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MAXICARE HEALTHCARE CORPORATION

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MAXICARE, an industry leader with 37 years of solid healthcare expertise,
has been a trusted name among top corporations and individuals.

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Juliet Ching
0917.8359547
02.8404.5829
 I. IN-PATIENT BENEFITS filiform warts, and molluscum contagiosum, in
any part of the body prescribed by an Affiliated
Physician/Specialist is up to
1.​ Room and Board Accommodation P1,000/member/year.
2.​ Use of Operating Room, Intensive Care Unit 3.​ Sclerotherapy for varicose veins (except
(ICU), Isolation Room (if prescribed by an medicines and for cosmetic purposes) as
attending affiliated physician) and Recovery prescribed by an Affiliated Physician, to be
Rooms availed through affiliated vascular surgeons is up
to P5,000/leg/member/year
3. ​ Professional Fees of Attending Physicians,
4.​ Allergy Testing/ allergy screening and other
Surgeons, Anesthesiologist and Cardio related examinations prescribed by an Affiliated
pulmonary clearance before surgery and Physician is up to P2,500/member/year.
cardiac 5. ​ Speech therapy for stroke patients only.
​ monitoring during surgery Covered as charged up to 10,000/member/year
4. ​ Standard nursing services on reimbursement basis.
Note: Consultations shall be part of the limit
5. ​ Medicines for in-patient use 6. Tuberculin test is up to P600/member/year
6. ​ Blood product transfusions and intravenous
​ fluids, including blood screening and cross
●​ Diagnostic / Therapeutic Procedures with
​ matching
Specific Limits
7. ​ X-ray, laboratory examinations, diagnostic tests
​ and therapeutic procedures incidental to 1. ​ All diagnostic / therapeutic procedures
​ confinement medically necessary for treatment - 100%
8. ​ Dressings, conventional casts (plaster of Paris) of actual cost subject to MBL
​ and sutures 2. ​ Arthrocentesis - up to six (6) sessions
9. ​ Anesthesia and its administration subject to MBL
10. ​Oxygen and its administration 3. ​ Continuous Positive Airway Pressure
11. ​ Standard admission kit (CPAP) titration for sleep study - up to
P60,000/member/year (shared limit for OP
12. ​All other items directly related in the medical
and IP)
​management of the patient, as deemed
4. ​ Dialysis - up to twelve (12) sessions
​medically necessary by the attending affiliated
subject to MBL
​physician
5. ​ Non-oral chemotherapy (for cancer
NOTE: Required to file Philhealth. Non-Philhealth treatment only) - up to twelve (12)
members will pay for the Philhealth portion. sessions subject to MBL
6. ​ Oral chemotherapy (for cancer treatment
SALIENT FEATURES only)- up to P60,000/member/year (shared
limit for OP and IP)
PLAN TYPE R&B MBL
7. ​ Physical therapy / Occupational therapy
excluding subspecialties such as cardiac
Platinum Plus Large Private Php 250,000
rehabilitation, pulmonary rehabilitation and
the like - shared limit of up to twelve (12)
Platinum Regular Private Php 200,000
sessions/member/year subject to MBL
Note: Therapy of one (1) body area shall
Gold Regular Private Php 150,000
be considered as one (1) session
8. ​ Therapeutic Radiology:
Silver Semi-Private Php 100,000 a.​ Brachytherapy - up to twelve (12)
sessions subject to MBL
b.​ Cobalt - up to twelve (12) sessions
R&B – Room and Board Accommodation (room subject to MBL
category) c.​ Linear Accelerator Therapy - up to
MBL – Maximum Benefit Limit (limit per illness twelve (12) sessions subject to MBL
per year) d.​ Radioactive Cesium - up to twelve
(12) sessions subject to MBL
II. OUT-PATIENT BENEFITS e.​ Radioactive Iodine - up to twelve (12)
sessions subject to MBL
All outpatient consultations and outpatient procedures 9. Transurethral Microwave Therapy of
(as long as it is Medically Necessary). Prostate-covered up to
25,000/member/year
1.​ Eye laser therapy only for retinal tear, retinal (shared limit for OP and IP)
hole, retinal detachment and glaucoma
prescribed by an Affiliated Physician/Specialist is 10. Stapled Hemorrhoidectomy - covered up
up to P10,000/eye/member/year. Eye correction to P10,000/member/year (shared limit for
such as Lasik, PRK and the like are not covered. OP and IP)
2.​ Electrocauterization of skin lesions such as
plantar warts, flat warts, periungual warts,
11. 4D Ultrasound except for maternity-related Ambulance Service
cases - covered up to P5,000/member/year Maxicare will cover road ambulance service for
(shared limit for OP and IP) transfers from an affiliated hospital to another
12. ​Esophageal Manometry - Covered up to affiliated hospital up to MBL and Php2,500 per
P5,000/member/year (shared limit for OP and conduction if it is from a non-affiliated Hospital to an
IP) affiliated Hospital (on reimbursement basis).
13.​ Intensified Modulated Radiotherapy - covered
up to P10,000/member/year (shared limit for OP Note: it is very important that you call the Maxicare
and IP) Hotline within 24 hours in order for Customer Care
14.​ Botox which is not cosmetic in nature nor for to arrange a transfer from the non-affiliated hospital
beautification purpose - covered up to to the affiliated hospital.
P5,000/member/year (shared limit for OP and
IP) IV. PREVENTIVE CARE
15. ​Positron Emission Tomography (PET) Scan -
1. ​ Passive and active vaccines for treatment of
covered up to P5,000/member/year (shared
tetanus and animal bites shall be covered up to
limit for OP and IP)
Php18,000 per member per year
16. ​CT Pulmonary Angiography - covered up to 2. ​ Periodic monitoring of health problems
P5,000/member/year (shared limit for OP and 3. ​ Health education and counseling on diets and
IP) exercise
17. ​Other Modalities - covered up to 4. ​ Health habits & family planning counseling
P5,000/member/year (shared limit for OP and
IP) V. ANNUAL CHECK-UP (ACU)

