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Mb life maxicare

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  • We have been in the business for more than 22 years already. We were the 1 st HMO to implement Hospital based availment. You are now part of our more than 450,000 cardholders nationwide. We are also proud to say that we are the HMO of choice of most of the Best employers not only in the Philippines but also in Asia. Our clients are also part of the top 20000 companies in the country.
  • The following slides will show you the value propositions that have been enjoyed by our clients and which we are now offering to all of you.
  • (Soon, you will be receiving your Maxicare Intelligent cards/ By now, you have received your Maxicare Intelligent Cards) It is intelligent simply because it does the talking for you. It saves you the hassle of waiting for any phone verifications because you simply has to swipe your cards to POS terminals. It works just like your credit card! With this card, we can immediately activate and deactivate membership within 24 hours which prevents unauthorized availments.
  • Part of your benefit is having access to our Primary Care Centers which are clinics owned by Maxicare. Here are the advantages of going to our primary care centers. First, it is exclusive to you guys only which saves you the hassle of lining up alongside cardholders of other HMOs. Second, you will have easy access to our specialists which are situated in these clinics. Since these clinics are owned by Maxicare, you can also avail of lab tests at a cheaper costs compared to accredited providers. The best thing about our PCCs is that you can avail of unlimited no. of free consultations. This means that any consultation which is availed from these clinics are free and not deducted to your Limit. (Give example) Lastly, for your convenience, we have placed our clinics in major hospitals and malls.
  • Here are our Primary Care Centers : 6 are located in Major Hospitals, and 2 are situated in Malls which operates during mall hours.
  • (Ask if there is any question on the previous discussion). Let us know proceed to your comprehensive healthcare package. For this year, your company has provided you a very comprehensive package which includes: Read fast.
  • Under, Preventive care, you can avail of the following: (read fast) Examples that you can mention: 1. Periodic Monitoring – people who have diabetes are required to have regular tests such as :

Mb life maxicare Mb life maxicare Presentation Transcript

  • A better life for the Filipino Family
  • ABOUT MB LIFE
      • Established in May 19, 1967 by Senator Gil J. Puyat as the Founding Chairman
      • Business Focus in Corporate or Group Benefits Program
      • Serves to over 300 private companies both local and multinational nationwide, government offices and agencies and more than 200 banks and other financial institutions in the country.
  • OUR VISION
    • We are the preferred group insurance provider in the Philippine market.
  • OUR MISSION
    • Provide our Clients, delivery of our commitments beyond their expectations.
    • Deal with our Marketing Allies and Suppliers, with utmost professionalism and integrity, recognizing their significant contribution to the growth of the company.
    • Provide our Employees, the opportunities for professional growth and full realization of their individual potentials as God‘s children.
    • Provide our Shareholders, with a fair return on invested capital and enhance shareholder value.
    • Be a good corporate citizen, by playing an active role in the task of community and nation building.
  • OUR CORE VALUES
    • With an unwavering faith in God, our core values are:
      • Integrity and Honesty
      • Hard Work, Competence and Excellence
      • Concern for People
  • OUR PRODUCTS
        • H OSPITAL INCOME AND FAMILY INCOME (HI-FI) PRIME
        • F AMILY TIES
        • M ICROPROTECT
        • MB LIFEGUARD
    • G ROUP YEARLY RENEWABLE TERM INSURANCE (GYRT) ‏
    • M ANAGED CARE PROGRAM
    • T HIRD PARTY ADMINISTRATION
    • TRIO PROTECT
  • SOME PROVIDERS
  • Maxicare’s Years of Service, Extent of Expertise About 450,000 Cardholders nationwide Best Employers in Asia/Philippines 22 years of SOLID Healthcare Expertise 1 ST HMO to implement the “HOSPITAL-BASED Program” Top 2,000 Companies in the Country HMO of Choice
  • 24 th Floor, Trafalgar Plaza, 105 H.V. dela Costa Street Salcedo Village, Makati City 1227 Philippines Tel.: +632 813-8080 Fax: +632 813-8081
    • Travel Assistance
    • Medical Evacuation and
    • Repatriation
    • Medical Guarantee Program
    • Third Party Administration
    • Claims Administration
    • On-Site Medical Services
    • Roadside Assistance
    • Concierge Services
    • Hotline Services
    • On-Call Services
    • Wellness Programs
    AA International
    • Philippine office of Assistance Alliance International
    • Regional Headquarters in Kuala Lumpur, Malaysia
    • Network of hospitals/clinics (700+), ambulance, aviation, towing companies, doctors and nurses, and other technical providers.
