Hospital Service Agreement

Answer:

A tripartite agreement is a legal contract shared by or involving three different parties. The agreement NOW involves the following three parties: Maxicare Healthcare Corporation + Maxilife + Healthcare Provider

MaxiLife - is a comprehensive life insurance company that offers new innovations in customer experience, affordability, and availability following the leadership experiences of its founders: Maxicare, Gokongwei Group and Equicom Group. Depending on the time for rollout of this HSA, MaxiLife may have a new President/CEO - President and Chief Executive Officer, Jose Pastor Z. Puno 

Answer:

NONE - In section I - C (page 2): A Maxicare/MaxiLife Coordinator is an active medical staff of the Hospital, duly appointed by Maxicare and MaxiLife as such and performing functions as provided in this Agreement. But this is subject to change from “Coordinator” to “Participating Physician” since the management of Coordinators will be transferred to Medical in relation to the organizational restructuring.

Answer:

“Maxicare ID Card” means the card validly issued by Maxicare to a Member containing the latter’s name and signature, ID reference number, and other matters pertaining to his/her membership with Maxicare.

“MaxiLife ID Card” means the card validly issued by MaxiLife to an Insured containing the latter’s name and signature, ID reference number, and other matters pertaining to his/her insurance coverage with MaxiLife. 

Answer:

“Member” - Any person who is duly qualified and accepted by Maxicare to be a bona fide member based on the eligibility standards set by Maxicare. Section I - P and Q (page 3)

“Patient” - Any Member of Maxicare and/or Insured of MaxiLife availing of the Medical Services of the Hospital.Section I - P and Q (page 3)

Reminder!

• A Member is ALWAYS a patient

• A Patient is NOT always a Member

- Member only

- MaxiLife insured only

- Both a Member and insured

• A Maxilife insured may NOT always be a Maxicare member

- Member only

- MaxiLife insured only

- Both a Member and insured

Answer:

In Section I - S (page 3): A web-based application service offered by Maxicare to the Hospital to establish efficient and mutually acceptable electronic procedures and systems which will provide reliable medical service to the Patients and promote the smoother flow of business transactions between Maxicare and the Hospital. The same Paylink system will be used to process MaxiLife’s Insured Benefit Claims.

Answer:

Letter of Authorization (LOA) is issued by Maxicare, and signed by the Members; Letter of Eligibility (LOE) is issued by Maxicare to Members;

Letter of Guarantee (LOG) is issued by MaxiLife, and signed by, the Insured (Ref: Section 1 - I, J, K (page 2))

Answer:

In section I - W (page 4): The statement/s of account (SOA) issued to the Patient, LOA/LOG and/or LOE with complete details, and/or all attachments required by Maxicare and MaxiLife for processing of payments to Hospital, as further described in Annex “C” on Maxicare and MaxiLife Availment Guidelines and Claims Submission. 

***Previously, Annex C is for Auto Credit Arrangement (ACA)

Answer:

In section V - A (page 5): Medical Services availed by Maxicare Members shall be included in Maxicare’s Billing Statements whereas Medical Services availed by MaxiLife Insured shall be included in MaxiLife’s Billing Statements.

Maxicare and MaxiLife shall be billed separately at all times.

Answer:

In section V - D (page 5): Hospital shall forward to Maxicare or MaxiLife the corresponding Billing Statements together with the Supporting Documents not later than thirty (30) days for Hospitals operating in the National Capital Region, Metropolitan Cebu and Metropolitan Davao, or sixty (60) days for other Hospitals from the date of availment for outpatient services or date of discharge for in-patient and emergency services through Maxicare or MaxiLife accepted modes of receipt as may be prescribed from time to time. 

Answer:

Luzon Office Addresses:

• 3F CIBI Info Center, 3308 Zapote St. cor. Mascardo St., Makati City 

• 203 Salcedo St., Legazpi Village, Makati City 

• 9th Flr. Equitable Building, 262 Juan Luna St., Binondo, Manila 

Visayas Office Address:

• Unit 804, 8th Flr Apple One Equicom Tower Cebu Business Park, Cebu City 6000 

Mindanao Office Address:

• 3rd Flr FTC Tower, Maxicare Healthcare Corp. Mt. Apo Road, Davao City 

Authorized Receiver: Receiving Team

Answer:

Luzon Office Addresses:

• Ground Floor, Equicom Center, 3308 Zapote Street, corner Mascardo Street, Makati City 

• 9th Flr. Equitable Building, 262 Juan Luna St., Binondo, Manila 

Visayas Office Address:

• Unit 804, 8th Flr Apple One Equicom Tower Cebu Business Park, Cebu City 6000 

Mindanao Office Address:

• 3rd Flr FTC Tower, Maxicare Healthcare Corp. Mt. Apo Road, Davao City 

Authorized Receiver: Receiving Team

Answer:

Option 1: In Annex E - 1 (page 29): The Documentary Requirements for a hospital/clinic provider are uploaded through Health Partners Affiliation Gateway (HPAG) with the following link: https://sites.google.com/maxicare.com.ph/ecapply/health-providers or any other link, portal or site as may be prescribed by Maxicare and MaxiLife from time to time.

***Previously, there is no Annex E

Option 2: Email TEMPLATE provided by PROs 

Answer:

In section XIV - A (page 11): Valid for a period of three (3) years. Shall be automatically terminated after Term, unless otherwise extended by a written mutual agreement by the Parties, and subject to the provisions on Breach and Termination. Any renewal or extension of the Term shall be subject to the conditions laid out in Annex “E” - Conditions for Renewal.