Anda di halaman 1dari 17

The Leader in Healthcare Services MAXICARE HEALTHCARE CORPORATION Premium quality healthcare is deserved by every individual.

MAXICARE, an industry leader with 22 years of solid healthcare expertise, has been a trusted name among top corporations and individuals.

I. IN-PATIENT BENEFITS Room and Board Accommodation Use of Operating Room, Intensive Care Unit (ICU), Isolation Room (if prescribed by an attending accredited physician) and Recovery Rooms Professional Fees of Attending Physicians, Surgeons, Anesthesiologist and Cardio-pulmonary clearance before surgery and cardiac monitoring during surgery Standard nursing services Medicines for in-patient use Blood product transfusions and intravenous fluids, including blood screening and cross matching X-ray, laboratory examinations, diagnostic tests and therapeutic procedures incidental to confinement Dressings, conventional casts (plaster of Paris) and sutures Anesthesia and its administration Oxygen and its administration Standard admission kit Other items directly related in the medical management of the patient, as deemed medically necessary by the attending accredited physician II. OUT-PATIENT BENEFITS The following services shall be provided when medically necessary: Consultations during regular clinic hours, except for medicines prescribed Eye, ear, nose and throat (EENT) treatment prescribed by an accredited physician/specialist Treatment of minor injuries such as lacerations, mild burns, sprains and the like Dressing, conventional casts (plaster of Paris) and sutures X-ray, laboratory examinations, routine, diagnostic and therapeutic procedures prescribed by an accredited physician/specialist, provided however that the cost of diagnostic and therapeutic procedures covered shall be limited to the amount set forth under pertinent sections below. o Routine procedures to be covered at 100% of actual cost and to be charged against MBL: 1. Blood Chemistries 2. Chest X-Ray 3. Complete Blood Count 4. Fecalysis 5. Urinalysis o Diagnostic procedures to be covered at 100% of actual cost and to be charged against MBL: 1. 24-Hour Electro Encephalogram Monitoring 2. Adrenocortical Function 3. Anti-Nuclear Antibody, C-Reactive Protein, Lupus Cell Exam 4. Arterial Blood Gas 5. Arthroscopic Procedures, Orthopedic Arthroscopy 6. Audiograms and Tympanograms 7. Bone Densitometry Scan (Dexascan) 8. Bone Mineral Density Studies 9. Cardiac Ambulatory Monitoring 10. Cardiac Stress Tests (Thallium and Dipyridamole Stress Tests) 11. Computed Tomography (CT) Scans 12. Diagnostic Angiogram: Cerebral, Coronary, Mesentric, Flourescein Angiography 13. Diagnostic Radiographs or X-rays i. Biliary Tract: Cholecystogram and Cholangiogram ii. Chest, Ribs, Sternum and Clavicle iii. Digestive Tract: Plain film of the abdomen, Barium Enema, Upper Gastro Intestinal (GI) Series, Small Bowel Series, Lower Gastro Intestinal Series iv. Face (including sinuses), Head and Neck v. Urinary Tract: Kidney Ureter Bladder (KUB), Pyelograms, Cystograms vi. X-ray of the extremities and pelvis vii. X-ray of the Spine (cervical, thoracic, lumbo-sacral)

14. Diagnostic Ultrasounds: i. 2D-Echo with Doppler ii. Abdomen iii. Duplex Scan iv. Digestive and Urinary Systems v. Ultrasound of the Lungs 15. Electro Encephalogram (EEG) 16. Electromyography & nerve conduction velocity studies 17. Endoscopic Procedures 18. Impedance Plethysmography 19. Lead Electrocardiogram 20. Magnetic Resonance Angiography (MRA) 21. Magnetic Resonance Imaging (MRI) 22. Microscopic Examinations 23. Myelogram 24. Nuclear Radioactive Isotope Scan 25. Paps Smear 26. Plasma Urinary Cortisol, Plasma Aldosterone 27. Polysomnograms (Sleep Recording) 28. Pulmonary Function tests 29. Radioisotope Scans and Function Studies: i. Cardiac ii. Gastrointestinal iii. Liver iv. Parathyroid, Bone, Pulmonary (Perfusion, Ventilation Lung Scans) v. Renal vi. Thyroid Scans vii. Total Body Scans 30. Radionuclide Ventriculography 31. Surface Electromyography (SEMG) 32. Thallium Scintigraphy 33. Treadmill Stress Test (TMST) Therapeutic procedures shall be covered at 100% of actual cost and to be charged against MBL up to twelve (12) sessions per member per year o Dialysis o Intravenous Chemotherapy o Therapeutic Radiology 1. Brachytherapy 2. Cobalt 3. Linear Accelerator Therapy 4. Radioactive Cesium 5. Radioactive Iodine o Physical therapy / Occupational therapy (shared limit) excluding subspecialties such as cardiac rehabilitation, pulmonary rehabilitation and the like. (Therapy of one (1) body area shall be considered as one (1) session,) Minor surgery not requiring confinement prescribed by an accredited physician/specialist Eye laser therapy for retinal tear, retinal hole, retinal detachment & glaucoma prescribed by an accredited physician/specialist up to Php10,000 per eye per member per year Cauterization of warts prescribed by an accredited physician/specialist up to Php1,000 per year, in any part of the body except genital warts and condyloma acuminata