    • 24/7 Alarm Center manned by well-trained medical assistance professionals
    “… Round the clock and around the world, we are there for you…” 24 th Floor, Trafalgar Plaza, 105 H.V. dela Costa Street Salcedo Village, Makati City 1227 Philippines Tel.: +632 813-8080 Fax: +632 813-8081 “… Round the clock and around the world, we are there for you…”
    • Medical Guarantee Program
    • Medical Evacuation and
    • Repatriation
    • On-Site Medical Services
    • Third Party Administration
    • Roadside Assistance
    • Claims Administration
    • Travel Assistance
    • Hotline Services
    • On-Call Services
    • Wellness Programs
  • SOME CLIENTS WE SERVE
  • SOME CLIENTS WE SERVE FIRST MACRO BANK
  • MANAGED CARE PROGRAM exclusively designed for UNIDEA
  • I. SERVICE SPECIFICATIONS
    • 1. In-Patient Benefits (IPB) & Out-Patient Benefits (OPB)
    • For hospital In-patient & Out-Patient benefit when availed within Room & Board accommodation specified on this program, Manila Bankers Life shall pay for all the following hospitalization expenses provided such confinement is recommended by a medical consultant, and the patient / member is confined in an AAI accredited hospital and attended to by an accredited doctor.
  • I. SERVICE SPECIFICATIONS
    • In-Patient Benefits (IPB) & Out-Patient Benefits (OPB)
    • The Maximum Benefit Limit is on a per illness basis.
    Accommodation Coverage/Package Maximum Limit Per Illness Per Year Principal Each Qualified Dependent (Level 1) Semi-Private Up to 900 1 principal + 3 dependents 90,000 90,000 (Level 2) Private Up to 1,100 1 principal + 2 dependents 120,000 120,000 (Level 3) Open Private 1 principal + 2 dependents 150,000 150,000 (Level 4) Open Private w/ Executive Check-up 1 principal + 2 dependent 150,000 150,000
  • I. SERVICE SPECIFICATIONS
    • In-Patient Benefits (IPB) & Out-Patient Benefits (OPB)
        • In-Patient availments are serviced by MB Life’s Network provider Assistance Alliance International (AAI). Out-Patient availments are provided and serviced by MB Life’s Outsourced OPB Partner Maxicare Healthcare Corporation.
        •  
        • MB Life has the option to provide Out-Patient Benefits directly, or may outsource through one of MB Life’s OPB Accredited Outsourced Partners (Maxicare). Such Out-Patient Benefits can be availed accordingly.
  • I. SERVICE SPECIFICATIONS
    • In-Patient Benefits (IPB) & Out-Patient Benefits (OPB)
    • Out Patient Benefits are up to a maximum of Php 35,000.00 only per illness per policy year. Benefits beyond the Php 35,000.00 OPB Limit shall be for a reimbursement only. The reimbursement shall be agreed, through a corporate guarantee, by the MPFAI and MB Life.
  • I. SERVICE SPECIFICATIONS
    • 2. Life Insurance benefits for Principal and Dependent enrollees only
    Benefits GYRT (Life Insurance) Maximum Amount of Coverage per Enrolled Principal Php. 20,000 per Enrolled Dependent Php. 10,000
  • I. SERVICE SPECIFICATIONS
    • 3. Maternity Assistance for female MIAA employees only
    Benefits Maximum Amount of Coverage a. Caesarian Php 10,000.00 b. Normal 5,000.00 c. Miscarriage/Abortion 2,500.00 d. Abnormal Pregnancy 10,000.00
  • I. SERVICE SPECIFICATIONS
  • I. SERVICE SPECIFICATIONS
    • 5. Dental Care Benefits (Plan B of Health Partners Dental Access Corp.)
    • The dental benefits may be availed of in our network of accredited dental clinics under an open door availment system. Member is only required to call for appointment.
    •  
        • Oral examination/ diagnosis as needed
        • Oral prophylaxis every six (6) months (twice a year)
        • Gum problem consultation and treatment planning
        • Simple tooth extraction when indicated (excluding impaction)
        • Temporary fillings when indicated
        • Recementation of loose Jacket crowns
  • I. SERVICE SPECIFICATIONS
    • 5. Dental Care Benefits (Plan B of Health Partners Dental Access Corp.)
    • The dental benefits may be availed of in our network of accredited dental clinics under an open door availment system. Member is only required to call for appointment.
