate
7AM to 8PM Mall, Fuente Osmena, Cebu City
Tel #: (032) 268-8502
22. Extensive Customer Care Center
1. MAXICARE SATELLITE OFFICES
BAGUIO PAMPANGA
HEAD OFFICE - MAKATI
BATANGAS
CEBU
BACOLOD
DUMAGUETE
ILOILO
DAVAO
CAGAYAN DE ORO
GENERAL SANTOS
24. Extensive Customer Care Center
3. MAXICARE 24/7 CUSTOMER CARE
1. 24/7 Customer Care Center No.
2. Provincial Toll Free No
25. Your Maxicare Team:
BENEFITS CONSULTANT
Chris Lingbaoan
Tel: 729-8256
Mobile: +63927.3267085
SALES
Miguel Apolonio– Account Officer
Email: miguel.apolonio@maxicare.com.ph
Tel. #: 908-6900 loc. 1126
AFTER-SALES SUPPORT
Cristina Lagda- After Sales Assistant
Email: cristina.lagda@maxicare.com.ph
Tel. #:908-6900 loc.1137
26. Extensive Customer Care Center
5. MAXICARE HELPDESKS
Clinica Manila
2nd Floor, Unit 202 Building A
SM Megamall Complex
Don Julia Vargas Avenue, Mandaluyong City
Monday to Saturday
Tel. No: (0632)661-7777 local 102
27. Extensive Customer Care Center
Mary Mediatrix
Medical Center
2nd Floor, H.B. Calleja Building
Mary Mediatrix Medical Center
J.P. Laurel Highway, Lipa City, Batangas
Monday to Saturday
Tel. No: (043)784-9999 local 1152
28. Extensive Customer Care Center
Calamba Medical
Center
Ground floor , Central Registration,
Crossing, Calamba,City
Monday to Saturday
29. Extensive Customer Care
Extensive Customer Care Center
MANILA DOCTORS
HOSPITAL
Room 220, Manila Doctors Hospital
Monday to Saturday
Tel. No: (02)524-3011 local 4510
30. Extensive Customer Care Center
6. EMAIL CUSTOMER SUPPORT
callcenter@maxicare.com.ph
Members can send their inquiries and
concerns through Email.
31. Extensive Customer Care Center
7. MAXICARE FAN PAGE
www.facebook.com/maxicarehealthcarecorp
Members can like us on facebook and
send inquires and concerns via chat.
32. Maxicare Web Portal
Provides information on Company profile and
milestones;
Allows access to the the features and brief
description of Maxicare products;
Provides members easier reference on
accredited doctors, hospitals and Primary Care
Centers;
Keeps everyone informed on latest updates and
achievements of the organization;
Presents to its channel partners such as
agents/brokers basic essential information
such as incentives, membership/accreditation
and commission;
33. As a Maxicare member, you have an access to
Maxicare MEMBER GATEWAY is a portal on the Maxicare’s website which
will now provide members unparalleled visibility and information regarding
their account with Maxicare.
Members will now have full access from one’s basic account information to
availment details.
40. Your Maximum Benefit Limit:
MAXIMUM ROOM & BOARD
PLAN TYPE BENEFIT LIMIT ACCOMODATION
PLATINUM P150,000 Large Private
GOLD P100,000 Regular Private
SILVER P75,000 Semi- Private
BRONZE P50,000 Ward
MBL or Maximum Benefit Limit-per illness/injury/member/year
* No access to SLMC Global
41. Preventive Care Coverage
Periodic Monitoring of Health Problems
Health Education & Counseling on diets and
exercise
Family Planning Counseling
* May be availed during the regular consultations.
42. Annual Check Up Coverage
Physical Examination
Urinalysis
Fecalysis
Chest X-ray
Complete Blood Count
ECG for members 35 yrs old and above
Pap Smear for female members 35 YO & above
* Note: This must be scheduled and coordinated to Maxicare by the Company’s HR.
