MAXICARE HEALTHCARE PROGRAM

““Our commitment to good health and peace of Our commitment to good health and peace of mind…”mind…”

Is your purse ready when you get sick?

FACT:

Despite recent economic gains, the government’s budget for health care is still far from the international standards set by the World Health Organization (WHO). The DOH budget in 2007 was 1.1 percent of the national budget, and 1.6 percent in 2006.  The DOH budget only ranked seventh among the budgets for government agencies.

You’ll never know when you’ll get sick.

Here, we give you the top reasons why we recommend or clients to get an HMO

1.         It is costly to get sick. With the high prices of medicines these days and the Professional fees of doctors do not come cheap too; they range from P250 to P1,000 per visit. And if hospitalization is required, the bill can run up to the millions for prolonged illnesses. It is not surprising, thus, for people to go broke over medical bills. Lifetime savings may be wiped out after one prolonged hospital stay.

2.       The government provides a health insurance to Filipinos through the Philippine Health Insurance Corp. (Philhealth). Members can avail of coverage for medicines, hospitalization and doctor¢s fees according to the schedules set by Philhealth. However, Philhealth coverage is not enough and covers to about 20-40% of your hospital fees.  Members have to turn to their savings to cover all health costs.

3.       For an annual fee, HMOs can insure a person and cover preventive health care costs (check-ups, laboratory fees) and hospitalization. The HMO has a list of accredited hospitals and health centers which one can go to for health care. Should a person require further examination by a specialist, the HMO will refer him to a physician accredited with them.

4.       With HMOs you don’t need to shell out cash at the hospital or doctor¢s office. The HMO takes care of all that as long as your account is current. There is no need to scrounge around for money in the event that a deposit has to be made to the hospital prior to admission.

What your MAXICARE CARD can do you for YOU?

Your MAXICARE card will give you free and unlimited access to over 300 hospitals and clinics nationwide. Simply present your card and avail of your benefits.

Whether it’s an emergency, confinement, consultation or annual check up, you’d be assured you are holding on to something, a protection not just for you but a financial protection for your parents, wife, kids, children AND peace of mind

More than 300,000 Cardholders nationwide

Best Employers in Asia/Philippines

Top 2,000 Companies in the Country

Years of Service, Extent of Years of Service, Extent of ExpertiseExpertise

20 years of SOLID Healthcare Expertise

HMO of Choice

1ST HMO to implement the “HOSPITAL-BASED Program”

Best Employers in Best Employers in Asia/PhilippinesAsia/Philippines

Banking & Finance IndustryBanking & Finance Industry

Business Processing – Business Processing – Outsourcing/ Contact CentersOutsourcing/ Contact Centers

Manufacturing IndustryManufacturing Industry

Food & Retail IndustryFood & Retail Industry

A few of the Clients we SERVE..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:

• Alabang Medical Center• Asian Hospital• Capitol Medical Center• Cardinal Santos Medical Center• Chinese General Hospital• De Los Santos Medical Center• FEU-Nicanor Reyes Hospital• Las Pinas City Medical Center• Las Pinas Doctors Medical Center• Makati Medical Center• Manila Doctors Hospital• Perpetual Help Medical Center• St. Lukes Medical Center• The New Medical City• University of Santo Tomas Hospital• University of the East-Ramon Magsaysay Medical Center

And many other top & recognized hospitals in Luzon, Visayas & Mindanao

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 CARDMaxicare Swipe Card

• Real-time validation of membership during availments

• Real-time record of availments which can be viewed via the web

• Swipe facility using more than 600 POS units of Equitable PCIBank nationwide

•Cards need not be replaced on a yearly basis

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 PLAN TYPE ROOM & BOARD MAXIMUM

BENEFIT LIMITANNUAL 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

1. Age eligibility is 2-60 years old renewable up to 65 years old2. With over 600 affiliated hospitals & clinics nationwide3. Maximum Benefit Limit is on a per type of illness/per injury per year

I. OUTPATIENT CARE• Medically necessary consultations during regular clinic hours,

except medicines.• Dermatology Consultations• Eye, ear, nose and throat (EENT) treatment• Treatment of minor injuries such as lacerations, mild burns,

sprains and the like• X-ray, laboratory examinations, routine, diagnostic and

therapeutic procedures prescribed by an accredited doctor• Minor surgery not requiring confinement• Physical Therapy/Occupational Therapy up to 12 sessions• Laser Therapy for retinal detachment and glaucoma prescribed

by an affiliated physician up to P10,000/eye/member/year• Cauterization of Warts up to P1,000/year / member• Speech Therapy up to 12 sessions (Stroke Patients)