    •  
        • Adjustment/ repair of dentures
        • Oral hygiene instruction
        • Dental health education and consultation
        • Orthodontic treatment consultation
        • Two surfaces of permanent fillings annually (any of the following that is needed Amalgam filling, Light Cure Composite or Glass Ionomer)
        • Discounted rates of up to 15 % for other services not covered by the dental plan. (e.g. dentures, x-rays and dental surgery.)
  • II. MEMBERSHIP FEES
    • Extended Dependents will have separate premium.
    • *Five major hospitals such as Asian Hospital, The Medical City, St. Lukes ’ s Medical Center, MMC & Cardinal Santos.
    • ** Except Asian Hospital
    Level MBL, per Head Quarterly Premium Access to 5 major Hospitals* Level 1 90,000.00 6,990.00 ** Level 2 120,000.00 6,990.00 With Level 3 150,000.00 11,704.00 With Level 4 150,000.00 22,487.00 With
  • MEMBERSHIP FEES WARD SEMI-PRIVATE SMALL PRIVATE OPEN REGULAR PRIVATE MBL 75,000 80,000 100,000 150,000 ANNUAL 6940 7315 11,815 14,065 QUARTERLY 1635 1735 2935 3535 MONTHLY 550 580 990 1195
  • MEDICAL SERVICES
    • Room Accommodation , Regular Private Room
    • Drugs and Medicines
    • Use of operating room and treatment room
    • Anesthesia and oxygen and the cost of administration thereof
    • Medical Supplies as expendable curative materials as drugs and medicines, dressings, ordinary splints, plaster casts, administration of blood and blood plasma and the cost of blood and blood plasma & intravenous solutions
    • Laboratory services, clinical and pathological
    • Films and X-rays and their interpretations
    • Doctor’s Services
  • DENTAL BENEFITS
    • Oral examination/ diagnosis as needed
    • Oral prophylaxis every six (6) months (twice a year)
    • Gum problem consultation and treatment planning
    • Simple tooth extraction when indicated (excluding impaction)
    • Temporary fillings when indicated
    • Recementation of loose jacket crowns
    • Adjustment/ repair of dentures
    • Oral hygiene instruction
    • Dental health education and consultation
    • Orthodontic treatment consultation
    • Two surfaces of permanent fillings annually (any of the following that is
    • needed Amalgam filling, Light Cure Composite or Glass Lonomer
    • Discounted rates up to 15% for other services not covered by the dental
    • plan, (e.g. dentures, x-rays and dental surgery.)
  • In-Patient Availment using AAI: AAI Coordinator shall issue admitting order Member presents admitting order to hospital admissions unit together with AAI membership card and employment ID Member will be admitted based on his/her medical benefits. AA International will fax to the hospital the Letter of Guarantee within 24 hours Member settles charges in excess of his/her benefits
  • Reminders:
    • Member must file Philhealth form and settle excess charges to the hospital prior to discharge.
    • Member has the option to file for reimbursement to the insurance company during cases of access to non-accredited doctors/clinic/hospital.
    • OUT-PATIENT BENEFIT
  • Premium Quality Care Guarantees
  • Access to our Vast Network of Providers
    • More than 14,000 Top-Caliber Accredited Doctors (Consultants, Fellows & Diplomates)
    • Over 700 Accredited Hospitals and Clinics nationwide
    • (65% are Tertiary Hospitals)
    • All Maxicare Centers are on-line with the Head Office
    • Real-time validation of membership during availments
    • Swipe facility using more than 1,000 POS units nationwide
    • Immediate activation & de-activation of memberships within 24 hours
    • Cards need not be replaced on a yearly basis
    • ** Upon resignation of member, please return to Maxicare the old card
    The MAXICARE Intelligent Card
  • Accessible and Extensive Customer Care Network Customer Care Network Primary Care Center CEBU DAVAO BACOLOD ILOILO GENERAL SANTOS 24/7 Call Center
  • Advantages of the On-Line Primary Care Centers
    • Exclusive to Maxicare Members Only
    • Easy access to Internal Medicine, Pediatricians & Ob-Gyne MDs
    • Quality lab exams at the least possible cost
    • Unlimited number of free consultations
    • Strategically & conveniently located at major hospitals
