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MAXICARE HEALTHCARE PROGRAM  “ Our commitment to good health and peace of mind…”
Is your purse ready when you get sick? ,[object Object],[object Object]
You’ll never know when you’ll get sick. ,[object Object],[object Object],[object Object],[object Object],[object Object]
What your MAXICARE CARD can do you for YOU? ,[object Object],[object Object]
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
Best Employers in Asia/Philippines
Banking & Finance Industry
Business Processing – Outsourcing/ Contact Centers
Manufacturing Industry
Food & Retail Industry
A few of the Clients we SERVE..
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
Can be used in over 300 hospitals and clinics nationwide including: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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
THE MAXICARE  INTELLIGENT CARD Maxicare Swipe Card ,[object Object],[object Object],[object Object],[object Object]
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
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
I. OUTPATIENT CARE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Out Patient Availment
II. IN PATIENT CARE  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
In-Patient Availment
III. ANNUAL CHECK UP  * according to plan of choice ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
III. ANNUAL CHECK UP  * according to plan of choice ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IV. PREVENTIVE CARE ,[object Object],[object Object],[object Object],[object Object]
V. EMERGENCY CARE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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
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
VI. DENTAL BENEFIT   *optional ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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
MAXICARE Affiliates/Partners Up to 20% discount on Optical Services & Purchases
VII. OTHER FEATURES   ,[object Object],[object Object],[object Object],[object Object]
VII. OTHER FEATURES
VIII. NON DREADED & DREADED CONDITIONS
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],General Exclusions
General Exclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General Exclusions ,[object Object],[object Object],[object Object],[object Object]
General Exclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General Exclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General Exclusions ,[object Object],[object Object],[object Object],[object Object],[object Object]
INDIVIDUAL  MEMBERSHIP FEES
FAMILY  MEMBERSHIP FEES
MEMBERSHIP REQUIREMENTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
…  and may you always be in the  pink of health !

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Maxicare individual-and-family-program

  • 1. MAXICARE HEALTHCARE PROGRAM “ Our commitment to good health and peace of mind…”
  • 2.
  • 3.
  • 4.
  • 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. Best Employers in Asia/Philippines
  • 7. Banking & Finance Industry
  • 8. Business Processing – Outsourcing/ Contact Centers
  • 10. Food & Retail Industry
  • 11. A few of the Clients we SERVE..
  • 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.
  • 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.
  • 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. 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.
  • 20.
  • 22.
  • 23.
  • 24.
  • 25.
  • 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. 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.
  • 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. MAXICARE Affiliates/Partners Up to 20% discount on Optical Services & Purchases
  • 31.
  • 33. VIII. NON DREADED & DREADED CONDITIONS
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.
  • 39.
  • 42.
  • 43. … and may you always be in the pink of health !