Out Patient Availment

II. IN PATIENT CARE • Room and Board Accommodation• Use of Operating and Recovery Rooms• Use of Intensive Care Unit (ICU)• Professional Fees of attending doctor(s)• Drugs and medicines for use in the hospital• Whole blood and human blood products and IV fluids• X-ray, laboratory examinations and diagnostic tests• Dressings, casts and sutures• Anesthesia and its administration• Oxygen and its administration• Laparoscopy and Lithotripsy covered up to 100% of the actual cost• Standard nursing services• Admission kit including ice cap and wee bag

In-Patient Availment

III. ANNUAL CHECK UP * according to plan of choice

Platinum Plus Plan: (Multi-Phasic B)• CBC (Complete Blood Count) • Blood Chemistry (FBS, HDL, Cholesterol, Creatine, Albumin, Uric Acid, Alkaline Phosphatase, Potassium, LDL,

triglycerides, SGOT, Globulin, Calcium Phosphatase, Urea, Total Cholesterol, VLDL, SGPT, Total Protein, Total Billrubin)

• Thyroid Function:TSH-IRMA• Hepatitis Screening: BhsAg, Anti-HBs, Anti-HBc• Routine Urinalysis• Routine Fecalysis• Cardiac Work-up (12-Lead ECG, Treadmill Stress Test)• Chest x-ray• Abdominal Work-up (Upper Gastrointestinal series, Ultrasound of liver, Gallbladder & Pancreas, barium Enema,

Proctosigmoidoscopy)Platinum Plan : (Executive Check-up)

• Physical Examination• Urinalysis• Fecalysis• Chest X-ray• CBC (Complete Blood Count)• Blood Chemistry – Potassium, Creatinine, Total Protein, Total Bilirubin, Triglycerides, Calcium, Uric Acid, Albumin,

SGOT, Alkaline, Fasting Blood Sugar, Phosphate• 12 – Lead Elecrocardiogram• Ultrasound of the Gallbladder and kidney• Treadmill Stress Test OR Barium Enema

III. ANNUAL CHECK UP * according to plan of choice

Gold Plan : Semi Executive Check Up• Physical Examination• Urinalysis• Fecalysis• Chest X-ray• CBC (Complete Blood Count)• Blood Chemistry (FBS, SGPT, Cholesterol, Creatinine, Uric Acid)• 12-Lead ECG• Papsmear

Silver Plan: (Routine)• Physical Examination• Urinalysis• Fecalysis• Chest X-ray• CBC (Complete Blood Count)• 12 – Lead Elecrocardiogram (exclusive for 40 years old & above as an optional package)• Papsmear (exclusive for 40 years old & above as an optional package)

IV. PREVENTIVE CARE

• Administration of passive immunization excluding cost of vaccines

• Periodic Monitoring of health problems• Health education and counseling on diets and

exercise• Health Habits and Family Planning counseling

V. EMERGENCY CARE

A. ACCREDITED HOSPITAL• Doctor’s services• Emergency room fees• Medicines used for immediate relief & during treatment• Oxygen, intravenous fluids, whole blood & human blood products• Dressings, casts & sutures• X-rays, laboratory & diagnostic examinations & other medical services

related to the emergency treatment of the patient.• Ambulance Service for accredited hospital-to-hospital transfer up to P

2,500./ per conduction (by reimbursement)

B. NON-ACCREDITED HOSPITAL• Maxicare shall reimburse 80% of the total hospital bills and 80% of the

professional fees up to Php 30,000.

C. OUT SIDE THE PHILIPPINES• Maxicare shall reimburse 80% of the total hospital bills and 80% of the

professional fees up to Php 30,000.

Emergency AvailmentEmergency Availment

MAXICAREMember

Proceed to the ER of the nearest Affiliated Hospital

Avail treatment atEmergency Room

Present MAXICARE IDAt Emergency Room

Avail Room PlanNotify MAXICARE

Within 24hrs.

File PhilHealthon or beforedischarge

Settle charges not covered by Maxicare at the Billing

Section once the Discharge Order is issued by the

Attending Doctor

Emergency Availment for Non-Emergency Availment for Non-AccreditedAccredited

MAXICAREMember

Proceed to the Emergency Room of nearest Hospital

Avail treatment atEmergency Room

Proceed to RoomNotify MAXICARE

Within 24hrs.

