Maxicare individual-and-family-program

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  • To know more about MAXICARE HEALTHCARE CORPORATION, kindly visit their business page at Yellow Pages: http://www.yellow-pages.ph/business/maxicare-pcib-cigna-health-care
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  • I had been a Maxicare card holder through our company or a corporate account. How could I possibly continue this health program though my personal and family account?
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  • dati po maxicare holder natapos na un 1 year gusto ituloy un members ko ano po ba ang dapat kong gawin pano po ba un individual
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  • can maxicare card be used during childbirth?
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  • how can i avail? is there any contact number where can i call?tnx
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Maxicare individual-and-family-program

  1. 1. MAXICARE HEALTHCARE PROGRAM “ Our commitment to good health and peace of mind…”
  2. 2. Is your purse ready when you get sick? <ul><li>FACT: </li></ul><ul><li>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. </li></ul>
  3. 3. You’ll never know when you’ll get sick. <ul><li>Here, we give you the top reasons why we recommend or clients to get an HMO </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>
  4. 4. What your MAXICARE CARD can do you for YOU? <ul><li>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. </li></ul><ul><li>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 </li></ul>
  5. 5. More than 300,000 Cardholders nationwide Best Employers in Asia/Philippines Top 2,000 Companies in the Country Years of Service, Extent of Expertise 20 years of SOLID Healthcare Expertise 1 ST HMO to implement the “HOSPITAL-BASED Program” HMO of Choice
  6. 6. Best Employers in Asia/Philippines
  7. 7. Banking & Finance Industry
  8. 8. Business Processing – Outsourcing/ Contact Centers
  9. 9. Manufacturing Industry
  10. 10. Food & Retail Industry
  11. 11. A few of the Clients we SERVE..
  12. 12. 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
  13. 13. Can be used in over 300 hospitals and clinics nationwide including: <ul><li>Alabang Medical Center </li></ul><ul><li>Asian Hospital </li></ul><ul><li>Capitol Medical Center </li></ul><ul><li>Cardinal Santos Medical Center </li></ul><ul><li>Chinese General Hospital </li></ul><ul><li>De Los Santos Medical Center </li></ul><ul><li>FEU-Nicanor Reyes Hospital </li></ul><ul><li>Las Pinas City Medical Center </li></ul><ul><li>Las Pinas Doctors Medical Center </li></ul><ul><li>Makati Medical Center </li></ul><ul><li>Manila Doctors Hospital </li></ul><ul><li>Perpetual Help Medical Center </li></ul><ul><li>St. Lukes Medical Center </li></ul><ul><li>The New Medical City </li></ul><ul><li>University of Santo Tomas Hospital </li></ul><ul><li>University of the East-Ramon Magsaysay Medical Center </li></ul><ul><li>And many other top & recognized hospitals in Luzon, Visayas & Mindanao </li></ul>
  14. 14. Extensive Customer Care Network Customer Care Division 24/7 Call Center Primary Care Centers (MMC, SLMC, N-TMC) Corporate-Based Roving Team Centers in Key Cities Cebu Bacolod Iloilo Davao General Santos
  15. 15. THE MAXICARE INTELLIGENT CARD Maxicare Swipe Card <ul><li>Real-time validation of membership during availments </li></ul><ul><li>Real-time record of availments which can be viewed via the web </li></ul><ul><li>Swipe facility using more than 600 POS units of Equitable PCIBank nationwide </li></ul><ul><li>Cards need not be replaced on a yearly basis </li></ul>
  16. 16. MAXICARE TYPES OF MEMBERSHIP Type Size Age Eligibility Dependents Eligibility MEMBERSHIP FEES Individual 1 applicant 2-60 years old, renewable up to 65 Not Applicable According to Plan of Choice, according to age Family At least 2. 1 principal and at least 1 dependent Principal must be 18 to 60 years old. Dependent must follow hierarchy/order. If single, mother > father > eldest to youngest sibling If married, spouse > eldest child >youngest child Per Person, According to Plan of Choice, according to age Group 5-19 employees Employee must be 18 up to 60 years old At least 75% of the employees must enroll at least 1 dependent. Must follow hierarchy Per Person, According to Plan of Choice, according to age Corporate 20 employees & up Employee must be 18 up to 65 years old At least 75% of the employees must enrol at least 1 dependent. Must follow hierarchy Uniform Rates for all, Subject to a separate quotation. Rates on this presentation do not apply