  • My Health Clinic 2L Style Boulevard, Festival Supermall, Alabang, Muntinlupa City Tel. Nos.: 850.4855 The Medical City RM MGR04, Ground Floor Medical Arts Tower 1, Ortigas Avenue, Pasig City Tel. Nos.: 636-2829 /706-1526 DLS STI Megaclinic 5 th Floor, Bldg. A, SM Megamall, Pasig City Tel. Nos.: 632-7624/ 637-9661 loc. 108 Maxicare Primary Care Centers Cebu Doctors Hospital Rm 308-309 Dr. JC Borromeo Center, Kamuning St, Cebu City Tel. Nos.: (032) 253-3082/ 253-3980 St. Luke’s Medical Center 15/F RM 1501 North Tower Cathedral Heights Bldg, Quezon City Tel. Nos.: 723-0101 loc. 5151/ 723-5329 DeLos Santos Medical Center Unit 302, 3/F Delos Santos Bldg., Delos Santos Medical Center, E. Rodriguez, Quezon City Tel. Nos.: 416-6144 / 416-6150/ 723-0041-54 loc 302 Makati Medical Center Rm 131, New Wing, #2 Amorsolo St., Makati City Tel. Nos.: 893-6064/ 893-9820/ 8888-999 loc 7265/ 7182 Filomena Bldg. – Makati G/ F Filomena Building Amorsolo Street Legaspi Village, Makati City Tel. Nos.: 893-3898/ 4858
    • Preventive Care
    • Annual Check Up
    • Out-Patient Care
    • Emergency Care
    • Benefit Enhancements
    Healthcare Program
  • Preventive Care
    • Periodic monitoring of health problems
    • Health Habits and Family Planning Counselling
    • Health Education and Counseling on diets and exercise
  • Annual Check Up
    • Physical Examination
    • Urinalysis
    • Fecalysis
    • Chest X-ray
    • Complete Blood Count
    • ECG for members 35 yrs old and above
    • Pap Smear for female members 35 yrs old and above
    • To be scheduled by HR for all employees
  • Out-Patient Care
    • Pre & post natal consultations
    • Medically necessary consultations during regular clinic hours, except prescribed medicines
    • Ophthalmology & Ear, Nose, & Throat (ENT) Treatment
    • Treatment of minor injuries
    • X-ray, laboratory exams, routine, and diagnostic procedures as prescribed by an accredited physician
    • Laser treatment for glaucoma & retinal detachment up to Php10,000/eye/member/year
  • Any life threatening, accidental injury or the unexpected onset of a condition that has the potential of causing immediate and permanent disability or death Ex. Heart attacks, stroke, cardiovascular and cerebrovascular accidents, loss of consciousness or respiration, convulsions. Emergency (Definition)
  • Emergency Care
    • Doctor’s Services
    • Emergency room fees
    • Medicines used for immediate relief and during treatment
    • Oxygen, I.V. fluids, whole blood, and human blood products
    • Dressings, casts, and sutures
    • X-ray, laboratory, and diagnostic procedures
    * For Out-Patient cases only*
  • 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 Php 15,000 per case for the 1st 24 hours Outside the Philippines Maxicare shall reimburse 80% of the Hospital Bills and Professional Fees, based on Maxicare Standard Rates up to Php 15,000 per case 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 Emergency Care (Non-Affiliated) * For Out-Patient cases only*
  • Emergency Availment at Accredited Hospitals Avail of treatment at the Emergency Room Member Emergency Room of nearest Accredited Hospital/Clinic File Philhealth on or before discharge Goes to Settle charges not covered by Maxicare at the Billing Section once the Discharge Order is issued by the Attending Doctor Present Maxicare Card at the Emergency Section (for Out-Patient emergency cases only)
  • Use of Non-Accredited Facilities Maxicare Member Reimbursement forms with complete documents (i.e. OR, SOA & additional documents as needed) should be forwarded to the HR HR team to submit forms to MB Life Member to receive check/s 30 days after submission of the complete documents Non-Accredited Hospital (for Out-Patient emergency cases only)
      • All claims must be submitted to MBLife, The following are the required documents for reimbursement:
      • Claim Reimbursement Form (CFR)
      • 2. Original Official Receipts of all Hospital Bills
      • 3. Original Receipts of the Professional fee of the doctor
      • 4. Original Charge Slips (if the statement of account does not include an itemized breakdown of charges)
      • 5. Clinical Abstract, Admitting History and Medical Certificate
      • 6. Histopath/Surgical Report (if surgical operation was done)
      • 7. Police Report in case of accident and medico legal cases.