File PhilHealthon or beforedischarge

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

• Annual Oral/Dental Examination & Consultation• Emergency Dental Treatment• Annual Oral Prophylaxis• Simple tooth extractions• Restorative and Prosthodontic Treatment Planning• Permanent fillings – 2 areas/year• Unlimited temporary fillings, as needed• Desensitization of hypersensitive teeth – 2/year• Simple adjustment of dentures• Recementation of loose crowns, Inlays or Onlays

Dental AvailmentDental Availment

Refer to Health PartnersListing for contact

numbers of Accredited Dentists

Call preferred dentistto set appointment

Proceed to Dentist’s Clinicon scheduled

date

Avail of Dental treatmentor consultations

Settle charges not covered by MAXICARE

Present MAXICARECard

MAXICARE MAXICARE Affiliates/PartnersAffiliates/Partners

Up to 20% discount on Optical Services & Purchases

VII. OTHER FEATURES

• Life Insurance Coverage of P25,000

• Free Emergency Overseas Medical Evacuation

• Congenital Illness up to P20,000

• Scoliosis whether congenital, pre existing or aquired up to P20,000

VII. OTHER FEATURES

Plan Type

Pre Existing Non Dreaded Conditions

Pre Existing Dreaded Conditions

Pre Existing Non Dreaded Conditions

Pre Existing Dreaded Conditions

Platinum Plus 20,000 20,000 20,000Platinum 15,000 15,000 15,000Gold 10,000 10,000 10,000Silver 5,000 5,000 5,000Acquired conditions are covered up to card limit from the 1st year

1st Year Subsequent Years

Up to Card Limit

VIII. NON DREADED & DREADED CONDITIONS

NON DREADED CONDITIONSHerniasTumors/NeoplasmsHemorrhoidsEar-Nose Throat Conditions Requiring SurgeryCataracts and GlaucomaAsthmaCirrhosis of the LiverAnal FistulaeCholecystisis/CholelithiasisCalculi of the Urinary SystemGastic or Duodenal UlcerHallux ValgusCollagen ConditionsDREADED CONDITIONSCerebrovascular Accident(stroke)Central Nervous System Lesions (poliomyelitis/meningitis/encephalitis/neurosurgical conditions)Cardiovascular DiseasesChronic Pulmonary DiseasesLiver Parenchymal DiseaseChronic-Genito Urinary Tract DisordersChronic Gastro-Intestinal Tract DiseasesConnective Tissue Disorders / Immunologic DisordersChronic Endocrine Disorders and their complicationsMalignancies and blood dyscrasis (cancer, leukemia, idiopathic thrombocytopenic purpuraInjuries and subsequent complications from accidents, assaults, frustrated homicide or frustrated murderComplications of apprent immunocompromise statusAny illness other than the above which would require intensive Care Unit confinements

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

General Exclusions

General Exclusions

2. Government funded healthcare entitlements & Personal medical requirements:• All other government funded health-care entitlements as provided for by law.• 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 within the initial confinement• Oral surgery following accidental injury to teeth for purposes of beautification

General Exclusions

4. Chronic Dermatoses:Psorasis / Skin Asthma / Chronic Dermatoses

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. and (b) riots, strikes, and other civil disturbances.

General Exclusions

6. 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 appliances• Take home medicine• Services obtained from Non-Accredited Physicians and Hospitals or other provider of care, except under emergency care.

General Exclusions

7. Other Non-Insurable Conditions:• Custodial, domiciliary, convalescent and intermediate 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 and maternity assistance• Circumcision, sex transformation, diagnosis and treatment of fertility or infertility, artificial insemination, sterilization or reversal of such.

General Exclusions

• 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 and speech therapy• Sexually transmitted diseases, AIDS and AIDS related diseases• Hepatitis B screening and all diagnostic examinations for Members who have pre-existing Hepa B.

INDIVIDUAL MEMBERSHIP FEES

Annual Semi-Annual Quarterly Annual Semi-Annual Quarterly 2 - 5 36,604 19,766 10,249 21,272 11,487 5,956 6 - 10 30,541 16,492 8,551 17,372 9,381 4,864 11 - 15 25,721 13,889 7,202 14,304 7,724 4,005 16 - 20 25,015 13,508 7,004 13,337 7,202 3,734 21 - 25 24,891 13,441 6,969 13,841 7,474 3,875 26 - 30 25,721 13,889 7,202 15,130 8,170 4,236 31 - 35 30,199 16,307 8,456 17,627 9,519 4,936 36 - 40 37,159 20,066 10,405 22,695 12,255 6,355 41 - 45 46,349 25,028 12,978 30,260 16,340 8,473 46 - 50 54,609 29,489 15,291 40,258 21,739 11,272 51 - 55 61,210 33,053 17,139 48,701 26,299 13,636 56 - 60 67,262 36,321 18,833 54,930 29,662 15,380 61 - 65 * 75,242 40,631 21,068 61,978 33,468 17,354