  17. 17. MAXICARE INDIVIDUAL & FAMILY HEALTHCARE PROGRAM 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 PLAN TYPE ROOM & BOARD MAXIMUM BENEFIT LIMIT ANNUAL CHECK UP 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
  18. 18. I. OUTPATIENT CARE <ul><li>Medically necessary consultations during regular clinic hours, except medicines. </li></ul><ul><li>Dermatology Consultations </li></ul><ul><li>Eye, ear, nose and throat (EENT) treatment </li></ul><ul><li>Treatment of minor injuries such as lacerations, mild burns, sprains and the like </li></ul><ul><li>X-ray, laboratory examinations, routine, diagnostic and therapeutic procedures prescribed by an accredited doctor </li></ul><ul><li>Minor surgery not requiring confinement </li></ul><ul><li>Physical Therapy/Occupational Therapy up to 12 sessions </li></ul><ul><li>Laser Therapy for retinal detachment and glaucoma prescribed by an affiliated physician up to P10,000/eye/member/year </li></ul><ul><li>Cauterization of Warts up to P1,000/year / member </li></ul><ul><li>Speech Therapy up to 12 sessions (Stroke Patients) </li></ul>
  19. 19. Out Patient Availment
  20. 20. II. IN PATIENT CARE <ul><li>Room and Board Accommodation </li></ul><ul><li>Use of Operating and Recovery Rooms </li></ul><ul><li>Use of Intensive Care Unit (ICU) </li></ul><ul><li>Professional Fees of attending doctor(s) </li></ul><ul><li>Drugs and medicines for use in the hospital </li></ul><ul><li>Whole blood and human blood products and IV fluids </li></ul><ul><li>X-ray, laboratory examinations and diagnostic tests </li></ul><ul><li>Dressings, casts and sutures </li></ul><ul><li>Anesthesia and its administration </li></ul><ul><li>Oxygen and its administration </li></ul><ul><li>Laparoscopy and Lithotripsy covered up to 100% of the actual cost </li></ul><ul><li>Standard nursing services </li></ul><ul><li>Admission kit including ice cap and wee bag </li></ul>
  21. 21. In-Patient Availment
  22. 22. III. ANNUAL CHECK UP * according to plan of choice <ul><li>Platinum Plus Plan: (Multi-Phasic B) </li></ul><ul><li>CBC (Complete Blood Count) </li></ul><ul><li>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) </li></ul><ul><li>Thyroid Function:TSH-IRMA </li></ul><ul><li>Hepatitis Screening: BhsAg, Anti-HBs, Anti-HBc </li></ul><ul><li>Routine Urinalysis </li></ul><ul><li>Routine Fecalysis </li></ul><ul><li>Cardiac Work-up (12-Lead ECG, Treadmill Stress Test) </li></ul><ul><li>Chest x-ray </li></ul><ul><li>Abdominal Work-up (Upper Gastrointestinal series, Ultrasound of liver, Gallbladder & Pancreas, barium Enema, Proctosigmoidoscopy) </li></ul><ul><li>Platinum Plan : (Executive Check-up) </li></ul><ul><li>Physical Examination </li></ul><ul><li>Urinalysis </li></ul><ul><li>Fecalysis </li></ul><ul><li>Chest X-ray </li></ul><ul><li>CBC (Complete Blood Count) </li></ul><ul><li>Blood Chemistry – Potassium, Creatinine, Total Protein, Total Bilirubin, Triglycerides, Calcium, Uric Acid, Albumin, SGOT, Alkaline, Fasting Blood Sugar, Phosphate </li></ul><ul><li>12 – Lead Elecrocardiogram </li></ul><ul><li>Ultrasound of the Gallbladder and kidney </li></ul><ul><li>Treadmill Stress Test OR Barium Enema </li></ul>
  23. 23. III. ANNUAL CHECK UP * according to plan of choice <ul><li>Gold Plan : Semi Executive Check Up </li></ul><ul><li>Physical Examination </li></ul><ul><li>Urinalysis </li></ul><ul><li>Fecalysis </li></ul><ul><li>Chest X-ray </li></ul><ul><li>CBC (Complete Blood Count) </li></ul><ul><li>Blood Chemistry (FBS, SGPT, Cholesterol, Creatinine, Uric Acid) </li></ul><ul><li>12-Lead ECG </li></ul><ul><li>Papsmear </li></ul><ul><li>Silver Plan: (Routine) </li></ul><ul><li>Physical Examination </li></ul><ul><li>Urinalysis </li></ul><ul><li>Fecalysis </li></ul><ul><li>Chest X-ray </li></ul><ul><li>CBC (Complete Blood Count) </li></ul><ul><li>12 – Lead Elecrocardiogram (exclusive for 40 years old & above as an optional package) </li></ul><ul><li>Papsmear (exclusive for 40 years old & above as an optional package) </li></ul>