III. EMERGENCY CARE Basic 5 Routine; Clinic-based: (Applicable to

Platinum Plus, Platinum, Gold and Silver Plan
Affiliated Hospital Type)
o ​ Doctor’s services ●​ History and Physical Exam
●​ CBC (Complete Blood Count)
o ​ Emergency Room fees
●​ Routine Urinalysis
o ​ Medicines used for immediate relief and during ●​ Routine Fecalysis
treatment ●​ Chest X-ray (PA)
o ​ Oxygen, intravenous fluids and blood products
o ​ Dressings, conventional casts (plaster of Paris) The ACU however, may only be availed within the
and sutures contract period after (1) payment of at least six (6)
o ​ Initial treatment of animal bites shall be covered month worth of membership, and (2) must be a
for the first twenty-four (24) hours from the time member of at least six (6) months starting from the
of bite subject to MBL (except cost of effectivity date. Members must notify Maxicare’s
vaccines). Customer Care Department (CCD) at least one (1)
o ​ X-rays, laboratory, diagnostic examinations and month prior to the preferred schedule. Any request
other medical services related to the for rescheduling or change of venue must be in
emergency treatment of the patient writing and shall be allowed only once provided
request was forwarded to CCD at least one (1) week
Non-Affiliated Hospitals prior to the original ACU schedule. Otherwise, ACU
o ​ Within the Philippines entitlement shall be forfeited.
Maxicare shall reimburse up to 80% of the
actual hospital bills and 80% of the VI. DENTAL CARE (OPTIONAL)
professional fees based on Maxicare rates
incurred during the first twenty-four (24) hours Exclusive for Dental Hub Provider Only
of treatment up to Php 30,000 per availment
per member.
1. ​ Oral Consultation/ Examination
2. ​ Once a year Oral Prophylaxis
o​ Areas without affiliated hospitals within the 3. ​ Simple Tooth Extraction
​ Philippines
4. ​ Unlimited Temporary Fillings, as needed
​ Maxicare shall reimburse 100% of the total 5. ​ Simple Repair and Adjustment of Dentures
​ hospital bills and Professional fees based on 6. ​ Recementation of Jacket Crowns, Bridges,
​ Maxicare rates Inlay and Onlay
o​ Outside the Philippines 7. ​ Palliative Treatment of Simple Mouth Sores
​ Maxicare shall reimburse 100% actual costs up and Blisters
to Php30,000 per availment per member. 8.​ Desensitization of Hypersensitive Teeth – up
to 2 Teeth per year
 9. ​ Permanent Fillings – up to 2 Teeth per year VIII. ADDITIONAL BENEFIT
10. Gum Treatment for Cases Like Inflammation
or Bleeding ●​ Life Insurance coverage with Accidental Death,
11. Emergency Dental Treatment Dismemberment & Disablement up to
12. Oral Incision and drainage Php50,000
●​ Initial Treatment within 24 hours from time of
bite of Animal bites - subject to MBL (except
Note: Dental Benefit is optional for an additional
fee, see page 11 and 12. cost of vaccines)
●​ Succeeding treatment after 24 hours from time
of bite of Animal bites - subject to MBL (except
VII. CRITICAL ILLNESS BENEFIT (OPTIONAL) cost of vaccines)
●​ Vaccines for treatment of tetanus and animal
List of Critical Illness bites (including administration fee but
1.​ Alzheimer’s Disease excluding ER Fees) - up to
2.​ Apallic Syndrome P18,000/member/year (shared limit for OP
3.​ Aplastic Anaemia and IP)
4.​ Bacterial Meningitis ●​ Scoliosis including necessary procedures,
5.​ Benign Brain Tumor except physical therapy sessions, whether
6.​ Cardiomyopathy congenital, pre-existing, developmental or
7.​ Cerebral Aneurysm Requiring Invasive Brain acquired - Up to P20,000/member/year
Surgery (shared limit for OP and IP)
8.​ Chronic Liver Disease Note: Physical Therapy sessions shall form part of
9.​ Chronic Lung Disease the Physical therapy/ Occupational therapy limits
10.​ Chronic Recurrent Pancreatitis ●​ Congenital Conditions except physical therapy
11.​ Coma sessions and developmental disorders - up to
12.​ Coronary Artery Bypass Grafting P20,000/member/year (shared limit for OP and
13.​ Crohn’s Disease IP)
Note: Physical Therapy sessions shall form part of
14.​ Encephalitis
the Physical therapy/ Occupational therapy limits
15.​ Fulminant Viral Hepatitis ●​ Chronic Dermatoses - Consultations only
16.​ Heart Valve Surgery ●​ Hepatitis B - Not Covered
17.​ HIV/AIDS due to Blood Transfusion ●​ Wellness Program - Not Covered
18.​ Loss of Hearing (Deafness)
19.​ Loss of Independent Existence IX. VALUE ADDED FEATURES
20.​ Loss of Limbs
21.​ Loss of Sight (Blindness) MAXICARE’S INTERNATIONAL
22.​ Loss of Speech ASSISTANCE PROGRAM
23.​ Major Burns Maxicare has partnered with Insurance Company
24.​ Major Cancer of Assist America Asia Limited.​
25.​ Major Head Trauma with Severe Brain Damage
26.​ Major Organ and Bone Marrow Transplant Note: ​
27.​ Major Stroke 1. Coverage begins when a member is traveling
28.​ Major Surgery to Aorta more than 150 km away from home or in another
country or territory.
29.​ Medullary Cystic Disease
30.​ Motor Neurone Disease Benefits:
31.​ Multiple Sclerosis Medical Emergency Assistance
32.​ Muscular Dystrophy ∙ Emergency Medical Evacuation
33.​ Myocardial Infarction (Heart Attack) ∙ Emergency Medical Repatriation
34.​ Occupationally-acquired HIV/AIDS ∙ Medical Referral
35.​ Paralysis ∙ Medical Monitoring
36.​ Parkinson’s Disease ∙ Prescription Assistance
37.​ Primary Pulmonary Arterial Hypertension ∙ Foreign Hospital Admission Assistance
38.​ Progressive Scleroderma ∙ Return of Mortal Remains
39.​ Renal Failure ∙ Compassionate Visit
40.​ Severe Rheumatoid Arthritis ∙ Care of Minor Children
41.​ Terminal Illness
42.​ Ulcerative Colitis Non-Medical Emergency Assistance
∙ Emergency Message Transmission
Note: Critical Illness Benefit is optional for an ∙ Lost Luggage or Document Assistance
additional fee, see page 11 and 12. ∙ Legal and Interpreter Referrals
∙ Pre-Trip Information
∙ Mobile App Services
 X. DREADED DISEASE / CONDITION Congestive Heart Failure, Cardiac Arrhythmia,
Cardiac Tamponade, Coronary Artery Disease,
Any condition that is considered to be chronic, Cardiomyopathies and Valvular Heart Disease
progressive, life-threatening and which may except Mitral Valve Prolapse, Aortic Dissection,
entail life long therapy wherein complete cure Abdominal Aortic Aneurysm and Peripheral
cannot be ensured Vascular Disease and its complications such as
but not limited to Buerger's Disease
COVERAGE FOR DREADED AND e). Chronic Glomerulonephritis
NON-DREADED CONDITIONS f). Cerebrovascular Diseases such as but not limited
to Stroke, Cerebral, Cerebellar, Thrombosis,
1st year of membership: Embolism and Ruptured aneurysm and all
●​ Dreaded and Non-dreaded covered Intracranial Hemorrhage and related conditions
subject to below limits: g). Cholecystolithiasis and Choledocholithiasis
h). Chronic Endocrine Disorders and its
