MyMaxicare - Individual

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.