43. Outpatient Care Coverage
COVERAGE: LIMIT
Regular Consultations (except prescribed Up to MBL
medicines)
Eye Laser Therapy (except Lasik/PRK) 10,000 per
eye/member/year
Ears, Nose and Throat Treatment
Pre and Post Natal Consultations
Treatment of minor injuries Up to MBL
Minor Surgeries not requiring
confinement
X-ray, laboratory exams, routine and
other diagnostic procedures
44. Outpatient Care Coverage
COVERAGE: LIMIT
Sclerotherapy – removal of varicose 5,000 per
veins (must be prescribed by an leg/member/year
accredited vascular surgeon)
Cauterization of Warts 1,000 per member/year
(except genital warts)
Speech Therapy 10,000 per member/year
(medically necessary and on a
reimbursement basis)
Tuberculin Test 600.00 per member/year
Therapeutic Procedures Up to MBL
(IV chemotherapy, dialysis, etc…)
Other Modalities Up to 5,000 per
(PET Scan, 4D ultrasound, etc…) member/year
45. How to Avail your Outpatient
Coverage
STEP 1 STEP 2 STEP 3 If required to
Plan Member (PM) PM goes to the Medilink POS PM presents his LOE, undergo
goes to Maxicare terminal and swipes the card Maxicare card & 1 valid laboratory
accredited facilities for membership verification ID to Plan Coordinator exam, secure
(LOE) and consultation takes Laboratory Slip
*LOE is only valid on the day it place; from the
was swiped Coordinator
STEP 5 STEP 4
For tests not available at the clinic, PM may For laboratory tests at P1000
proceed to Maxicare accredited hospitals. below, no need to secure
confirmation from Maxicare;
Members should go back to the doctors at otherwise Hospital will get
the clinic/primary care center for follow-up. confirmation from Maxicare if cost is
more than P1000
46. Inpatient Care Coverage
COVERAGE:
Room and Board accommodation
(based on your plan type and entitlement)
Use of Recovery Room and Intensive Care Unit
Professional Fee of Attending Doctors & Nursing Services
Drugs and Medicines for Use in the Hospital
Whole blood/human blood products & IV fluids
transfusion
Anesthesia, Oxygen and its Administration
Standard Hospital Admission Kit
Dressings, casts, sutures, and other supplies/services
directly related to the medical management of the patient
47. How to Avail your Inpatient
Coverage
Secure Admitting Slip Call Maxicare Hotline al least 24 On Confinement day, go
from a Maxicare hours before admission for to the Admitting Section
Accredited Physician assistance in securing the entitled POS Terminal to secure
room assignment and other the LOE
verification MAXICARE will
issue LOA,
member proceeds
with confinement
Settle charges not coverable File Philhealth on or
by Maxicare at the Billing
Present Maxicare Card before discharge
Section once the discharge
order is issued by the and sign the
Attending Doctor hospital bills
before discharge
Secure Follow up
Prescription from the attending
Physician
48. Emergency Care Coverage
Doctor’s Services
Emergency room fees
Medicines used for immediate relief and during
treatment
Initial Treatment of animal bites up to MBL
Passive and active vaccine for animal bites up to
P18,000
Ambulance Services up to MBL if within the
network, and up to Php2,500/member/case if
outside the network
Coverage for room upgrade – 1st 24 hours
49. How to Avail your Emergency
Coverage
Member Emergency Room of nearest Present Maxicare Card at the
Accredited Hospital/Clinic Emergency Section
If for Confinement
Avail of treatment
at the Emergency Room
File Philhealth on or
Settle charges not covered by before discharge
Maxicare at the Billing Section
once the Discharge Order is Avail of entitled room plan and
issued by the Attending notify MAXICARE within 24
Doctor hours for proper assistance
50. How to Avail your Emergency
Coverage
For Non-Accredited Facility
Maxicare Non-Accredited Secure Reimbursement forms
Member Hospital with complete documents
File PhilHealth if for (i.e. OR, SOA & additional
confinement documents as needed) should be
forwarded to the HR
HR team to submit forms
to Maxicare
Member to receive check/s
30 days after submission of
the complete documents
51. Emergency Care
(for non-affiliated)
Availment in Non-accredited hospital within the Philippines
Maxicare shall reimburse 80% of the Hospital Bills and Professional Fees,
based on Maxicare standard rates up to P30,000/availment/member/year
for the 1st 24 hours
Outside the Philippines
Maxicare shall reimburse 100% of the Hospital Bills and Professional fees,
based on actual cost up to P30,000/availment/member/year
Areas without affiliated hospitals within the Philippines
Maxicare shall reimburse 100% of the Hospital Bills and Professional Fees,
based on Maxicare Standard Rates up to MBL
52. Claims Reimbursement Procedure
Maxicare Reimbursement Card
All claims must be submitted to the Maxicare Head Office within 30 days from date of discharge
from the hospital. The following are the required documents for reimbursement:
Claim Reimbursement Form for MRC (with filled out SMS number and email);
Original Receipts of all Hospital Bills & Professional Fee of the Doctor;
Original Charge Slips (with itemized breakdown of charges);
Clinical Abstract, Admitting History and Medical Certificate;
Histopath/Surgical Report (if surgical operation was done);
Police Report in case of accident and medico legal cases:
Processing of Claims will be 7-15 days from receipt of complete documents.