complications such as but not limited to
Plan Type Per illness per
Dyslipidemia, Obesity, Diabetes Mellitus,
member per year
Hormonal Dysfunctions excluding surgical
treatment/procedures for obesity
Platinum Plus Php 20,000
i). Chronic Gastrointestinal Diseases such as but
not limited to Irritable Bowel Syndrome, Crohn's
Platinum Php 15,000
disease
Gold Php 10,000 j). Chronic Genito-urinary Disorders
k) . Chronic Kidney Disease/Failure & its
Silver Php 5,000 complications
l).Chronic Liver Parenchymal Diseases such as but
not limited to Liver Cirrhosis, Chronic hepatitis,
Subsequent years of membership: Non-alcoholic Fatty Liver
●​ Dreaded conditions not considered Disease/Steatohepatisis (NASH), Newgrowth
acquired are covered subject to below m). Chronic Pulmonary Diseases such as but not
limits: limited to Bronchial Asthma, Chronic Obstructive
Pulmonary Disease (COPD), emphysema, and
Plan Type Per illness per other chronic lung disease
member per year n). Collagen Vascular/Connective
Tissue/Immunologic Disorders such as but not
Platinum Plus Php 20,000 limited to Systemic Lupus Erythematosus,
scleroderma, rheumatoid arthritis and its
Platinum Php 15,000 complications
o). Complications of immuno-compromised clinical
Gold Php 10,000 conditions except HIV/AIDS
p). Extrapulmonary Tuberculosis including Pott's
Silver Php 5,000 disease and Multi-Drug Resistance Case
(MDR) case
q). Multiple Organ Failure
●​ Non-dreaded conditions shall be
r). Muscular Dystrophies such as but not limited
covered up to MBL
to Duchenne, Becker, limb girdle,
●​ Acquired dreaded conditions shall be
facioscapulohumeral, myotonic,
covered up to MBL
oculopharyngeal, distal, and Emery-Dreifuss
s). Neuro-surgical interventions and/or major
Such dreaded conditions are as follows, but
neurological diseases such as but not limited
not limited to:
to Poliomyelitis/Meningitis/Encephalitides,
a). All malignancies (including indicated Demyelinating Neurologic diseases and its
chemotherapy or radiotherapy) complications/sequelae and Peripheral
b). Arthritis Nervous System Disorders/Diseases;
c). Blood Dyscrasias such as but not limited to Neurosurgical conditions: brain tumors,
Leukemia, Idiopathic Thrombocytopenic arteriovenous fistula, aneurysm and other
Purpura, Lymphoma t). Previous craniotomy sequelae
d). Chronic Cardiovascular Diseases and its u). Slipped disc
complications such as but not limited to v).Spinal Stenosis
Uncontrolled Hypertension of whatever etiology, w). Thyroid Dysfunctions due to disease of thyroid
Aortic Dissection, Abdominal Aortic Aneurysm, such as but not limited to Hypothyroidism and
Myocardial infarction, Cardiac Arrest, Hyperthyroidism
x). Any illness other than above which would
 require Critical Care/Intensive Care Unit (ICU) identification card (e.g., company ID,
Confinement SSS ID, driver’s license, or other ID cards
y). All complications resulting from above list of bearing photo and signature) for
conditions verification. For cases when the Maxicare
ID card is not available, the Maxicare
Such non-dreaded conditions are as follows, Certification can be honored.
but not limited to: ii.​ The Maxicare Coordinator shall diagnose
the Member for any ailment. Appropriate
a). All benign tumors, except those causing medical treatment will then be given or
compression and obstructive symptoms or confinement may be recommended, if
complications necessary. If a medical case requires
b). Anal Fistulae treatment or consultation with another
c). Cervical Polyps (if benign biopsy) specialist, the Maxicare primary care
d). Conjunctivitis (except chemical, complicated) physician or Coordinator may refer
Endometriosis/Controlled Dysfunctional accordingly.
Uterine Bleeding (except if caused by uterine iii.​ Necessary laboratory examinations or
malignancies) diagnostic procedures may be requested by
f). Hearing impairment the Maxicare primary care physician or
g). Hemorrhoids Coordinator using the Maxicare Laboratory
h). Uncomplicated Hepatitis A Request Form. The member then proceeds
i). Gastritis, Duodenitis or Uncomplicated to the laboratory where the tests will be
Gastric / Duodenal Ulcer performed. Results of the tests may be
j). Inactive Pulmonary Tuberculosis followed up with the Maxicare primary care
k). Migraine physician or Coordinator.
l). Non-surgical Ear-Nose-Throat conditions
such as but not limited to Sinusitis, Rhinitis, Note: Referral Slips and Laboratory Slips* are
Tonsillopharyngitis, Laryngitis, Parotitis, necessary in order for the doctor to know that
Otitis Media, Otitis Externa and Surgical Maxicare is to be billed for the procedure. For
Ear-Nose-Throat conditions such as but not queries and assistance, please call Maxicare
limited to Tonsillectomy, Nasal Polypectomy, Hotline at (02) 8582-1900.
Tympanoplasty, Sialolithotomy,
Sialodochoplasty. 2. IN-PATIENT SERVICES
m).Non-Toxic Goiter (if uncomplicated
n). Ovarian cysts Uncomplicated Cholecystitis, a)​ Upon recommendation of the Maxicare primary
Cholelithiasis care physician or Coordinator, the Member may
o). Uncomplicated Hernias (Congenital Hernia be admitted to the hospital either on emergency
or Elective Confinement.
will have coverage as listed in the
Congenital Clause) b) For proper monitoring and notification of
p). Uncomplicated Hypertension confinement by Maxicare, the Member must
q). Uncomplicated Urinary Tract Infection, present the Maxicare ID Card to the hospital’s
Stones/Calculi admitting section immediately upon admission.
r). Urinary Incontinence Likewise, said section must be notified by the
s). Cataract and Glaucoma Maxicare Coordinator of room-and-board
entitlement for proper room accommodation.
XI. AVAILMENT PROCEDURES i.​ Room upgrading during an Elective
Confinement is allowed. However, the
1. OUT-PATIENT/NON-EMERGENCY SERVICES difference in the room-and-board, doctor’s
Professional Fees and incremental costs
a)​ Any out-patient or non-emergency incurred shall be charged to and settled by
services are accommodated by the the Member upon discharge.
Maxicare primary care physician at any ii.​ In an emergency confinement where room
Maxicare Primary Care Center (PCC). entitlement may not be available, room
Please refer to the list and location of upgrading is allowed subject to the conditions
Maxicare PCCs and helpdesks on the
inside back cover. c.​ Once confinement is monitored, Maxicare
b)​ If any of the PCCs is inaccessible to the prepares the LOA, which contains Maxicare’s
Member, he may proceed to any Maxicare extent of coverage on availment. This is issued
Affiliated Hospital/Medical Clinic and must go by the Maxicare representative to the hospital
through the Maxicare Coordinator. where the Member is admitted.