      • Procedure in filing the Claims for Reimbursement
  • Additional Concessions
    • Work related cases is covered up to Php 20,000/member/year for principal only (based on conditions covered by ECC)
    • Physical / Occupational Therapy with shared limit up to 12 sessions / member / year (consults shall be considered as a session)
    • Lithotripsy, Laparoscopy and Hysteroscopic Myoma Resection up to MBL
    • Coverage for Transurethral Microwave Therapy of the prostate up to Php 25,000 /member/year
    • Coverage for Scoliosis up to Php20,000/member/year whether pre-existing, congenital, developmental or acquired
    *For Out-Patient cases only*
  • Additional Concessions
    • Coverage on other procedures and Modalities Php 5,000/member/year (such as Mammotone, 4D ultrasound, 24 hour EEG monitoring, Esophageal Manometry, Intensified Modulated radiotheraphy, Botox)
    • Coverage for Angiogram & /or Angioplasty / CABG with shared limit up to MBL
    • Sclerotherapy for varicose veins (prescribed by an affiliated physician) up to Php5,000/leg/member/year
    • Coverage on Speech Therapy up to Php10,000/member/year for stroke patients only (consults considered as sessions), reimbursement basis
    • Coverage on Congenital Illnessess up to Php 20,000/member/year
    • * For Out-Patient cases only*
  • Additional Concessions
    • Coverage for Pre-existing Non-dreaded and Dreaded conditions up to MBL
    • Passive and active vaccines for treatment of tetanus, animal bites and snake bites up to Php18,000/member/year.
    • Coverage for Provoked and Unprovoked Assault up to MBL
    • Coverage for Tuberculin Test up to Php 600 / member / year (covered outright if availed at PCC, reimbursement basis if otherwise)
    • Scalpel and Conventional Hemorrhoidectomy up to MBL
    • Congenital Hernia up to MBL
    • Coverage for Scabies up to MBL
    • *For Out-Patient cases only*
  • General Exclusions
    • 1. Self Inflicted Injuries and Injuries from Member’s Own Misconduct:
    • Treatment of injuries or illnesses resulting from war or any combat-related activities while in military service.
    • Functional disorders of the mind, alcoholism and drug addiction or abuse.
    • Treatment of any injuries resulted from the Member’s own misconduct:
      • gross negligence
      • vicious or immoral habits
      • direct or indirect participation in the commission of a crime
      • whether consummated or not
      • violation of a law or ordinance
      • unnecessary exposure to imminent danger or hazard to health
    • Government funded healthcare entitlements & Personal
    • medical requirements:
    • 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
    • Routine physical examinations required for obtaining or continuing
    • employment, requirement in school, insurance or government
    • licensing
    • 3. For Purposes of Beautification:
    • Cosmetic surgery, reconstructive surgery to treat a functional defect due to accidental injury
    • 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.
    • 4. Chronic Dermatoses:
    • (ie, Psorasis / Skin Asthma)
    • 5. Unlawful Acts & Hazardous Sports:
    • Treatment of injuries/illnesses the direct and immediate cause of which is the engagement and participation of the Member in any (a) hazardous sport or activity i.e. scuba diving, mountain climbing, parachuting et. al. ,
    • 6. Any Additional or Extra Charges:
    • Corrective appliances, artificial aids, prosthetic appliances
    • Take home medicine/Out-patient medicines
    • Services obtained from Non-Accredited Physicians and Hospitals or other provider of care, except under emergency care.
    • Other Non-Insurable Conditions:
    • Custodial, domiciliary and convalescent care.
    • Long-term rehabilitation and Psychiatric care.
    • Other dental treatment not provided under the program except to the extent that are medically necessary for repair or alleviation of damage to the member caused solely by an accident.
    • Maternity and all maternity related conditions except for pre and post natal consultations
    • 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 enrollment
    • Experimental medical procedures, acupuncture
    • Sexually transmitted diseases, AIDS and AIDS related diseases
    • Hepatitis B screening and all diagnostic examinations for Members
    • who have pre-existing Hepa B.
  • MBLIFE CONTACT PERSONS
    • OFFICE 810-1051
    • 810-1072 Local 302 and 306
    • MARIO ALBARILLO - 0917-505-8167
    • E-mail: mario.albarillo@mblic.com.ph
    • MARISSA PECSON 0917-505-8154
    • E-mail: marissa.pecson@mblic.com.ph
  • AA International: 24 Hour Alarm Center Contact Numbers: Hotline Number: 810-8080 Toll Free Number: 1-800-10-810-8080 Text Hotline: 0917-814-1464 Mobile Numbers: 0917-890-7088 / 0922-836-2590
  • Maxicare Access Numbers 24/7 Customer Care Center Head Office Trunkline Provincial Toll Free No. 582-1900 (0918) 907-2652 908-6900 1-800-10-582-1900