Sclerotherapy for varicose veins as prescribed by an accredited physician up to Php5,000 per leg per member per year to be availed through accredited vascular surgeons Allergy testing / allergy screening and other related examinations prescribed by an accredited physician up to Php2,500 per member per year Speech therapy (for stroke patients only) shall be covered as charged but on reimbursement basis up to Php10,000 per member per year. Consultations shall be part of the limit and treated as sessions for purposes of determining coverage Tuberculin test up to Php600 per member per year. III. SALIENT FEATURES PLAN TYPE Platinum Plus Platinum Gold Silver R&B Large Private Regular Private Regular Private Semi-Private MBL Php 200,000 150,000 100,000 60,000

R&B Room and Board Accommodation (room category) MBL Maximum Benefit Limit (limit per illness per year) IV. PREVENTIVE CARE Passive and active vaccines for treatment of tetanus and animal bites shall be covered up to Php18,000 per member per year Periodic monitoring of health problems Health education and counseling on diets and exercise Health habits & family planning counseling V. EMERGENCY CARE Accredited Hospital o Doctors services

o Emergency Room fees

o Medicines used for immediate relief and during treatment o Oxygen, intravenous fluids and blood products o Dressings, conventional casts (plaster of Paris) and sutures o X-rays, laboratory, diagnostic examinations and other medical services related to the emergency treatment of the patient Non-Accredited Hospitals o Within the Philippines Maxicare shall reimburse 80% of the total hospital bills and 80% of the professional fees based on Maxicares rates up to Php 30,000 per case during the first 24 hours. o Areas without accredited hospitals within the Philippines Maxicare shall reimburse 100% of the total hospital bills and Professional fees based on Maxicare rates. o Outside the Philippines Maxicare shall reimburse 100% actual costs up to Php30,000 per case during the first 24 hours. Ambulance Service Maxicare will cover road ambulance service for transfers from an accredited hospital to another accredited hospital up to MBL and Php2,500 per conduction if it is from a non-accredited Hospital to an accredited Hospital (on reimbursement basis). Note: it is very important that you call the Maxicare Hotline within 24 hours in order for Customer Care to arrange a transfer from the non-accredited hospital to the accredited hospital. Initial treatment of animal bites shall be covered for the first twenty-four (24) hours from the time of bite subject to MBL.

VI. ADDITIONAL BENEFITS Life coverage with Accidental Death & Dismemberment up to Php25,000 Motor vehicular accidents shall be covered up to MBL. Scoliosis (whether congenital, pre-existing or acquired) covered up to Php20,000 per member per year Congenital illness, except physical therapy sessions and developmental disorders, shall be covered up to Php20,000 per member per year. Congenital hernia shall however be covered up to MBL. Consultations for Chronic Dermatoses shall be covered up to MBL per member per year. Additional Modalities and Procedures covered up to MBL whether done in in-patient or out-patient: 1. Cryosurgery 2. Gamma Knife Surgery 3. Hysterescopic Myoma Resection 4. Hysterescopically-guided Dilation & Curettage 5. Laparoscopy 6. Lithotripsy 7. Percutaneous Ultrasonic Nephrolithomy 8. Conventional Hemmorhoidectomy 9. Scalpel Hemmorhoidectomy Other medically necessary modalities not mentioned above for which there are no comparable, conventional or traditional counterparts shall be covered up to Php 5,000 per procedure per member per year. Transurethral Microwave Therapy of Prostate covered up to Php25,000 per member per year VII. ANNUAL CHECK-UP (ACU) Platinum Plus Plan: (Multi Phasic B) Overnight at MMC CBC (Complete Blood Count) Blood Chemistry (Fasting Blood Sugar, Potassium, Total Cholesterol HDL, LDL, VLDL Cholesterol, Triglycerides, Urea, Creatinine, SGOT, SGPT, Alkaline Phosphatase, Total Bilirubin, Total Protein, Albumin, Globulin, Calcium, Uric Acid) Thyroid Function: TSH-IRMA Hepatitis Screening: HBsAG, Anti-HBs Routine Urinalysis Routine Fecalysis Cardiac Work-up (Upper Gastrointestinal series or Barium Enema, Ultrasound of Liver, Gallbladder & Pancreas, Proctosigmoidoscopy_ Papsmear for female members regardless of age Prostate Ultrasound for male members regardless of age Consultations to a Gastroenterologist, Gynecologist/Urologist and Cardiologist Platinum Plan: Executive Out-patient Physical Examination Routine Urinalysis Routine Fecalysis Chest X-ray CBC (Complete Blood Count) Blood Chemistry (Fasting Blood Sugar, Potassium, Creatinine, SGOT/AST, Alkaline Phosphatase, Total Protein, Albumin, Calcium, uric Acid, BUN, Total Bilirubin, Sodium Chloride/CO2 and Cholesterol) Ultrasound of Kidney 12 Lead ECG Treadmill Stress Test Ultrasound of Liver, Gallbladder and Pancreas Pap Smear (slides) for female members regardless of age Gold Plan: Semi-Executive Out-patient Physical Examination Routine Urinalysis Routine Fecalysis Chest X-ray