i.​ Prior to availment, Member shall present d.​ All provisions indicated in the LOA shall be
his Maxicare ID Card and, another valid discussed by the Maxicare representative with
 the Member on the first or second day of order):
confinement. This informs the Member of any *​ For single enrollees: Mother, Father, then
charges that will not be shouldered by Maxicare, Siblings 21 years and 5 months old and
as well as other requirements pertinent to the below, according to age.
availment. The Member must indicate his * ​ For married enrollees: Spouse, then
conforme to the LOA provisions by signing the Children 21 years and 5 months old
same. and below, according to age.
• ​ Individual Membership Requirements:
Note: For queries and assistance, call 1.​ Application form
Maxicare Hotline: (02) 8582-1900. 2.​ 1 Valid ID/Copy of Birth Certificate
3.​ Photocopy of ACR (Alien Certificate
3. EMERGENCY CARE SERVICES of Residency) if nationality is foreign
A life threatening or accidental injury or a • ​ Family Membership Requirements
sudden and unexpected onset of a condition Couples only:
which at the time of the occurrence reasonably 1.​ Application form
appears to have the potential of causing 2.​ Copy of marriage certificate
immediate disability or death, or which
3.​ Photocopy of ACR (Alien Certificate of
requires the immediate alleviation of pain or
Residency) if nationality is foreign
discomfort.
With child dependent:
a.​ Affiliated Hospitals 1.​ Application form
i.​ Once confinement is determined, the 2.​ Copy of birth certificate (each child)
Member must notify MAXICARE HEAD 3.​ Photocopy of ACR (Alien Certificate of
OFFICE, through the customer care Residency) if nationality is foreign
department, WITHIN 24 HOURS so that Note: Maxicare may request for additional
proper assistance is promptly rendered. requirements when deemed necessary
b.​ Non-Affiliated Hospitals
i.​ After treatment at the emergency room, all HIERARCHY OF ENROLLMENT:
necessary receipts and clinical records Unless there is a valid reason for the non
must be secured by the Member for enrollment of certain dependents (i.e.
processing of claim for reimbursement. currently enrolled in another HMO, abroad,
ii.​ The Maxicare claim for reimbursement separated, deceased, etc.), applicants
form, medical certificate and all pertinent should enroll their dependents in the priority
documents must be promptly specified above.
accomplished and submitted to Maxicare Sufficient documentation shall be requested
Head Office within thirty (30) days upon the by Maxicare from the applicant to validate the
date of discharge. non-eligibility of the dependent (i.e. photocopy
of HMO card, certificate of employment from
XII. ENROLLMENT PROCESS AND GUIDELINES
company abroad, death certificate, etc.)
1. ​ Fill out the IF application form completely.
2.​ Dependent’s plan must be the same plan as the REQUIREMENTS FOR ALIEN
Principal or one plan lower. RESIDENTS/ FOREIGN NATIONALS:
3.​ Forward the accomplished application form 1.​ Photocopy of ACR (Alien Certificate of
and other requirements needed (if Residency) ID
applicable) to the Account Officer for 2.​ Certificate of employment (if applicable)
processing.
4. Once the application has been approved, XIII. EXCLUSIONS AND LIMITATIONS
the Statement of Account shall be sent to
your billing address for settlement. Notwithstanding any provisions to the contrary,
Payments (cash or check) may be made at the following shall not be covered except
the Maxicare Head Office or at any Banco otherwise specified in Agreement:
de Oro branches via bills payments. 1.​ Services obtained for non-emergency
5. Members will receive a Maxicare ID card as conditions from Physicians and Hospitals in
proof of membership. any of the following circumstances:
a.​ Non-affiliated physicians in non-affiliated
Who may be enrolled into the Maxicare hospitals or clinics;
Program and what are the requirements?
b. ​ Non-affiliated physicians in affiliated
●​ The age eligibility for principal and hospitals or clinics;
dependents are from 15 days old to 60 c.​ Affiliated physicians in non affiliated
years and 5 months of age. hospitals or other non affiliated
●​ Eligible dependents are as follows (in healthcare facilities.
2.​ Additional hospital charges and physician’s Neural Tube Defects, and Mental Retardation.
professional fees resulting from: 7. ​ Treatment of any injury received when there is:
a.​ Room-upgrading beyond member’s a.​Negligence
allowable time during emergency care; b.​Unauthorized use of prohibited drugs or
regulated drugs
b. ​ Extension of hospital stay despite c.​Alcoholic liquor intake
release of discharge order from d.​Direct or indirect participation in the
member’s attending physician; commission of a crime whether consummated
or not
c. ​ Fees of the assistant surgeons/
e.​Violation of a law or ordinance
resident doctors who assisted the f.​ Unnecessary exposure to imminent danger,
Attending Physician in the process of knowingly or unknowingly or hazard to health,
rendering the above mentioned by the member.
services shall not be chargeable to the Note: Maxicare shall be given a copy the police or
Member and/or Maxicare except for doctor's report (the “Report”), if any. To
hospitals that do not have resident determine whether or not such treatment is an
physicians to assist during surgeries exclusion under this paragraph, Maxicare may
subject to the prior approval of rely on the Report, as well as on the evaluation
Maxicare of its own medical resource group provided,
d.​ Use of extra bed, TV, electric fan, however, that if Maxicare has yet to receive the
​ DVD/VCD, and other similar items Report or the evaluation of its medical resource
unless such appliances and items are group, the Member shall shoulder the expenses
necessarily and ordinarily included in for medical treatment subject to Maxicare’s
the Member’s Room & Board reimbursement should it be found, after
Accommodation; submission of pertinent documentary evidence,
that the treatment is not an exclusion under this
e.​ Extra food;
paragraph. Reimbursement will be based on
f.​ Toilet articles like face towel, soap,
Maxicare standard rates and will be based on
toothbrush and the like; the terms and conditions of this Agreement.
g.​ Difference in room and board, the 8. Aesthetic, cosmetic and reconstructive surgery
​incremental rate differences for or any consultation or treatment for any
​professional fees, diagnostic and beautification purposes except if necessary to
laboratory examinations, and other treat a functional defect due to accidental injury
ancillary medical services brought within the initial confinement.
