MyMaxicare - Individual
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.
