MyMaxicare - Individual

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My Maxicare - Individual offers different types of affordable health insurance for individuals so you can choose the plans that best suits your personal situation. It covers wide variety of medical emergency such as in-patient and out-patient care, preventive care, life coverage and travel assistance services. As we go through changes in our lives, our health plans should adjust as well. Help protect your well-being with health coverages to support all your personal needs.

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Product Overview

Product Name	MyMaxicare - Individual
Coverage Area	Local

Cover by Plan Type

Plan Type	Maximum Benefit Limit	Room Type	Remarks
Platinum Plus	PHP200,000.00	Large Private	Platinum Plus
Platinum	PHP150,000.00	Regular Private	Platinum
Gold	PHP100,000.00	Regular Private	Gold
Silver	PHP60,000.00	Semi Private	Silver

OTHER KEY BENEFITS

Benefit Type	Cover	Deductible	Remarks
Room and Board	Included	Large private room	N/A
Use of Operating Room	Included	If prescribed by an attending Accredited Physician	N/A
Intensive Care Unit, Isolation Room	Included	N/A	N/A
Professional Fees	Included	N/A	N/A
Surgeons Fee	Included	N/A	N/A
Anaesthetist's Fee	Included	N/A	N/A
Standard Nursing Services	Included	N/A	N/A
Medicines for in-patient use	Included	N/A	N/A
Blood Transfusion and intravenous fluids	Included	N/A	N/A
Diagnostic, X-rays and Laboratory Tests	Included	N/A	N/A
Dressings, Conventional Casts and Sutures	Included	N/A	N/A
Anesthesia and its administration	Included	N/A	N/A
Oxygen and its administration	Included	N/A	N/A
Standard admission kit	Included	N/A	N/A
Other items directly related in the medical management of the patient	Included	As deemed medically necessary by the attending Accredited Physician	N/A
Consultation during regular clinic hours	Included	N/A	N/A
Eye, ear, nose and throat (EENT) treatment	Included	N/A	N/A
Treatment of minor injuries such as lacerations, mild burns, sprains, and the like	Included	N/A	N/A
Dressings, Conventional Casts and Sutures	Included	N/A	N/A
Diagnostic, X-rays and Laboratory Tests	Included	N/A	N/A
Minor surgery not requiring confinement	Included	N/A	N/A
Eye Laser Theraphy (retinal tear/detachment, glaucoma)	Included	Up to PHP10,000 per eye per member per year	As prescribed by an Accredited Physician
Electrocauterization of skin lesions	Included	Up to PHP1,000 per member per year	As prescribed by an Accredited Physician
Sclerotheraphy for varicose veins	Included	As prescribed by an Accredited Physician, up to PHP5,000 per leg per member per year	Except medicines and for cosmetic purposes
Allergy Testing	Included	Up to PHP2,500 per member per year	As prescribed by an Accredited Physician
Speech Theraphy (for Stroke patients)	Included	Up to PHP10,000 per member per year, reimbursement basis	As Charged
Tuberculin Testing	Included	Up to PHP600 per member per year	N/A
Emergency Care	Included	Subject to condition if Non-Accredited Hospital	As Charged if Accredited Hospital
Emergency Local Ambulance Service	Included	Up to limit and PHP2,500 per condition if non-accredited hospital, reimbursement basis	From accredited hospital to accredited hospital
Preventive Care Benefit	Included	N/A	N/A
Passive and active vaccines for treatment of tetanus and animal bites	Included	Up to PHP18,000 per member per year	Included
Periodic monitoring of health problems	Included	N/A	N/A
Health education and counseling on diets and exercise	Included	N/A	N/A
Health habits & Family planning counseling	Included	N/A	N/A
Annual Physical Examination	Included	N/A	N/A
Dental Care : Annual Fee	Included	PHP387.00	OPTIONAL
Life Coverage with accidental death and dismemberment	Included	Up to PHP25,000	N/A
Scoliosis treatment	Included	Up to PHP20,000 per member per year	N/A
Congenital treatment	Included	Up to PHP20,000 per member per year	N/A
Physical therapy/ Occupational therapy	Included	Up to limit	N/A
Consultation for Chronic Dermatoses	Included	Up to limit per year	N/A
Emergency Out-Patient	Included	N/A	N/A
International emergency assistance	Included	Hotline: (632) 3282460	via CHUBB
Emergency Medical Accident Assistance Services	Included	N/A	N/A
Coverage for Dreaded Conditions	Included	N/A	Depend on Type of Plan
Dental Care : Semi-Annual Fee	Included	PHP209.00	OPTIONAL
Dental Care : Quarterly Fee	Included	PHP108.00	OPTIONAL
Room and Board	Included	Regular private room	N/A
Room and Board	Included	Semi private room	N/A

FAQs

Who can be covered by My Maxicare Individual?

Applicants aged fifteen (15) days old to sixty (60) years and five (5) month old are eligible for My Maxicare Individual.

What are the requirements needed when applying for My Maxicare Individual?

Application Form
Medical Requirements (applicable for enrollees aged 49 years old above)
Photocopy of Alien Certificate of Residency (for foreign nationals)

What does a My Maxicare Individual cover?

As one of the most efficient HMO providers, My Maxicare Individual covers a wide variety of medical assistance, such as in-patient care, out-patient care, preventive care, and emergency care benefits.

What are the steps in filing reimbursement from a non-affiliated facility during an emergency case?

To file for a reimbursement, present the following documents:

Accomplish a Claims Reimbursement form
Original Official Receipt/s of the hospital bills, which includes the Statement of Account (SOA) and charge slips
Clinical Abstract of the case (if a surgical procedure was performed) and its hispathological report
Operative Record of the case/treatment or admission/discharge record signed by the attending physician

What is an example of an emergency condition?

A medical case is considered an emergency condition when it is either life-threatening, an accidental injury, or an unexpected onset of a health condition, such as heart attack, cardiovascular, or loss of consciousness.

Does My Maxicare Individual cover dreaded and non-dreaded conditions?

Just like My Maxicare Family, My Maxicare Individual is an HMO that covers dreaded and non-dreaded conditions. However, coverage is subject to a certain amount and depends on when the health insurance starts.

How do I know if I’ve consumed my Maximum Benefit (MBL)?

To know if you’ve fully consumed your MBL or not, you can log in on the Maxicare Member’s Gateway to check your Maxicare health card transaction history. Take note that you need to register before you can view the information.