Annual Semi-Annual Quarterly Annual Semi-Annual Quarterly 2 - 5 17,372 9,381 4,864 12,866 6,948 3,602 6 - 10 13,600 7,344 3,808 10,720 5,789 3,002 11 - 15 11,191 6,043 3,133 9,073 4,899 2,540 16 - 20 10,709 5,783 2,999 8,630 4,660 2,416 21 - 25 10,462 5,649 2,929 8,630 4,660 2,416 26 - 30 12,272 6,627 3,436 9,818 5,302 2,749 31 - 35 14,800 7,992 4,144 10,575 5,711 2,961 36 - 40 19,423 10,488 5,438 12,877 6,954 3,606 41 - 45 24,870 13,430 6,964 19,305 10,425 5,405 46 - 50 29,812 16,098 8,347 23,110 12,479 6,471 51 - 55 34,648 18,710 9,701 25,684 13,869 7,192 56 - 60 40,398 21,815 11,311 28,534 15,408 7,990 61 - 65 * 43,962 23,739 12,309 29,756 16,068 8,332

Age Group

Gold SilverPhp 100,000 Php 60,000

Regular Private Semi-Private

Age Group

Platinum Plus PlatinumPhp 200,000 Php 150,000

Large Private Regular Private

FAMILY MEMBERSHIP FEES

Annual Semi-Annual Quarterly Annual Semi-Annual Quarterly 2 - 5 30,505 16,473 8,541 19,480 10,519 5,454

6 - 10 25,534 13,788 7,150 15,974 8,626 4,473 11 - 15 22,648 12,230 6,341 13,270 7,166 3,716

16 - 20 20,939 11,307 5,863 12,283 6,633 3,439 21 - 25 21,114 11,402 5,912 13,014 7,028 3,644

26 - 30 21,963 11,860 6,150 14,170 7,652 3,968 31 - 35 24,429 13,192 6,840 16,714 9,026 4,680

36 - 40 27,437 14,816 7,682 20,692 11,174 5,794 41 - 45 34,593 18,680 9,686 26,392 14,252 7,390 46 - 50 45,339 24,483 12,695 34,727 18,753 9,724 51 - 55 52,744 28,482 14,768 42,000 22,680 11,760

56 - 60 60,131 32,471 16,837 49,131 26,531 13,757 61 - 65 * 67,952 36,694 19,027 55,617 30,033 15,573

Annual Semi-Annual Quarterly Annual Semi-Annual Quarterly 2 - 5 14,341 7,744 4,015 11,278 6,090 3,158

6 - 10 11,561 6,243 3,237 9,188 4,962 2,573 11 - 15 9,534 5,148 2,670 7,886 4,258 2,208

16 - 20 8,518 4,600 2,385 7,494 4,047 2,098 21 - 25 8,398 4,535 2,351 7,469 4,033 2,091

26 - 30 9,884 5,337 2,768 8,285 4,474 2,320 31 - 35 11,539 6,231 3,231 8,975 4,847 2,513

36 - 40 14,621 7,895 4,094 10,689 5,772 2,993 41 - 45 18,219 9,838 5,101 15,396 8,314 4,311 46 - 50 23,203 12,530 6,497 19,183 10,359 5,371 51 - 55 27,073 14,619 7,580 21,410 11,561 5,995

56 - 60 31,340 16,924 8,775 23,776 12,839 6,657 61 - 65 * 34,492 18,626 9,658 24,947 13,471 6,985

Age Group

Gold SilverPhp 100,000 Php 60,000

Regular Private Semi-Private

Age Group

Platinum Plus PlatinumPhp 200,000 Php 150,000

Large Private Regular Private

MEMBERSHIP REQUIREMENTS1. Application Form2. For Family Applications

If the principal is single• If enrolling the PARENTS, pls attach a photocopy of the principal’s birth

certificate• If enrolling the SIBLINGS as well, pls attach a photocopy of the sibling’s birth

certificateIf the principal is married

• If enrolling the SPOUSE, pls attach a photocopy of the marriage contract• If enrolling the CHILDREN as well, pls attach a photocopy of the child’s birth

certificate

3. For new applicants whether the principal or dependent aged 50-60 yrs old, please submit the following:

a) 12 Lead ECG / Electrocardiogramb) Chest Xrayc) FBS / Fasting Blood Sugard) Total Cholesterole) HDL-C (High Density Lipoprotein)f) LDL-C (Low Density Lipoprotein)

• Group Corporate Programs also available.• Fees are inclusive of VAT• No application & processing fees.• Dental Fee of P650 not yet included.

… and may you always be in the pink of health!