  24. 24. IV. PREVENTIVE CARE <ul><li>Administration of passive immunization excluding cost of vaccines </li></ul><ul><li>Periodic Monitoring of health problems </li></ul><ul><li>Health education and counseling on diets and exercise </li></ul><ul><li>Health Habits and Family Planning counseling </li></ul>
  25. 25. V. EMERGENCY CARE <ul><li>A. ACCREDITED HOSPITAL </li></ul><ul><li>Doctor’s services </li></ul><ul><li>Emergency room fees </li></ul><ul><li>Medicines used for immediate relief & during treatment </li></ul><ul><li>Oxygen, intravenous fluids, whole blood & human blood products </li></ul><ul><li>Dressings, casts & sutures </li></ul><ul><li>X-rays, laboratory & diagnostic examinations & other medical services related to the emergency treatment of the patient. </li></ul><ul><li>Ambulance Service for accredited hospital-to-hospital transfer up to P 2,500./ per conduction (by reimbursement) </li></ul><ul><li>B. NON-ACCREDITED HOSPITAL </li></ul><ul><li>Maxicare shall reimburse 80% of the total hospital bills and 80% of the professional fees up to Php 30,000. </li></ul><ul><li>C. OUT SIDE THE PHILIPPINES </li></ul><ul><li>Maxicare shall reimburse 80% of the total hospital bills and 80% of the professional fees up to Php 30,000. </li></ul>
  26. 26. Emergency Availment MAXICARE Member Proceed to the ER of the nearest Affiliated Hospital Avail treatment at Emergency Room Present MAXICARE ID At Emergency Room Avail Room Plan Notify MAXICARE Within 24hrs. File PhilHealth on or before discharge Settle charges not covered by Maxicare at the Billing Section once the Discharge Order is issued by the Attending Doctor
  27. 27. Emergency Availment for Non-Accredited MAXICARE Member Proceed to the Emergency Room of nearest Hospital Avail treatment at Emergency Room Proceed to Room Notify MAXICARE Within 24hrs. File PhilHealth on or before discharge Settle charges all ER fees and secure Medical Cert. Original Receipts, etc. Forward all Medical Documents to MAXICARE HO within 30 from discharge for reimbursement
  28. 28. VI. DENTAL BENEFIT *optional <ul><li>Annual Oral/Dental Examination & Consultation </li></ul><ul><li>Emergency Dental Treatment </li></ul><ul><li>Annual Oral Prophylaxis </li></ul><ul><li>Simple tooth extractions </li></ul><ul><li>Restorative and Prosthodontic Treatment Planning </li></ul><ul><li>Permanent fillings – 2 areas/year </li></ul><ul><li>Unlimited temporary fillings, as needed </li></ul><ul><li>Desensitization of hypersensitive teeth – 2/year </li></ul><ul><li>Simple adjustment of dentures </li></ul><ul><li>Recementation of loose crowns, Inlays or Onlays </li></ul>
  29. 29. Dental Availment Refer to Health Partners Listing for contact numbers of Accredited Dentists Call preferred dentist to set appointment Proceed to Dentist’s Clinic on scheduled date Avail of Dental treatment or consultations Settle charges not covered by MAXICARE Present MAXICARE Card
  30. 30. MAXICARE Affiliates/Partners Up to 20% discount on Optical Services & Purchases
  31. 31. VII. OTHER FEATURES <ul><li>Life Insurance Coverage of P25,000 </li></ul><ul><li>Free Emergency Overseas Medical Evacuation </li></ul><ul><li>Congenital Illness up to P20,000 </li></ul><ul><li>Scoliosis whether congenital, pre existing or aquired up to P20,000 </li></ul>
  32. 32. VII. OTHER FEATURES
  33. 33. VIII. NON DREADED & DREADED CONDITIONS
  34. 34. <ul><li>1. Self Inflicted Injuries and Injuries from Member’s Own Misconduct: </li></ul><ul><li>Treatment of injuries or illnesses resulting from war or any combat-related activities while in military service. </li></ul><ul><li>Functional disorders of the mind, alcoholism and drug addiction or abuse. </li></ul><ul><li>Treatment of any injuries resulted from the Member’s own misconduct: </li></ul><ul><ul><li>gross negligence </li></ul></ul><ul><ul><li>vicious or immoral habits </li></ul></ul><ul><ul><li>direct or indirect participation in the commission of a crime </li></ul></ul><ul><ul><li>whether consummated or not </li></ul></ul><ul><ul><li>violation of a law or ordinance </li></ul></ul><ul><ul><li>unnecessary exposure to imminent danger or hazard to health </li></ul></ul>General Exclusions