about by obtaining a room 9. Oral surgery following accidental injury to teeth
accommodation higher than the for purposes of beautification. Dental
Member’s Room and Board
examinations, extractions, fillings, other dental
Accommodation limit;
treatment and their complications to the extent
h. ​ Services of a private or a special
that are medically necessary for repair or
nurse;
alleviation of damage to the member caused
i.​ All other items not medically necessary solely by an accident. Medical care resulting
in the medical management of the from any dental related conditions.
​patient 10.​Maternity care and all other conditions,
3.​ Custodial, domiciliary, convalescent and including pre and post-natal consultations,
intermediate care. related to and/or resulting from pregnancy
4. ​ Long-term rehabilitation and psychiatric and/or delivery which affect the conditions of
care and/or psychological illnesses and the principal member and the unborn child.
conditions including neurotic and psychotic 11.​Circumcision (except for treatment of urological
behavior disorders; anxiety disorders. ​conditions), sex transformation, diagnosis,
5. ​ Treatment for injury and its complications ​treatment and procedures related to fertility or
​ resulting from self-inflicted injuries including ​infertility, artificial insemination, sterilization or
​ infections as a result of tattoos, piercing of ​reversal of such procedures and their
​ the ear or in any body part, whether self ​complications.
​ inflicted or done by a third party or attempted 12.​Experimental medical procedures and its
​ suicide or self-destruction, whether sane or ​complications.
​ insane. 13.​Acupuncture and cryotherapy and other
6.​ Developmental disorders including functional forms of therapies, and its complications.
disorders of the mind, such as but not limited to 14.​All expenses incurred in the process of
Attention-Deficit Disorder ​organ donation and transplantation if the
(ADD)/Attention-Deficit Hyperactivity Disorder member is the donor of such donation or
(ADHD), Autism Spectrum Disorders, Bipolar transplantation, and its complications.
Disorders, Central Auditory Processing Disorder 15.​Routine physical examinations required for
(CAPD), Cerebral Palsy, Down Syndrome, ​obtaining or continuing employment,
 ​requirement in school, insurance, 29. Benefits covered by PhilHealth and all
​government licensing, health permit and other government funded healthcare
​other similar purposes. entitlements as provided for by law.
16.​Purchase or lease of durable medical 30. ​Speech therapy for developmental and
​equipment, oxygen dispensing equipment, congenital diseases.
and oxygen, except during in-patient care. 31. ​Weight reduction programs, surgical operation
17.Corrective appliances, prosthetics and or procedure for treatment of obesity, including
orthotics such as but not limited to eye gastric stapling or balloon procedures and
glasses and contact lenses, hearing aids, liposuction
pacemaker, artificial limbs, valves, 32. ​Cost of vaccines and immunization
knee-tibial insert for total knee arthroplasty, including its administration.
vascular grafts, titanium thread, 33. ​Cost of medico-legal cases.
myringotomy tube, intravascular catheters, 34. ​Routine medical examination or check up or
vascular stents, bone screws/plates, pins, medical examination for employment or medical
wires, balloons, orthopedic internal examination for travel.
fixator/fixation systems, orthopedic external 35. ​Intravenous Immunoglobulin (IVIG).
fixator/fixation systems, intraocular lens, 36. ​Treatment of work-related injuries of high-risk
braces, crutches, herniorrhaphy mesh or occupations such as but not limited to
mesh used for herniorrhaphy. construction workers, miners, loggers and
18. ​Take-home medicine and outpatient drillers.
medicine except 37. ​Cost of the medical services and Professional
a.​Chemotherapy medicine (except for cancer Fees in excess of the MBL.
treatment
38. Guillain-Barre Syndrome
b.​Medicine administered during an emergency
treatment. 39. Multiple sclerosis, epilepsy and seizures.
19. ​Congenital, genetic and heredity disease 40. Routine, diagnostic, therapeutic and other
and their complications (except for procedures of the same or similar nature not
hernias) affecting functions of individuals. otherwise specified in this Agreement
20. ​All physical deformities prior to enrollment. 41. Open heart surgeries, angioplasties,
21. ​Treatment of injuries/illnesses caused valvuloplasties, permanent pacemaker, balloon
​directly or indirectly by engaging in any valvuloplasties, percutaneous intra aortic balloon
​professional sport or hazardous activity counter pulsation and balloon atrial septostomy.
such as but not limited to scuba diving, 42. ​All cases of assault whether provoked or
surfing, water skiing, mountain climbing, unprovoked, whether initiated by the Member or
rock climbing, mountaineering, by a known or unknown third party.
parachuting, airsoft, drag racing,
43. ​Home service.
paintballing, wakeboarding and bungee
44. ​Laser procedures or treatments.
jumping, except for activities under
45. ​Neurologic degenerative diseases such as but
company-sponsored sports activities.
not limited to Alzheimer’s disease, Parkinson’s
22. ​Injuries resulting from direct participation
disease, amyotrophic lateral sclerosis
in riots, strikes, and other civil
46. All screening tests.
disturbances.
23. ​Treatment of injuries or illnesses resulting
OTHER PROVISIONS:
from war or any combat-related activities
while in military service.
24. ​Sexually transmitted diseases, genital ENHANCED ACTIVATION POLICY
warts, AIDS and AIDS related diseases.
25. ​Pre-existing Conditions For Individual and Family
a. Dreaded OR Issuance Effectivity will be after
b. Non-dreaded Date 7th calendar days
Note: Please refer to the Dreaded and
**Effective on October 25, 2021
Non-dreaded above provision
26. Treatment for Chronic Dermatoses, except
LAPSATION
Scabies.
27.​ Infectious diseases (i.e. Avian Flu,
If a member fails to pay a membership fee on its
Meningococcemia, etc.) that are declared due date, his or her membership shall be
epidemic or pandemic by the Department considered lapsed effective the day after the due
of Health, World Health Organization or date. A member whose membership has lapsed
any recognized health authority. will not be entitled to any Benefit during the period
28. ​Hepatitis B and screening and vaccines for all that his membership is on a lapsed status, except
​types of Hepatitis. in connection with illness or injury that
supervened prior to such lapsation and for which
the member had at that time made the necessary
claim for the benefits under this Agreement.

REACTIVATION

A Member whose coverage has lapsed may apply

to reactivate his or her coverage within fifteen (15)
days from end of Grace Period by (a) submitting a
written request for reactivation; (b) paying the
Membership fee due with arrears, including the
penalty charge of five hundred pesos (Php500) per
Member; (c) for modes of payment other than
annual, paying in advance the Membership fee due
for the next period.

Suspension of benefits under this Agreement shall

be in force until such time the Member shall have
paid in full all fees required in reactivation of his or
her coverage and within thirty (30) days from the
effective date of reactivation.

After forty-five (45) days from the due date and all
fees required in reactivation of coverage is not yet
paid and settled, Maxicare reserves the right to
disapprove reactivation. However, Member may
re-apply subject to approval of the Maxicare
Underwriting Department.

***May change without prior notice***

 2025 INDIVIDUAL MEMBERSHIP FEES

2025 Annual Rates 2025 Semi-Annual Rates

AGE BRACKET PLATINUM PLATINUM
PLATINUM GOLD SILVER PLATINUM GOLD SILVER
PLUS PLUS

R&B Large Pvt Reg Pvt Reg Pvt Semi-Pvt Large Pvt Reg Pvt Reg Pvt Semi-Pvt
MBL 250,000 200,000 150,000 100,000 250,000 200,000 150,000 100,000
15 days old -5 y.o. 72,403 42,443 37,573 27,843 39,098 22,919 20,289 15,035
6-10 y.o. 59,282 34,001 29,415 23,199 32,012 18,361 15,884 12,527
11-15 y.o. 48,852 27,365 24,201 19,632 26,380 14,777 13,069 10,601
16-20 y.o. 47,322 25,271 23,159 18,674 25,554 13,646 12,506 10,084
21-25 y.o. 47,055 26,364 22,623 18,674 25,410 14,237 12,216 10,084
26-30 y.o. 48,852 29,152 26,542 21,245 26,380 15,742 14,333 11,472
31-35 y.o. 58,543 34,553 32,009 22,884 31,613 18,659 17,285 12,357
36-40 y.o. 73,603 45,522 42,014 27,866 39,746 24,582 22,688 15,048
41-45 y.o. 93,488 61,893 53,800 41,774 50,484 33,422 29,052 22,558
46-50 y.o. 111,362 83,525 64,494 50,006 60,135 45,104 34,827 27,003
51-55 y.o. 125,647 101,796 67,461 50,020 67,849 54,970 36,429 27,011
56-60 y.o. 138,743 115,275 78,660 55,571 74,921 62,249 42,476 30,008

NOTES:
1) Above rates are inclusive of 12% VAT
2) With access to all affiliated hospitals and clinics including Healthway Clinics
3) Status quo benefits and arrangements including the following:
a.​ ACU/ECU type: ACU Basic 5 only (applicable to ALL plan types)
b.​ Philhealth provision: Required to file Philhealth. Non-Philhealth members will pay for the
Philhealth portion.
c.​ Riders: Built-in on Rates
i. ​ International Assistance Program
ii. ​ Group Life Insurance with Accidental Death, Dismemberment & Disablement
(ADD&D) up to Php 50,000

Separate Fee
2025 Rates
Rider
Annual Semi-Annual

Standard Dental Benefit 387 209

Critical Illness (42) Benefit up to 537 290

Php 50,000 c/o MaxiLife
 2025 FAMILY MEMBERSHIP FEES

2025 Annual Rates 2025 Semi-Annual Rates

AGE BRACKET PLATINUM PLATINUM
PLATINUM GOLD SILVER PLATINUM GOLD SILVER
PLUS PLUS

R&B Large Pvt Reg Pvt Reg Pvt Semi-Pvt Large Pvt Reg Pvt Reg Pvt Semi-Pvt
MBL 250,000 200,000 150,000 100,000 250,000 200,000 150,000 100,000
15 days old -5 y.o. 59,205 38,563 31,019 24,405 31,971 20,824 16,750 13,179
6-10 y.o. 48,449 30,980 25,001 19,882 26,162 16,729 13,501 10,736
11-15 y.o. 42,206 25,125 20,616 17,068 22,791 13,568 11,133 9,217
16-20 y.o. 38,506 22,992 18,417 16,217 20,793 12,416 9,945 8,757
21-25 y.o. 38,885 24,574 18,157 16,162 20,998 13,270 9,805 8,727
26-30 y.o. 40,723 27,073 21,374 17,930 21,990 14,619 11,542 9,682
31-35 y.o. 46,057 32,579 24,954 19,422 24,871 17,593 13,475 10,488
36-40 y.o. 52,564 41,188 31,625 23,129 28,385 22,242 17,078 12,490
41-45 y.o. 68,051 53,520 39,408 33,317 36,748 28,901 21,280 17,991
46-50 y.o. 91,302 71,555 50,194 41,512 49,303 38,640 27,105 22,416
51-55 y.o. 107,329 87,296 52,712 41,697 57,958 47,140 28,464 22,516
56-60 y.o. 123,308 102,724 61,019 46,303 66,586 55,471 32,950 25,004

