Professional Documents
Culture Documents
Our VISION
Cardholders nationwide
HMO of Choice
Real-time validation of
membership during availments
Swipe facility using hospitals and
clinics’ POS units nationwide
Immediate activation & de-
activation of memberships within
24 hours
Cards need not be replaced
on a yearly basis
Access to our Vast Network of Providers
NCR
REGION 1
HOSPITALS 56
HOSPITALS 24
CLINICS 153
CLINICS 6
REGION 3
HOSPITALS 24 REGION 2
CLINICS 4 HOSPITALS 8
CLINICS 1
REGION 4
HOSPITALS 49 REGION 5
CLINICS 15 HOSPITALS 11
CLINICS 7
REGION 6
HOSPITALS 8 REGION 8
CLINICS 3 HOSPITALS 5
Customer Care
Network
CEBU
DAVAO
24/7 Call Center On-site
BACOLOD Corporate-Based
ILOILO
GENERAL
SANTOS
CAGAYAN
DE ORO
Makati Med
SM Megamall
De Los Santos
St. Luke’s
MAXICARE
Headquarters
Medical City
Cebu City
Advantages of the On-Line
Maxicare Primary Care Centers
Provincial Toll-Free
Number
Maxicare SMS Inquiry
SMS Inquiry Service
0918-889MAXI (0918-8896294)
• accredited providers per area
• accredited doctors per specialization
• doctors’ schedules and contact numbers
1) To register your number in the program 3) To request list of accredited doctors per specialization
Key in: reg <space> Maxicare ID Number per hospital
Example: reg 050123456700 Key in: doc <space> hospital name <slash> specialization
Examples: doc makati med/gastro
2) Inquiry on Accredited Hospital doc riverside/cardio
Key in: prov <space> hos <space> location
Examples: prov hos makati 4) To request doctor’s schedule and contact number per
prov hos bacolod hospital
Key in: sked<day> <space> hospital name <slash>
3) Inquiry on Accredited Clinic doctor’s surname
Key in: prov <space> clinic <space> location Key words for each day: mon, tue, wed, thu, fri, sat, sun
Examples: prov clinic makati Examples: skedmon medical city/flandes
prov clinic ortigas skedsat makati med/genuino
Maxicare Database Management System
Hospitals’ Bills
Processed Data
Linux Java
Solaris
Doctors’ Fees Operating
System
Member
Company
Clinics’ Bills
On Time Utilization Report & Analysis
Utilization Report on . . .
ICD 10 Coding System for Illnesses
Per Member Medical History
Hospitals/Clinics Accessed
Attending Physicians
Cost Per Availment
Date of Availment
Management Information System
Statistical reports
Health Profile Analysis
… thru Maxicare’s
Claims Management System
“The Flexi-Claims”
Sample Utilization Report & Analysis
BREAKDOWN OF SERVICES PRINCIPAL DEPENDENT TOTAL
Out-Patients & Medical Services
In-Patients
Reimbursement
TOTAL
MONTHLY AVERAGE
ANNUALIZED PROJECTION
*Inclusive of assumption for claims that have not yet been processed
Dental
Statistical Reports, Analysis & Recommendations
(In Tables and Graphs for cost and frequencies)
Wellness Strategies :
up to 20%
Discount
2% Discount
Out-Patient Care
In-Patient Care
Preventive Care
Annual Check-Up
Emergency Care
Special Benefits
Out-Patient Care
Medically necessary consultations during regular clinic hours, except prescribed
medicines
Ear, Nose & Throat (ENT) Treatment
Unlimited Pre & post natal consultations
Treatment of minor injuries such as lacerations, mild burns, sprains
Minor surgery not requiring confinement
X-ray, laboratory exams, routine, and diagnostic procedures as prescribed by an
accredited physician
Physical/Occupational Therapy covered up to 12 sessions/member/year.