Approved reimbursement shall be credited to your Maxicare Card.
53. Claims Reimbursement Procedure
Maxicare Reimbursement Card
Once your reimbursement has been approved:
Your card will be activated to cash
card and you will receive
notification thru SMS of your PIN Member may withdraw the OR member may use the amount
and approved reimbursement amount to Equicom ATMs or to purchase from any of the
amount. Bancnet, Expressnet or Megalink Bancnet accredited merchants
ATMs
*Your SMS number must be
correctly reflected in the Claims
Reimbursement Form.
54. Additional Coverage
Coverage For: Limit:
Coverage for pre-existing dreaded & non dreaded conditions
Work related cases based on conditions set by ECC
(Employee Compensation Commission)
Up to MBL
Coverage for Motor vehicular accident
(subject to exclusions & limitations)
Coverage for Provoked and unprovoked assault
Congenital Conditions Up to 20,000.00
Coverage for Scoliosis per member per year Up to 20,000.00
(whether pre-existing, acquired, congenital & developmental)
Consultations for Chronic Dermatoses Up to MBL
Group Life Accidental Death & Dismemberment Up to 25,000
55. Dental Care Benefits
Oral Prophylaxis
Simple tooth extractions
Temporary Fillings - unlimited
Permanent Fillings – 2 teeth
Emergency Dental Treatment
Comprehensive Restorative & Prosthodontic Treatment Planning
Desensitization of Hypersensitive teeth – 2 teeth
Simple Adjustment of Dentures
Recementation of loose crowns, inlays or onlays
Pre natal check of teeth and gums
TMJ Consultation
Gum treatment for cases of bleeding and inflammation
56. Dental Hub (povider)
Sets an appointment
by calling
Accredited Dental Facilities
(02) 908-6900 Nationwide through
Member
Or by Dental Hub
Directly calling the
Accredited Dental Clinic
57.
58. 1. Injuries arising from any of the following
• War or any combat-related activities while in military service;
• Self infliction as a result of functional disorders of the
mind, alcoholism and drug addiction or abuse;
• Member’s own misconduct which may be a cause of:
- Gross Negligence;
- Vicious or immoral habits;
- Direct of 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
59. 2. Government funded healthcare entitlements:
• All other government funded health-care entitlements as
provided for by law.
• Infectious diseases (according to the local epidemiologic patterns) that
may arise in times of epidemic (i.e. Avian Flu, Meningococcemia, etc.) as
declared by the Department of Health
3. Personal Medical Requirements
• Routine physical examinations required for obtaining or continuing
employment, requirement in school, insurance or government licensing
60. 4. For Purposes of Beautification:
• Cosmetic surgery and aesthetic procedures
• Oral surgery following accidental injury to teeth for purposes of
beautification
• Weight reduction programs, surgical operation or procedure for
treatment of obesity, including gastric stapling or balloon procedures and
liposuctions.
5. Chronic Dermatoses: except consultations
(ie, Psoriasis / Skin Asthma)
61. 6. 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. ,
7. 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 devices
• Take home medicine
• Services obtained from Non-Accredited Physicians and Hospitals or other
provider of care, except under emergency care.
62. 8. Other Non-Insurable Conditions:
• Custodial, domiciliary and convalescent care.
• Long-term rehabilitation and Psychiatric care.
• Dental and Maternity cases
• Circumcision, sex transformation, diagnosis and treatment of fertility or
infertility, artificial insemination, sterilization or reversal of such.
• 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 enrolment
• Experimental medical procedures, acupuncture
• Sexually Transmitted Diseases, AIDS and AIDS related illnesses
• Hepatitis screening and all diagnostic examinations for Members who have
pre-existing Hepatitis B.
Thus, for our annual check up coverage, we have the following benefits: (see the slide for reference)
No charge will be given on emergency care services rendered at affiliated Hospitals under the services of an accredited physician up to the maximum plan limits. * Go through and explain the emergency provision as indicated in the slides.* (based on our rates/HMO rates and not the actual cost… since we are balancing quality healthcare with cost management).
