Frequently Asked Questions

FREQUENTLY ASKED QUESTIONS (FAQ)

Below are the common questions being asked of Maxicare.  This will serve as a guide to existing Maxicare healthcard members and prospective applicants/members.  However, kindly verify with your Maxicare sales agent to make sure if this is still in effect.

Does the rate or membership fee cover both principal and family members?

No. Each principal or dependent applicant has a different membership fee which is based on the age and plan chosen.

How much is the monthly fee for me to be covered for Maxicare healthcard?

Maxicare does not offer a monthly pay mode for health insurance. Pay modes available are only annual, semi-annual, and quarterly. However, you can settle via credit card (for individual and family membership only) in selected Maxicare satellite offices with credit card terminals and you can arrange to pay your credit card company on a monthly basis.

What is the youngest and oldest age can an individual be covered by Maxicare?

For individual and family applications the youngest is 2 months old and the oldest is 60 years old and 5 months. But for group and corporate plans, the principal applicant and adult dependent should be between 18 to 65 years old while the minor dependent should be at least 15 days old up to 21 years old.

Can I enrol any of my family member within the year from the time my membership took effect?

No. First of all, you can only enrol a family member based on the hierarchy rule (this is standard in all HMO/healthcard companies). A good example of the hierarchy rule is if you are the father in the family you should apply your wife first before you can add your eldest child and the next and so on. It cannot be that you allow first your eldest child or wife to apply ahead of you. Second, if you are applying for a Family account you can only enrol your dependent on the same day you applied for a healthcard, but for Corporate accounts you can only enrol that family member within thirty (30) days from start date of your membership (if new) or on the renewal date of your membership. However, exemptions to this rule can be made if you are under a Corporate plan and you are a new principal member whose employment status was changed to a regular employee within the middle of the year.

Is there any exemption in the hierarchy rule to enrol other family members under a Family account?

Yes. If the prospective member/s has an existing healthcard or some form of health insurance coverage from another company/provider.  It is also possible to cover a dependent child of a single parent carrying the lastname of the father if the prospective member/applicant and single parent to be enrolled has a certified true copy of a certificate of no marriage (CENOMAR) from the National Statistics Office (NSO) or subject to approval, any legal notarized document acceptable to Maxicare.

Does Maxicare cover dreaded and non-dreaded disease?

Yes, for individual and family health insurance plans, it covers both dreaded and non-dreaded disease up to a certain amount depending on the plan starting on the first year of membership.  Below are the pre-existing coverage for individual and family accounts per illness per year per member.

Platinum Plus   P20,000
Platinum             P15,000
Gold                      P10,000
Silver                    P5,000

However, for corporate accounts, pre-existing illnesses will be covered one hundred percent based on the Maximum Benefit Limit (MBL) of the plan per illness per year per member.

How can I avail of the services of Maxicare if I have not receive my Maxicare card ?

This is common in group and corporate plans because the Maxicare card takes time to be delivered due to the number of applicants and volume of cards being processed. But normally, a card identification number have been generated for each member (you can ask this from your agent) of which you can show to the Maxicare coordinator/liason officer in the accredited hospital of your choice together with your Valid ID and company ID. The same applies if you misplaced or lost your Maxicare card. So, it’s better to write down or save the Maxicare card number in your cellphone for easy reference.

I want to know the detailed benefits of my healthcard plan?

If you are an employee, you can find this information from your Human Resources Department, Administration Department, or whoever department is in charge of your employee benefits. You may also call Maxicare Customer Care or view the info in the Maxicare Member’s Gateway (you should register online first)

I am afraid that I might have fully consumed my Maximum Benefit Limit (MBL) or coverage and have to pay in the hospital?

You can log in the Maxicare Member’s Gateway to view your transaction history pertaining to your Maxicare health card.  However, you should register first before you can obtain information about your account.

My doctor is not accredited with Maxicare and I prefer to see my doctor?

If your doctor is a specialist, you can actually choose among several accredited doctor specialist in our database. You may call Maxicare Customer Care about this. Once you know the schedule of the accredited doctor specialist, you still have to go first to the Maxicare Coordinator/Liason Officer to get a LOA (Letter of Approval). Just remember that you need to know first the schedule of the accredited doctor specialist so as to save you time and effort.

Why do I have to go to a Maxicare Coordinator/Liason Officer before I can go to a doctor?

There are only selected doctors that Maxicare accredited or are allowed to diagnose and treat Maxicare members. Also, it is best to discuss your health condition or problem to the Maxicare Coordinator/Liason Officer so that he/she may assist you as to what particular hospital room you can go to especially if you need to be confined.

Why do some dentist / dental clinics still charge us of teeth cleaning or oral prophylaxis or light cure filling ?

If your teeth are very dirty and full of plaque due to cigarette smoking or you have heavy stains on your teeth caused by drinking too much coffee or tea, chances are the dentist will charge you for that because the tooth cleaning that is covered with your plan is only for those with light to moderate dirt and stains. The cost for this will depend on each dentist.

For light cure filling (or in Filipino they call it pasta) to fix small holes on our teeth due to tooth cavity, it is probable that the dentist will charge you extra if the number of tooth surfaces to be treated exceeds the maximum limit set in your health card / plan.

Do I get any additional benefits if I continue my Maxicare (ex-Maxicare corporate member) but this time as an individual after I have resigned from my employer/company?

Yes. You can continue Maxicare membership by applying again within 30 days from date of your resignation from your employer/company. Under Maxi-Link, we will link your previous account to your new account so that you can get 10% discount on the membership fee (if you have also dependents enrolled in your previous employer/company they can avail this as well), you also get 100% coverage for non-dreaded disease based on the Maximum Benefit Limit (MBL) of your plan. Also, if you are 49 years old and above, the medical requirement for this age will be waived. For membership application please contact us.

 

8 thoughts on “Frequently Asked Questions”

  1. hello. I just want to ask if as a maxicare member, do we allowed to reimburse medicine/vitamins/vaccines with the prescription of the doctor?

    Like

    1. Generally, we do not reimburse medicines, vitamins, or vaccines. Unless you are under a corporate account and if contract with Maxicare indicates that you do so. For you to make sure please contact your HR personnel or the Maxicare Account Officer or Agent assigned to your company.

      Like

  2. Hello. I’m having an issue registering in the member’s gateway. It invalid says birthdate. Is there I can check what is my registered birthday and/ or make necessary corrections. Thank you.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s