MKTG Corporate Standard Presentation


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  • 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).
  • MKTG Corporate Standard Presentation

    1. 1. PRETIOLAS PHILIPPINES, INC. Coverage Period: August 10, 2012 to August 9, 2013
    2. 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.
    7. 7. OUR ROSTER OF CLIENTSAnd a few more known brands and clients we serve....
    8. 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. 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. 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. 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. 12. The Maxicare Card is now capable of receiving reimbursementsthru 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. 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. 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. 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. 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. 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. 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. 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. 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. 21. SM City North Edsa Festival Supermall2nd Level Building F, SM City A-3 Level 2 Style Boulevard,North Edsa, North Avenue, Festival Supermall, FilinvestQuezon 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
    23. 23. Extensive Customer Care Center2. MAXICARE ROVING TEAM
    24. 24. Extensive Customer Care Center3. MAXICARE 24/7 CUSTOMER CARE 1. 24/7 Customer Care Center No. 2. Provincial Toll Free No
    25. 25. Your Maxicare Team:BENEFITS CONSULTANTChris LingbaoanTel: 729-8256Mobile: +63927.3267085SALESMiguel Apolonio– Account OfficerEmail: #: 908-6900 loc. 1126AFTER-SALES SUPPORTCristina Lagda- After Sales AssistantEmail: #:908-6900 loc.1137
    26. 26. Extensive Customer Care Center5. 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. 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. 28. Extensive Customer Care Center Calamba Medical Center Ground floor , Central Registration, Crossing, Calamba,City Monday to Saturday
    29. 29. Extensive Customer CareExtensive Customer Care Center MANILA DOCTORS HOSPITAL Room 220, Manila Doctors Hospital Monday to Saturday Tel. No: (02)524-3011 local 4510
    30. 30. Extensive Customer Care Center6. EMAIL CUSTOMER SUPPORT  Members can send their inquiries and concerns through Email.
    31. 31. Extensive Customer Care Center7. MAXICARE FAN PAGE  Members can like us on facebook and send inquires and concerns via chat.
    32. 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. 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.
    34. 34. Maxicare Lifestyle Partners
    35. 35. Maxicare Lifestyle Partners
    36. 36. Maxicare Lifestyle Partners  10% – 20 % discount on frames and sunglasses (EO exclusive brands)  5% - 10% discount on signature frames and sunglasses (except Rayban and Oakley)  Free Consultation ( Licensed Optometrist)  Free Minor repair services  Free Cleaning
    37. 37. Maxicare Lifestyle Partners
    38. 38. Coverage of theHealthCare Program
    39. 39. 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
    40. 40. 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.
    41. 41.  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.
    42. 42. Outpatient Care CoverageCOVERAGE: LIMITRegular Consultations (except prescribed Up to MBLmedicines)Eye Laser Therapy (except Lasik/PRK) 10,000 per eye/member/yearEars, Nose and Throat TreatmentPre and Post Natal ConsultationsTreatment of minor injuries Up to MBLMinor Surgeries not requiringconfinementX-ray, laboratory exams, routine andother diagnostic procedures
    43. 43. Outpatient Care CoverageCOVERAGE: LIMITSclerotherapy – removal of varicose 5,000 perveins (must be prescribed by an leg/member/yearaccredited vascular surgeon)Cauterization of Warts 1,000 per member/year(except genital warts)Speech Therapy 10,000 per member/year(medically necessary and on areimbursement basis)Tuberculin Test 600.00 per member/yearTherapeutic Procedures Up to MBL(IV chemotherapy, dialysis, etc…)Other Modalities Up to 5,000 per(PET Scan, 4D ultrasound, etc…) member/year
    44. 44. How to Avail your Outpatient CoverageSTEP 1 STEP 2 STEP 3 If required toPlan Member (PM) PM goes to the Medilink POS PM presents his LOE, undergogoes to Maxicare terminal and swipes the card Maxicare card & 1 valid laboratoryaccredited 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
    45. 45. Inpatient Care CoverageCOVERAGE:Room and Board accommodation(based on your plan type and entitlement)Use of Recovery Room and Intensive Care UnitProfessional Fee of Attending Doctors & Nursing ServicesDrugs and Medicines for Use in the HospitalWhole blood/human blood products & IV fluidstransfusionAnesthesia, Oxygen and its AdministrationStandard Hospital Admission KitDressings, casts, sutures, and other supplies/servicesdirectly related to the medical management of the patient
    46. 46. 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 upPrescription from the attending Physician
    47. 47. 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
    48. 48. 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 orSettle charges not covered by before dischargeMaxicare 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
    49. 49. 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 MaxicareMember to receive check/s30 days after submission of the complete documents
    50. 50.  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 hoursOutside the PhilippinesMaxicare shall reimburse 100% of the Hospital Bills and Professional fees, based on actual cost up to P30,000/availment/member/yearAreas 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
    51. 51. Claims Reimbursement Procedure Maxicare Reimbursement CardAll claims must be submitted to the Maxicare Head Office within 30 days from date of dischargefrom 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.
    52. 52. Claims Reimbursement Procedure Maxicare Reimbursement Card Once your reimbursement has been approved:Your card will be activated to cashcard and you will receivenotification thru SMS of your PIN Member may withdraw the OR member may use the amountand approved reimbursement amount to Equicom ATMs or to purchase from any of theamount. Bancnet, Expressnet or Megalink Bancnet accredited merchants ATMs*Your SMS number must becorrectly reflected in the ClaimsReimbursement Form.
    53. 53. Additional CoverageCoverage For: Limit:Coverage for pre-existing dreaded & non dreaded conditionsWork related cases based on conditions set by ECC(Employee Compensation Commission) Up to MBLCoverage for Motor vehicular accident(subject to exclusions & limitations)Coverage for Provoked and unprovoked assaultCongenital Conditions Up to 20,000.00Coverage for Scoliosis per member per year Up to 20,000.00(whether pre-existing, acquired, congenital & developmental)Consultations for Chronic Dermatoses Up to MBLGroup Life Accidental Death & Dismemberment Up to 25,000
    54. 54.  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
    55. 55. Dental Hub (povider) Sets an appointment by calling Accredited Dental Facilities (02) 908-6900 Nationwide throughMember Or by Dental Hub Directly calling the Accredited Dental Clinic
    56. 56. 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
    57. 57. 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 Health3. Personal Medical Requirements• Routine physical examinations required for obtaining or continuing employment, requirement in school, insurance or government licensing
    58. 58. 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)
    59. 59. 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.
    60. 60. 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.
    61. 61. Thank You!