NOTES:
1) Above rates are inclusive of 12% VAT
2) With access to all affiliated hospitals and clinics including Healthway Clinics
3) Status quo benefits and arrangements including the following:
a.​ ACU/ECU type: ACU Basic 5 only (applicable to ALL plan types)
b.​ Philhealth provision: Required to file Philhealth. Non-Philhealth members will pay for the
Philhealth portion.
c. ​ Riders: Built-in on Rates
iii.​ International Assistance Program
iv. ​ Group Life Insurance with Accidental Death, Dismemberment & Disablement
(ADD&D) up to Php 50,000

Separate Fee
2025 Rates
Rider
Annual Semi-Annual

Standard Dental Benefit 387 209

Critical Illness (42) Benefit up to 537 290

Php 50,000 c/o MaxiLife
MAXICARE PRIMARY CARE CENTERS were put BRIDGETOWNE
together with your convenience in mind. These are Unit 1-3, Zeta Tower, Bridgetowne, C-5 Road, Ugong
well- appointed to give the cardholders access to Norte, QC
quality health care close enough to where they work Contact No: (02) 798-7739
or live. Each center has its staff of Customer
Email: [email protected]
Service Assistants, Primary Care Physicians
(specialists in some centers on certain days) and
CAGAYAN DE ORO
additional services like urinalysis and CBC.
G/F Primavera City Citta Verde, Pueblo De Oro, Upper
Because our centers are located close to major
Carmen, Cagayan De Oro
hospitals, our Customer Service Assistants are
able to facilitate easy access to quality diagnostics, Contact No: (088) 864 8804
specialist consultation and hospitalization when Email: [email protected]
you need it.
CEBU BUSINESS PARK
Lot 5, Block 6, Mindanao Avenue, Cebu Business
MAXICARE PRIMARY CARE CENTERS Park, Ayala, Barangay Luz, Cebu City
AND MYHEALTH CLINICS Contact No: (032) 260-9067
Email: [email protected]
ABREEZA MALL DAVAO
G/F, Space 1C-1D, Abreeza Corporate Center, J.P
CEBU EXCHANGE
Laurel Avenue Bajada, Davao City
G/F Cebu Exchange Tower, Salinas Dr. Cebu City
Contact No: (082) 293 2446
Contact No: (02) 7798-7739
Email: [email protected]
Email: [email protected]

ALABANG NORTHGATE
CEBU SKY RISE
G/F Southkey Hub, Indo-China Drive,
Block 8, Lot 3 Cebu IT Park Subdivision, Barangay
Northgate Cyberzone Filinvest, Alabang,
Apas, Cebu City
Muntinlupa City
Contact No: (032) 260 9069
Contact No: (02) 798-7739
Email: [email protected]
Email: [email protected]
CLARK
AYALA NORTH EXCHANGE
G/F City Clark, Tech Hub 6, Manuel A. Roxas highway,
2/F The Shops, Ayala North Exchange, Ayala Clark Freeport, Angeles, Pampanga
Avenue, Makati City Contact No: (045) 6498001
Tel No: (02) 7798-7739 Email: [email protected]
Email:
[email protected] CUBAO
Upper G/F, Cyberpark Tower 2, Araneta City, Cubao, QC
BACOLOD Contact No: (02) 7798-7739
G/F Lopues Mandalagan Building, Lacson St., Email: [email protected]
Mandalagan, Bacolod City
Contact No: (034) 458 6715 DASMARINAS
Email: [email protected] Level 2, Terraza Dasma (Robinsons Dasmarinas),
Aguinaldo Highway, Dasmarinas, Cavite
BAGUIO Contact No: (02) 7798-7739
G/F Patria de Baguio, Porta Vaga Mall, Session Road, Email: [email protected]
Baguio City
Contact No: (074) 661 8833 DOUBLE DRAGON
Email: [email protected] G/F Tower 2, Double Dragon Meridian Park.
EDSA Exit corner Macapagal Avenue, Pasay City
BONIFACIO TECHNOLOGY CENTER Contact No: (02) 7798-7739
2nd Ave cor 31st St. Bonifacio Technology Center, Email: [email protected]
Bonifacio Global City
Tel No: (02) 7798-7739
Email:
[email protected]
DONA ELENA TOWER ROBINSONS NOVALICHES
2nd Level, P. Sanchez St., 3rd St, Santa Mesa, Manila G/F, Robinsons Novaliches Expansion Area, Quirino
Contact No: (02) 7798-7739 Highway, QC
Email: [email protected] Contact No: (02) 7798-7739
Email: [email protected]
ETON CENTRIS
G/F Cyberpod Centris 5, Eton Centris, Quezon City ROBINSONS OTIS
Contact No:: (02) 7798-7739 2nd Floor Robinsons Mall OTIS, Paco Manila
Rehab: 0917-830-6211 Contact No: (02) 7798-7739
Email: [email protected] Email: [email protected]
For Rehab concerns:
[email protected] ROBINSONS STARMILLS (SAN FERNANDO)
G/F Robinsons Starmills, Jose Abad Santos Ave., Brgy
San Jose, San Fernando, Pampanga
FAIRVIEW
Contact No: (02) 7798-7739
Unit 1&2 AD Center, Regalado Ave., Fairview, QC
Email: [email protected]
Contact No: (02) 7798-7739
Email: [email protected]
SAN JOSE DEL MONTE BULACAN (SJDM)
2F Skyline Drive Bldg.., Quirino Hi-way Maharlika San
HEMADY
Jose Del Monte, Bulacan
Unit 102 & Unit 203-205, Hemady Square
Contact No: (02) 7798-7739
86 Dona Hemady St. Cor E. Rodriguez Sr Ave., QC
Email: [email protected]
Contact No: (02) 7798-7739
Email: [email protected]
SOLENAD LAGUNA
G/F Solenad 2, Nuvali, Sta. Rosa, Laguna
ILOILO
Contact No: (049) 559 8008 or 0917-848-9274
Unit 4, Three Techno Place, Megaworld Blvd,
Email: [email protected]
Mandurriao, Iloilo City, Iloilo
Contact No: (033) 3287031
SOMO BACOOR
Email: [email protected]
Ground floor, SOMO A Vista Mall, Molino Paliparan
Road, Bacoor, Cavite
IMUS
Contact No: (02) 7798-7739
Metro MPC Building, E. Aguinaldo Hway, Imus, Cavite
Email: [email protected]
Contact No: (046) 4198017
Email: [email protected]
THE MEZZO CALAMBA
G/F The Mezzo Barangay Turbina, Calamba, Laguna
ROBINSONS LAS PINAS
Contact No: (02) 7798-7739 or 0917-127-2505
Level 2, Robinsons Place Las Pinas, Talon Uno,
Email: [email protected]
Alabang Zapote Road, Las Pinas City
Contact No: (02) 7798-7739
VV SOLIVEN
Email: [email protected]
GF-SOL1 (Centro Del Sol), VV Soliven Shopping
Complex, EDSA Greenhills, San Juan City
ROBINSONS MALOLOS
Contact No: (02) 7798 7788, (02)7798 7739
4th Level, Robinsons Malolos, Bulacan
Email: [email protected]
Contact No: (02) 7798-7739
Email: [email protected]
W CITY CENTER
ROBINSONS METRO EAST G/F, W City Center , 7th Avenue cor. 30th St., Bonifacio
4th Level, Robinsons Metro East, Marikina-Infanta Global City, Taguig
Highway, Pasig City Contact No: (02) 7798-7739
Contact No: (02) 7798-7739 Email: [email protected]
Email: [email protected]
MY HEALTH CLINIC – TAGUIG CITY CHINESE GENERAL HOSPITAL & MEDICAL CENTER
nd
2 Floor, Venice Grand Canal Mall, McKinley 10/F Medical Arts Building, Chinese General Hospital,
Hills, Taguig City Blumentritt, Sta. Cruz, Manila
Tel Nos: (+632)8784-6930
Clinic Hours: Open 24 hours daily CAPITOL MEDICAL CENTER
Room 1101, 11th Floor, Capitol Medical Center, Scout
Magbanua St. cor Quezon Ave, Quezon City
MY HEALTH CLINIC- SHANGRILA
Unit 146, Level 1 Shangri La Plaza VRP MEDICAL CENTER
Mall, Mandaluyong City G/F, Doctor’s Building Victor Potenciano Medical
Tel. Nos.: (02) 8570-4325 loc. 206 Center, EDSA, Mandaluyong City
Clinic Hours: 7am- 8pm Monday- Sunday
ASIAN HOSPITAL & MEDICAL CENTER
MY HEALTH CLINIC- NORTH EDSA Upper Ground Floor, Tower 2 Asian Hospital & Medical
2nd Floor, North Link Bldg., F, SM City North Center 2205 Civic Drive, FCC Alabang, Muntinlupa
Edsa North Avenue, Quezon City
Tel. Nos.: (02) 8441-4106 loc. 206 CALAMBA MEDICAL CENTER
Maxicare Office, 2nd Floor, Calamba Medical Center
Clinic Hours: 7am-9pm, Monday-Sunday
Tower 1, Crossing Real, Calamba City, Laguna