CBC (Complete Blood Count) Blood Chemistry (Fasting Blood Sugar, SGPT, Cholesterol, Creatinine, Uric Acid) 12 Lead ECG Pap Smear (slides) for female members regardless of age

Silver Plan: Routine Physical Examination Routine Urinalysis Routine Fecalysis Chest X-ray CBC (Complete Blood Count) 12 Lead ECG (exclusive for 35 years old and above as an optional package) Pap Smear (exclusive for 35 years old and above as an optional package) The ACU however, may only be availed within the contract period after and the member is at least six (6) months starting from the effectivity date. Member must notify Maxicares Customer Care Department (CCD) at least one (1) month prior to preferred schedule. Any request for rescheduling or change of venue must be in writing and shall be allowed only once provided request was forwarded to CCD at least one (1) week prior to the original ACU schedule. Otherwise, ACU entitlement shall be forfeited Note: Inclusive tests are subject to change based on hospitals/clinics current ACU package.

VIII. DENTAL CARE (OPTIONAL) Annual Oral/Dental Examinations & Consultation Emergency Dental Treatment Annual Oral Prophylaxis Simple Tooth Extractions Restorative and Prosthodontic Treatment Planning Permanent fillings up to 2 fillings per year Unlimited temporary fillings,as needed Desensitization of hypersensitive teeth 2 per year Simple adjustment of dentures Recementation of loose crowns, inlays or onlays Dental nutrition and dietary counseling Dental Health Education

IX. VALUE ADDED FEATURES MAXICARES INTERNATIONAL EMERGENCY ASSIST PROGRAM Maxicare has partnered with International SOS, the worlds largest medical and emergency assistance company, to give you Maxicare International Assist Program. It gives you worldwide access to 24-hour expert advice and assistance - - whether its help you need to prepare you for your travels or emergency advice and medical care while abroad. Medical Assistance 24-Hour Telephone Medical Advice Emergency Medical Evacuation Emergency Medical Repatriation Repatriation of Mortal Remains Hospital Referral, arrangement of admission and Guarantee of Medical Expenses

Monitoring of Medical Condition Delivery of Essential Medicine Discounted Hospitalization Expenses in the United States The limit of indemnity for a member per event, per illness or condition per year is US$ 1,000,000. International SOS retains the absolute right to decide whether the members medical condition is sufficiently serious to warrant Emergency Medical Evacuation or Repatriation. If and when members condition does not merit an evacuation, repatriation afs per International SOS assessment and the member requests for such evacuation / repatriation, International SOS shall carry out the request, however, expenses shall be the members responsibility. All pre-existing conditions are waived under this coverage. Travel Assistance Pre-trip Information Services Embassy / Legal / Interpreter Referrals Lost luggage and Passport Assistance Emergency Message Transmission or Document Delivery Assistance

*Any advice through the hotline is free. All third party costs shall be members responsibility. 24 hour Alarm Center: (+632) 687-8522

X. AVAILMENT PROCEDURES Out-patient 1. To avail of consultations or treatment, go to any Maxicare Accredited Clinics/Hospitals or Maxicare Primary Care Centers (PCC). 2. Member goes to the POS terminal in the hospital/clinic (Billing/ER/Admitting section) or at the PCC.


Hospital staff swipes the members swipe card. The Letter of Eligibility (LOE) will be given to the member with his Maxicare card.

Please note that the LOE is valid only on the same date that it was swiped. Availments made on different dates will need an LOE per date.

4. 5. 6. 7.

Member proceeds to the Medical Coordinators clinic and presents his LOE and Maxicare card for consultation. If referred to an accredited specialist, secure LOE and Referral Slip* from the Medical Coordinator/ PCC. Present Maxicare ID Card, LOE and Referral Slip to accredited specialist to avail of consultation.

If member is requested to take a laboratory test, secure the Laboratory Slip* from the Medical Coordinator/ PCC. 8. Proceed to the laboratory and present the laboratory slip with the LOE and avail of the test. 9. For follow-up consultations, follow steps 1-5 to secure LOE and referral slip/ laboratory slip from Maxicare Centers and/or Coordinator. Note: Referral Slips and Laboratory Slips* are necessary in order for the doctor to know that Maxicare is to be billed for the procedure. For queries and assistance, please call Maxicare Hotline at 582-1900. In-patient

1. 2.

Secure an Admitting Order from a Maxicare Accredited Specialist.

Coordinate with the admitting section and coordinator in the hospital for room reservation 3. If possible, call Maxicare at least 24 hours prior to admission for assistance in securing the doctor 4. Member goes to the Admitting Section in the hospital and presents his/her Maxicare swipe card and admitting order from the Maxicare Coordinator/ Specialist to the admitting staff. 5. Once the LOE is generated by the hospital staff, the member will be asked to sign on it. This will be attached to the other admitting documents. 6. Proceed to the reserved room entitled or operating room (for operation)

7. 8. 9.

Maxicare will issue the Letter of Authority (LOA) upon receiving hospitals advice on the members confinement. Member must file Philhealth on or before discharge. All uncoverable and excess charges must be settled by the member upon discharge.

Note: For queries and assistance, call Maxicare Hotline: 582-1900 Emergency Care A life threatening or accidental injury or a sudden and unexpected onset of a condition which at the time of the occurrence reasonably appears to have the potential of causing immediate disability or death, or which requires the immediate alleviation of pain or discomfort. The Member must notify MAXICARE HEAD OFFICE, thru the Customer Care Department, WITHIN 24 HOURS so that proper assistance is promptly rendered. o Accredited Hospital 1. Go to the Emergency Room of nearest accredited hospital. 2. Avail of treatment at Emergency Room. 3. Present Maxicare ID Card to ER Staff. ER Personnel will facilitate swiping for the LOE. 4. File Philhealth before discharge. Note: Settle charges not covered by Maxicare at the Billing Section once the Discharge Order is issued by the attending doctor. o Non-Accredited Hospital


Member may proceed to the Emergency Room of nearest hospital. 2. Avail treatment at the Emergency Room. 3. Call Maxicare within 24 hours to arrange transfer to an accredited hospital. 4. Settle all ER fees and secure Medical Certificate, Official Receipts, etc. 5. Forward all original documents to Maxicare for reimbursement within 30 days upon discharge.

XI. ENROLLMENT PROCESS AND GUIDELINES 1. Fill up the IFG application form completely. Indicate your Tax Identification Number (TIN) on the front page if applicable. 2. Initial submission of Medical Requirements is applicable to enrollees who are 50 years old and above, whether Principal or Dependent. The date of the conduction of these Medical Requirements should not exceed 6 months before the date of submission. Medical Requirements for 50 years old and above 12 - lead ECG (Electrocardiogram) Chest X-ray FBS (Fasting Blood Sugar) Total Cholesterol HDL-C (High Density Lipoprotein) LDL-C (Low Density Lipoprotein) Note: test results should not be more than 6 months from the date it was taken 3. Dependents plan must be the same plan as the Principal or one plan lower. 4. Forward the accomplished application form and medical requirements (if applicable) to the Account Officer for processing. 5. Once the application has been approved, the Statement of Account shall be sent to your billing address for settlement. Payments (cash or check) may be made at the Maxicare Head Office or at any Banco de Oro branches via bills payments. 6. Member will receive Maxicare ID card as proof of membership.

Who may be enrolled into the Maxicare Program and what are the requirements? The age eligibility for principal and dependents is from 2 to 60 years of age. Eligible dependents are as follows (in order): * For single enrollees: Mother, Father, then Siblings 21 years old and below, according to age. * For married enrollees: Spouse, then Children 21 years old and below, according to age. Individual Membership Requirements: 1. Application form 2. Medical requirements if already 50 years old 3. Photocopy of ACR (Alien Certificate of Residency) if nationality is foreign Family Membership Requirements Couples only: 1. Application form 2. Copy of marriage certificate 3. Medical requirements if already 50 years old (principal and dependent) 4. Photocopy of ACR (Alien Certificate of Residency) if nationality is foreign With child dependent 1. Application form 2. Copy of birth certificate (each child) 3. Medical requirements if already 50 years old (principal and dependent) 4. Photocopy of ACR (Alien Certificate of Residency) if nationality is foreign Note: Maxicare may request for additional requirements when deemed necessary HIERARCHY OF ENROLLMENT: Unless there is a valid reason for the non-enrollment of certain dependents (i.e. currently enrolled in another HMO, abroad, separated, deceased, etc.), applicants should enroll their dependents in the priority specified above. Sufficient documentation shall be requested by Maxicare from the applicant to validate the non-eligibility of the dependent (i.e. photocopy of HMO card, certificate of employment from company abroad, death certificate, etc.) REQUIREMENTS FOR ALIEN RESIDENTS/ FOREIGN NATIONALS: 1. Photocopy of ACR (Alien Certificate of Residency) ID 2. Medical Requirements for enrollees 50 years old and above (if applicable) 3. Certificate of employment (if applicable) XII. DREADED DISEASE / CONDITION Any condition that is considered to be chronic, progressive, life-threatening and which may entail lifelong therapy. This refers also to conditions where complete cure cannot be ensured. COVERAGE FOR DREADED AND NON-DREADED CONDITONS 1st year of membership: Dreaded and Non-dreaded covered subject to below limits: Plan Type Platinum Plus Platinum Gold Silver Per illness per member per year Php 20,000 15,000 10,000 5,000

Subsequent years of membership: Dreaded conditions not considered acquired are covered subject to below limits:

Plan Type Platinum Plus Platinum Gold Silver Non-dreaded conditions shall be covered up to MBL Acquired dreaded conditions shall be covered up to MBL

Per illness per member per year Php 20,000 15,000 10,000 5,000

Such dreaded conditions are as follows, but not limited to: 1. All cancers (malignant masses) including carcinoma in situ and related conditions 2. Blood Dyscrasias (Leukemia, Idiopathic Thrombocytopenic Purpura, etc) 3. Central Nervous System Infections (Poliomyelitis/Meningitis/Encephalitis) 4. Cerebrovascular Accident (Stroke, Cerebral, Cerebellar and all Intracranial Hemorrhage) and related conditions 5. Chronic Cardiovascular Diseases (Complicated Hypertension and related conditions, Aortic Dissection, Abdominal Aortic Aneurysm, etc.) 6. Chronic Endocrine Disorders and its complications (Dyslipidemia, Impaired Fasting Glucose, Impaired Glucose Tolerance, Obesity, Diabetes Mellitus, Hormonal Dysfunctions, etc.) excluding surgical treatment/procedures for obesity-exclusion 7. Chronic Gastrointestinal Diseases (ex. Irritable Bowel Syndrome, Crohns disease) 8. Chronic Genito-urinary Disorders 9. Chronic Kidney Disease/Failure 10. Chronic Liver Parenchymal Diseases (Liver Cirrhosis, Chronic hepatitis) 11. Chronic Pulmonary Diseases except asthma (COPD, emphysema, and other chronic lung disease) 12. Collagen Vascular/Connective Tissue/Immunologic Disorders 13. Complications of immuno-compromised state except HIV/AIDS 14. Injuries incurred prior to and up to one year from effective date and its subsequent complications 15. Systemic Lupus Erythematosus including Lupus Nephritis 16. Thyroid conditions (Hypothyroidism, Hyperthyroidism) except Thyroid masses 17. Valvular Heart Diseases 18. Any illness other than above which would require Intensive Care Unit Confinement 19. All complications resulting from above list of conditions

Such non-dreaded conditions are as follows, but not limited to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. All tumors (benign masses) Anal Fistulae Arthritis Bronchial Asthma Bueghers Disease Cataract and Glaucoma Cholecystitis, Cholelithiasis, Cholecystolithiasis and Choledocholithiasis Ear-Nose-Throat conditions requiring surgery (except cancers which are considered dreaded conditions) Endometrioses/Dysfunctional Uterine Bleeding (except if caused by uterine malignancies) Gastric or Duodenal Ulcers Hallux valgus Hemorrhoids Hernias (Congenital Hernia will have coverage as listed in the Congenital Clause) Migraine Muscular Dystrophies (Duchenne, Becker, limb girdle, facioscapulohumeral, myotonic, oculopharyngeal, distal, and Emery-Dreifuss) Ovarian cysts (except Ovarian Malignancies) Peripheral Nervous System Lesions (except Multiple Sclerosis and Guillan Barre Syndrome) Tuberculosis (Pulmonary or Extrapulmonary including Potts disease) Uncomplicated Hypertension Urinary Tract Stones/Calculi All complications resulting from above list of conditions

XIII. EXCLUSIONS AND LIMITATIONS Notwithstanding any provisions to the contrary, the following shall not be covered except otherwise specified in Agreement: Services obtained for non-emergency conditions from Physicians and Hospitals in any of the following circumstances: o non-accredited physicians in non-accredited hospitals or clinics; o non-accredited physicians in accredited hospitals or clinics; o accredited physicians in non-accredited hospitals or other non accredited healthcare facility. Additional hospital charges and physicians professional fees resulting from: o room-upgrading beyond members allowable time during emergency care; o obtaining a room accommodation higher than the members room and board Accommodation. o extension of hospital stay despite release of discharge order from members attending physician; o additional personal comfort items such as additional telephone and TV, etc., not ordinarily included in the members room and board Accommodation. Custodial, domiciliary, convalescent and intermediate care. Long-term rehabilitation and psychiatric care and/or psychological illnesses and conditions including neurotic and psychotic behavior disorders; anxiety disorders. Treatment for injury and its complications resulting from self-inflicted injuries including infections as a result of tattoos, piercing of the ear or in any body part, whether self-inflicted or done by a third party or attempted suicide or selfdestruction, whether sane or insane. Developmental disorders including functional disorders of the mind, such as but not limited to Attention-Deficit Disorder (ADD)/Attention-Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorders, Bipolar Disorders, Central Auditory Processing Disorder (CAPD), Cerebral Palsy, Down Syndrome, Neural Tube Defects, and Mental Retardation. Treatment of any injury received when there is negligence, unauthorized use of prohibited or regulated drugs, alcoholic liquor intake, direct or indirect participation in the commission of a crime whether consummated or not, violation of a law or ordinance or unnecessary exposure to imminent danger, knowingly or unknowingly or hazard to health, by the member. Maxicare may, in its discretion, rely on Police and Doctors report in evaluating such claim. Aesthetic, cosmetic and reconstructive surgery or any consultation or treatment for any beautification purposes except if necessary to treat a functional defect due to accidental injury within the initial confinement. Oral surgery following accidental injury to teeth for purposes of beautification. Dental examinations, extractions, fillings, other dental treatment and their complications to the extent that are medically necessary for repair or alleviation of damage to the member caused solely by an accident. Medical care resulting from any dental related conditions. Maternity care and all other conditions, including pre and post natal consultations, related to and/or resulting from pregnancy and/or delivery which affect the conditions of the principal member and the unborn child. Circumcision (except for treatment of urological conditions), sex transformation, diagnosis, treatment and procedures related to fertility or infertility, artificial insemination, sterilization or reversal of such procedures and their complications. Experimental medical procedures. Acupuncture and chirotheraphy and other forms of rehabilitations therapies or any complications arising from its application. All expenses incurred in the process of organ donation and transplantation if the member is the donor of such donation or transplantation. Routine physical examinations required for obtaining or continuing employment, requirement in school, insurance, government licensing, health permit and other similar purposes. Purchase or lease of durable medical equipment, oxygen dispensing equipment, and oxygen, except during in-patient care.

Corrective appliances, artificial aids, prosthetic appliances such as but not limited to artificial limbs, hearing aids, intraocular lens, eyeglasses, contact lenses, braces, crutches, pace maker, pins, screws, plates, wires, balloons, valves, knee-tibial insert for total knee arthroplasty, orthopedic internal fixator/fixation systems, orthopedic external fixator/fixation systems, bone screws and plates, vascular grafts/stents, intravascular catheters, myringotomy tube. Take-home medicine and outpatient medicine except o Intravenous medicine o Oral chemotherapy medicine o Medicine administered during an emergency treatment Congenital diseases, abnormalities and their complications (except for hernias) affecting functions of individuals. All physical deformities prior to enrollment. Treatment of injuries/illnesses caused directly or indirectly by engaging in any hazardous or sport activity such as but not limited to scuba diving, surfing, water skiing, mountain climbing, rock climbing, mountaineering, parachuting, airsoft, drag racing, paintballing, wakeboarding and bungee jumping, except for activities under company-sponsored sports activities. Injuries resulting from direct participation in riots, strikes, and other civil disturbances. Treatment of injuries or illnesses resulting from war and any combat-related activities while in military service. Sexually transmitted diseases, genital warts, AIDS and AIDS related diseases. Valvular heart disease (congenital and/or acquired) including Cardiomyopathies, Chronic Glomerulonephritis, previous craniotomy sequelae/hearing impairment/ Neurologic disease and Spinal Stenosis (if pre-existing)/Poliomyelitis/Slipped disc (if pre-existing) and Guillain-Barre Syndrome, Diabetes and its complications (if pre-existing), Complicated Hypertension (e.g. those with history of stroke, myocardial ischemia or infarction and poor kidney function), and all malignant tumors (if pre-existing). Treatment for Chronic Dermatoses, except Scabies. Infectious diseases (according to the local epidemiologic patterns) that may arise in times of an epidemic or pandemic (i.e. Avian Flu, Meningococcemia, etc.) as declared by the Department of Health, World Health Organization or any recognized health organization. Hepatitis B and screening and vaccines for all types of Hepatitis. Animal bite/scratch/lick or snake bite including its complications. Benefits covered by Philhealth, Employees Compensation Commission Benefits (ECC) and all other government funded healthcare entitlements as provided for by law. Laser procedures/treatments. Speech therapy for developmental and congenital diseases. Weight reduction programs, surgical operation or procedure for treatment of obesity, including gastric stapling or balloon procedures and liposuction. Routine, diagnostic, therapeutic and other procedures of the same or similar nature not otherwise specified in this Agreement Cost of vaccines and immunization including its administration. Cost of medico-legal cases. All screening tests if patient is o asymptomatic, no clinical signs and symptoms; o no previous history of the disease for which the test is requested for; and o personal request of the member which may fall under the above reasons. Treatment of work-related injuries of high-risk occupations such as but not limited to construction workers, miners, loggers and drillers. Cost of the medical services and professional fees in excess of the MBL. All cases of assault whether provoked or unprovoked, whether initiated by the member or by a known or unknown third party. Open heart surgeries, angioplasties, valvuloplasties, permanent pacemaker, balloon valvuloplasties, percutaneous intraaortic balloon counter pulsation and balloon atrial septostomy. Home service. Additional modalities and procedures not specified in this Agreement, in excess of Php 5,000. Multiple sclerosis, epilepsy and seizures. Degenerative diseases such as Alzheimers disease, Parkinsons disease, Amyotrophic lateral sclerosis and others.

OTHER PROVISIONS: CUT OFF DATES For Individual and Family PAYMENT RECEIVED or Official Receipt dates 11th to 25th of the month 26th to 30/31st of the month 1st to the 10th of the month

EFFECTIVE DATE 1st of the following month 16th of the next month 16th of the current month

LAPSATION If a member fails to pay a membership fee on its due date, his or her membership shall be considered lapsed effective the day after the due date. A member whose membership has lapsed will not be entitled to any Benefit during the period that his membership is on a lapsed status, except 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.

REINSTATEMENT A member whose coverage has lapsed for failure to pay the membership fee on the due date may apply to reinstate his or her coverage within forty-five (45) calendar days from the date it is considered lapsed by (a) submitting a written request for reinstatement; (b) paying the membership fee due with arrears, including 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, provided however that there shall be no coverage of any benefit to the reinstated member within 30 calendar days from the effective date of reinstatement. If the membership fees due including five hundred pesos (Php500) remain unpaid within forty-five (45) days from the date it is considered lapsed, Maxicare reserves the right to suspend all services under this Agreement until full payment of all fees have been paid and settled. After the forty-five (45) days of non-payment of membership fees, Maxicare reserves the right to disapprove reinstatement and will require the member to re-apply. ***May change without prior notice***

2010 INDIVIDUAL MEMBERSHIP FEES Platinum Plus Age Group Annual 2-5 6 - 10 11 - 15 16 - 20 21 - 25 26 - 30 31 - 35 36 - 40 41 - 45 46 - 50 51 - 55 56 - 60 61 - 65* Php 36,604 30,541 25,721 25,015 24,891 25,721 30,199 37,159 46,349 54,609 61,210 67,262 75,242 Php 200,000 Large Private Semi-Annual Php 19,766 16,492 13,890 13,508 13,441 13,890 16,307 20,066 25,028 29,489 33,053 36,322 40,631 Gold Php 100,000 Regular Private Semi-Annual Php 9,381 7,344 6,043 5,783 5,650 6,627 7,992 10,488 13,430 16,099 18,710 21,815 23,739 Quarterly Php 10,249 8.551 7,202 7,004 6,969 7,202 8,456 10,404 12,978 15,290 17,139 18,833 21,068 Annual Php 21,272 17,372 14,304 13,337 13,841 15,130 17,627 22,695 30,260 40,258 48,701 54,930 61,978 Platinum Php 150,000 Regular Private Semi-Annual Php 11,487 9,381 7,724 7,202 7,474 8,170 9,519 12,255 16,341 21,739 26,299 29,662 33,468 Silver Php 60,000 Semi-Private Semi-Annual Php 6,948 5,789 4,899 4,660 4,660 5,302 5,711 6,954 10,425 12,479 13,870 15,409 16,068 Quarterly Php 5,956 4,864 4,005 3,734 3,876 4,236 4,936 6,355 8,473 11,272 13,636 15,381 17,354

Age Group 2-5 6 - 10 11 - 15 16 - 20 21 - 25 26 - 30 31 - 35 36 - 40 41 - 45 46 - 50 51 - 55 56 - 60 61 - 65* Annual Php 17,372 13,600 11,191 10,709 10,462 12,272 14,800 19,423 24,870 29,812 34,648 40,398 43,962

Quarterly Php 4,864 3,808 3,133 2,998 2,929 3,436 4,144 5,438 6,963 8,347 9,701 11,311 12,309

Annual Php 12,866 10,720 9,073 8,630 8,630 9,818 10,575 12,877 19,305 23,110 25,684 28,534 29,756

Quarterly Php 3,603 3,002 2,540 2,416 2,416 2,749 2,961 3,606 5,405 6,471 7,192 7,990 8,332

Note: 1) *(61-65 age group) For renewing members only 2) Exclusive of Dental Benefit


20% of membership fees at net of VAT is subject to 12% VAT. Additional VAT that may be imposed at the time of transaction is to be shouldered by the member Rates are effective January 1, 2010 and valid until December 31, 2010

2010 FAMILY MEMBERSHIP FEES Platinum Plus Age Group Annual 2-5 6 - 10 11 - 15 16 - 20 21 - 25 26 - 30 31 - 35 36 - 40 41 - 45 46 - 50 51 - 55 56 - 60 61 - 65* Php 30,505 25,534 22,648 20,939 21,114 21,963 24,429 27,437 34,593 45,339 52,744 60,131 67,952 Php 200,000 Large Private Semi-Annual Php 16,473 13,788 12,230 11,307 11,402 11,860 13,192 14,816 18,680 24,483 28,482 32,471 36,694 Gold Age Group Annual 2-5 6 10 11 - 15 16 - 20 21 - 25 26 - 30 31 - 35 36 - 40 41 - 45 46 - 50 51 - 55 56 - 60 61 - 65* Php 14,341 11,561 9,534 8,518 8,398 9,884 11,539 14,621 18,219 23,203 27,073 31,340 34,492 Php 100,000 Regular Private Semi-Annual Php 7,744 6,243 5,149 4,600 4,535 5,337 6,231 7,896 9,838 12,530 14,619 16,923 18,626 Quarterly Php 4,016 3,237 2,670 2,385 2,351 2,768 3,231 4,094 5,101 6,497 7,580 8,775 9,658 Annual Php 11,278 9,188 7,886 7,494 7,469 8,285 8,975 10,689 15,396 19,183 21,410 23,776 24,947 Quarterly Php 8,541 7,150 6,341 5,863 5,912 6,150 6,840 7,682 9,686 12,695 14,768 16,837 19,027 Annual Php 19,480 15,974 13,270 12,283 13,014 14,170 16,714 20,692 26,392 34,727 42,000 49,131 55,617 Platinum Php 150,000 Regular Private Semi-Annual Php 10,519 8,626 7,166 6,633 7,028 7,652 9,025 11,174 14,251 18,752 22,680 26,530 30,033 Silver Php 60,000 Semi-Private Semi-Annual Php 6,090 4,961 4,258 4,047 4,033 4,474 4,847 5,772 8,314 10,359 11,561 12,839 13,471 Quarterly Php 3,158 2,573 2,208 2,098 2,091 2,320 2,513 2,993 4,311 5,371 5,995 6,657 6,985 Quarterly Php 5,454 4,473 3,716 3,439 3,644 3,968 4,680 5,794 7,390 9,723 11,760 13,757 15,573

Note: 1) * (61-65 age group) For renewing members only 2) Exclusive of Dental Benefit 3) 20% of membership fees at net of VAT is subject to 12% VAT. Additional VAT that may be imposed at the time of transaction is to be shouldered by the member


Rates are effective January 1, 2010 and valid until December 31, 2010

MAXICARE PRIMARY CARE CENTERS were put together with your convenience in mind. These are well- appointed to give the cardholders access to quality health care close enough to where they work or live. Each center has its staff of Customer Service Associates, Primary Care Physicians who are consultants specializing in Internal Medicine & Pediatrics and additional services like laboratory and ECG examinations (available at Filomena Bldg.). Because our centers are located close to major hospitals, our Customer Service Associates are able to facilitate easy access to quality diagnostics, specialist consultation and hospitalization when you need it. MAXICARE MEDICAL CLINICS OUTPATIENT G/F Filomena Building Amorsolo cor. Dela Rosa Sts., Legaspi Village, Makati City Tel. Nos: 893-4858 or 3898 MAKATI MEDICAL CENTER INPATIENT Room 131, New Wing #2 Amorsolo Street, Makati City Tel. Nos: 893-6064 | 893-9820 | 8888-999 loc 7265 & 7182 The NEW MEDICAL CITY Room MGR04, Ground Floor MATI Bldg. The Medical City Ortigas Avenue, Pasig City Tel. Nos. 636-2829 | 706-1526 635-6789 local 3006 & 5073 ST. LUKES MEDICAL CENTER Room 1501 North Tower, Cathedral Heights, E. Rodriguez, Quezon City Tel. Nos: 723-5329 | 723-0101 loc 5151 DE LOS SANTOS MEDICAL CENTER Unit 302 De los Santos Bldg., De los Santos Medical Center, Quezon City Tel. Nos. 723-0041 to 54 Loc. 302 | 416-6144 | 416-6150 CEBU Unit 308-309 3/F Dr. Jose Cecilio Borromeo Bldg., Kamuning St., Capitol Site, Cebu City (Across ER unit of Cebu Doctors Hospital) (032) 253-3082 | (032) 254-3980 DE LOS SANTOS STI MEGACLINIC 5/F SM Megamall Bldg. A Tel. No.: 632-7624 | 637-9661 local 108 MY HEALTH CLINIC- ALABANG 2L Style Boulevard, Festival Supermall Filinvest Corporate City, Alabang, Muntinlupa Tel. No.: 850-4855 CUSTOMER CARE CENTERS BACOLOD Rm. 215 North Point Building B.S. Aquino Drive, Bacolod City Tel. Nos: (034) 433-3044 | (034) 434-9230 CAGAYAN DE ORO 2/F Unit 215, De Leon Bldg. Yacapin St. Cor Velez St., Cagayan De Oro (08822) 71-47-25 | 71-47-26 DAVAO 2nd Floor Room 17 Jocar Complex C. de Guzman Street, Davao City (082) 227-2941 | 300-5553 GENERAL SANTOS General Santos Doctors Hospital Engineering Office Ground Floor near 1B Station National Highway, General Santos City Tel. Nos: (083) 553-3963 ILOILO 2nd Floor, M22 AJL Annex Bldg. cor. Ibarra & General Luna Sts., Iloilo City Tel. No: (033) 337-1051

*For Providers Directory, please refer to List of Accredited Hospitals & Clinics at

Your Easy Guide to Maxicares SMS Inquiry Service (0918-889-MAXI) 1) To request list of accredited providers per area a) Hospital Key in: prov <space> hos <space> location Examples: prov hos makati prov hos bacolod b) Clinic Key in: prov <space> clinic <space> location Examples: prov clinic makati prov clinic ortigas 2) To request list of accredited doctors per specialization per hospital Key in: doc <space> hospital name <slash> specialization Examples: doc makati med/gastro doc riverside/cardio To request doctors schedule and contact number per hospital Key in: sked<day> <space> hospital name <slash> doctors surname Key words for each day: mon, tue, wed, thu, fri, sat, sun Examples: skedmon medical city/flandes skedsat makati med/genuino


Domestic: 908-6900 International Assist Hotline: (02) 687-8522 Customer Care Center: 582-1900 Toll Free No. for Provincial Inquiries (PLDT Line): 1-800-10-582-1900 SMS Inquiry: 0918-889-MAXI