  35. 35. General Exclusions <ul><li>2. Government funded healthcare entitlements & Personal medical requirements: </li></ul><ul><li>All other government funded health-care entitlements as provided for by law. </li></ul><ul><li>Routine physical examinations required for obtaining or continuing employment, requirement in school, insurance or government licensing </li></ul><ul><li>3. For Purposes of Beautification: </li></ul><ul><li>Cosmetic surgery, reconstructive surgery to treat a functional defect due to accidental injury within the initial confinement </li></ul><ul><li>Oral surgery following accidental injury to teeth for purposes of beautification </li></ul>
  36. 36. General Exclusions <ul><li>4. Chronic Dermatoses: </li></ul><ul><li>Psorasis / Skin Asthma / Chronic Dermatoses </li></ul><ul><li>5. Unlawful Acts & Hazardous Sports: </li></ul><ul><li>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. </li></ul>
  37. 37. General Exclusions <ul><li>6. Any Additional or Extra Charges: </li></ul><ul><li>Additional charges resulting from room upgrading, or additional personal comfort items not included in the room & board accommodation ( T.V., telephone, etc.) </li></ul><ul><li>Purchase or lease of durable medical equipment, oxygen dispensing equipment, and oxygen except during covered in-patient care. </li></ul><ul><li>Corrective appliances, artificial aids, prosthetic appliances </li></ul><ul><li>Take home medicine </li></ul><ul><li>Services obtained from Non-Accredited Physicians and Hospitals or other provider of care, except under emergency care. </li></ul>
  38. 38. General Exclusions <ul><li>7. Other Non-Insurable Conditions: </li></ul><ul><li>Custodial, domiciliary, convalescent and intermediate care. </li></ul><ul><li>Long-term rehabilitation and Psychiatric care. </li></ul><ul><li>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. </li></ul><ul><li>Maternity and all maternity related conditions except for pre and post natal consultations and maternity assistance </li></ul><ul><li>Circumcision, sex transformation, diagnosis and treatment of fertility or infertility, artificial insemination, sterilization or reversal of such. </li></ul>
  39. 39. General Exclusions <ul><li>All expenses incurred in the process of organ donation and transplantation, unless the Member thereof is the recipient of such donation or transplantation. </li></ul><ul><li>All physical deformities prior to enrollment </li></ul><ul><li>Experimental medical procedures, acupuncture and speech therapy </li></ul><ul><li>Sexually transmitted diseases, AIDS and AIDS related diseases </li></ul><ul><li>Hepatitis B screening and all diagnostic examinations for Members who have pre-existing Hepa B. </li></ul>
  40. 40. INDIVIDUAL MEMBERSHIP FEES
  41. 41. FAMILY MEMBERSHIP FEES
  42. 42. MEMBERSHIP REQUIREMENTS <ul><li>Application Form </li></ul><ul><li>For Family Applications </li></ul><ul><ul><li>If the principal is single </li></ul></ul><ul><ul><li>If enrolling the PARENTS, pls attach a photocopy of the principal’s birth certificate </li></ul></ul><ul><ul><li>If enrolling the SIBLINGS as well, pls attach a photocopy of the sibling’s birth certificate </li></ul></ul><ul><ul><li>If the principal is married </li></ul></ul><ul><ul><li>If enrolling the SPOUSE, pls attach a photocopy of the marriage contract </li></ul></ul><ul><ul><li>If enrolling the CHILDREN as well, pls attach a photocopy of the child’s birth certificate </li></ul></ul><ul><li>For new applicants whether the principal or dependent aged 50-60 yrs old, please submit the following: </li></ul><ul><ul><li>12 Lead ECG / Electrocardiogram </li></ul></ul><ul><ul><li>Chest Xray </li></ul></ul><ul><ul><li>FBS / Fasting Blood Sugar </li></ul></ul><ul><ul><li>Total Cholesterol </li></ul></ul><ul><ul><li>HDL-C (High Density Lipoprotein) </li></ul></ul><ul><ul><li>LDL-C (Low Density Lipoprotein) </li></ul></ul><ul><li>Group Corporate Programs also available. </li></ul><ul><li>Fees are inclusive of VAT </li></ul><ul><li>No application & processing fees. </li></ul><ul><li>Dental Fee of P650 not yet included. </li></ul>
  43. 43. … and may you always be in the pink of health !

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