MY HEALTH CLINIC- FESTIVAL MALL

THE MEDICAL CITY SOUTH LUZON, LAGUNA
21 Style Blvd, Festival Mall, Alabang, Muntinlupa 2/F, The Medical City South Luzon, United boulevard ,
City Greenfield city, Sta rosa Laguna
Tel. Nos.: (02) 8850-4855 loc.102; Telefax (02)8
809- 4388 CEBU CYBERGATE
Clinic Hours: 7am-8pm Monday to Saturday 4F, Robinsons Cybergate Mall Cebu City

MY HEALTH CLINIC- ROBINSON’S CYBERGATE DAVAO

3rd Floor, Room 305-306, Robinson’s Cybergate Mall, 3/F FTC Tower, Mt. Apo Street, Davao City
Fuente Osmeña Street, Cebu City
Tel. Nos.: (032) 8268-8502 loc. 204 or 205 Clinic Hours:
GENERAL SANTOS
7am-7pm Monday to Saturday
Unit 206, 2nd floor Santanna Bldg., Santiago Blvd.,
General Santos City

HELPDESK CAGAYAN DE ORO

2nd floor Gateway Tower Limketkai Mall, CM Recto
MAKATI MEDICAL CENTER
Street, Cagayan de Oro, 9000 Misamis Oriental
Digital Hub 1/F Tower Two, Makati Medical Center
Amorsolo St., Makati City
BACOLOD
MANILA DOCTORS HOSPITAL Unit 102 A&B 103 A&B and 104 AG/F, VLI Medical
2/F, Manila Doctor's Hospital, Kalaw Wing, Ermita, Plaza Bldg., Ipil St., Capitol Shopping Business
Manila Center, Bacolod City, Negros Occidental

CARDINAL SANTOS MEDICA CENTER

Room 160, G/F Medical Arts Building, Cardinal Santos
Medical Center, Wilson Street, Greenhills, San Juan City

THE MEDICAL CITY

MGR04, G/F, Medical Arts Tower, Ortigas Avenue, Pasig
City

ST. LUKE’S MEDICAL CENTER, GLOBAL CITY

Room 325, 3/F, Medical Arts Bldg, Rizal Drive Cor. 5th
Ave & 32nd Ave., Fort Bonifacio Global City, Taguig
*For Providers’ Directory, please refer to List of
Accredited Hospitals & Clinics at www.maxicare.com.ph

Sales Dept: 8908 6900 or you may send us an email at [email protected]

Maxicare Hotline: 8908-6900
Product Inquiry Hotline: (02) 8798-7770
International Assist Hotline: (02) 8811 2521 or (+63917) 562-2100
24/7 Customer Care Hotline: 8582-1900 or 7798-7777
24/7 Teleconsult Hotline: 8582-1980
Toll Free No. for Provincial Inquiries (PLDT Line): 1-800-10-582-1900
Live Chat: www.maxicare.com.ph

Happy to assist you!

Juliet Ching
0917.8359547
02.8404.5829