Sclerotherapy for varicose veins covered up to 5,000/leg/member/year
Cauterization of warts covered up to 1,000/member/year from head to feet
(except genital warts & condyloma acuminata)
Therapeutic Procedures ( Chemotherapy, Radiotherapy ( cobalt, iodine,
radioactive cesium, linear accelerator therapy, brachytherapy ) Dialysis up to up
to MBL
Laser therapy for retinal detachment and glaucoma are covered ( excluding eye
correction e.g. lasik & PRK ) up to 10,000/member/year
Out-Patient Care…cont
Allergy Testing/ allergy screening and other related examinations up to Php 2,500
/member /year
Tuberculin Tests up to Php 600 /member /year (reimbursement basis) prescribed
by an Affiliated Physician to be availed at the Maxicare Primary Care Centers
Speech Therapy for Stroke Patients up to P10,000 /member /year (reimbursement
basis, consultations treated as sessions)
Annual Check up Coverage for employees and dependents
Cataract Extraction except cost of lens up to MBL
In-Patient Care
Room and Board Accommodation
Use of operating and recovery rooms
Use of the intensive care unit (ICU)
Professional fees of the attending doctor/s
Drugs & medicines for use in the hospital
Whole blood/human blood products & IV fluids
X-ray, Laboratory tests & diagnostic tests
Dressings, casts & sutures
Anesthesia, Oxygen & its administration
Standard nursing services and admission kit
Other supplies/services directly related to the
medical management of the patient
Preventive Care
Doctor’s Services
Emergency room fees
Medicines used for immediate relief & during treatment
Oxygen, I.V. fluids, whole blood & human blood products
Dressings, casts, sutures
X-ray, laboratory & diagnostic exams
Ambulance Services reimbursable up to Php 2,500 per conduction
(hospital to hospital transfer only)
Coverage for Passive and Active vaccines for anti venom, anti
tetanus and anti rabies up to P18,000./member/year
If room assignment is unavailable, upgrading of one higher room is
allowed within 24 hours
Emergency Care (Non-Affiliated)
Principals - Existing
Covered up to MBL
Principals – New & Additional
Covered up to MBL
Dependents – Existing
Covered up to MBL
Dependents – New & Additional
Covered up to MBL
Additional Features
Rates assume that employees are Philhealth Members. Hospitalization expenses are
shared by Philhealth and Maxicare. Non Philhealth members must pay additional
P1,800.00
MEMBERSHIP GUIDELINES
Masterlist
Signed Conforme
2010 Membership Fees
RATES FOR EMPLOYEES PER HEAD
Principals
Annual Maximum
Plan Room and Semi
Check Benefit Annual Quarterly
Type Board Annual
Up Limit
Platinum 1Suite up to 4,000 Routine 200,000 19,703 10,640 5,517
Platinum 2Large Private Routine 150,000 15,012 8,106 4,203
Gold 1 Regular Private Routine 150,000 13,676 7,385 3,829
Gold 2 Regular Private Routine 100,000 13,258 7,159 3,712
Silver Semi Private Routine 75,000 10,643 5,747 2,980
RATES FOR DEPENDENTS PER HEAD
Maximum
Annual Semi
Plan Type Room and Board Benefit Annual Quarterly
Check Up Annual
Limit
Platinum 1Suite up to 4,000 Routine 200,000 26,736 14,437 7,486
Platinum 2Large Private Routine 150,000 20,237 10,928 5,666
Gold 1 Regular Private Routine 150,000 18,338 9,903 5,135
Gold 2 Regular Private Routine 100,000 17,919 9,676 5,017
Silver Semi Private Routine 75,000 14,091 7,609 3,945
Rates for all types include Makati Medical Center, St. Lukes Hospital,
The New Medical City, Asian Hospital & Cardinal Santos. VAT Inclusive
TO APPLY NOW:
Mark Gastardo, Corporate Account Executive
Telephone: (02) 496 4690
Mobile: (0922) 604 7864
Email: slime_ateneo@yahoo.com
YM: slime_ateneo
http://maxicareinquiry.blogspot.com
Mark Gastardo has been a corporate account executive for a number of years. He
has served numerous individual and family memberships. He has also handled
corporate HMO clients including: