NOTE: The amount indicated is per dependent. The deduction is every payout (15th and 30th of the month).

NOTE: The amount indicated is per dependent. The deduction is every payout (15th and 30th of the month).

• Room and board accommodation (based on your plan type and entitlement

• Use of Recovery Room and Intensive Care Unit (ICU)

• Professional Fees for attending doctors and nursing services

• Drugs and medicines for use in the hospital

• Whole blood/human blood products and IV fluids transfusion

• Anesthesia, oxygen, and its administration

• Standard hospital admission kit

• Dressings, casts, sutures, and other supplies/services directly related to the medical management of the patient

• Regular consultations - up to MBL

• Eye Laser Therapy (including cataract removal except cost of lens) (PRK treatment is not covered) - up to PHP 15,000.00 per eye/member/year

• Ears, Nose, Throat (ENT) Treatment - up to MBL

• Pre and Post Natal Consultations - up to MBL

• Treatment of minor injuries - up to MBL

• Minor surgeries not requiring confinement - up to MBL

• X-ray, laboratory exams, routine and other diagnostic procedures - up to MBL

• Doctor's Services

• Emergency Room fees

• Medicines used for immediate relief and during treatment

• Ambulance services

  • • • Within the network - up to MBL

      • Outside the network - reimbursable up to PHP 5,000.00 per conduction

• Involuntary for Room Upgrade - covered for the first 48 hours

• Panoramic X-ray inclusion for Principal Members (employees) - (1) session per year (reimbursement)

• Oral consultation/examination

• Oral prophylaxis - twice a year

• Simple tooth extractions

• Oral/dental surgery - (1) session per year

• Flouride treatment - (1) session per year

• Deep scaling - (1) session per year

• Temporary fillings

• Permanent fillings - (4) teeth per year

• Desensitization of hypersensitive teeth - (2) teeth per year

• Emergency dental treatment

• Simple repair and adjustments of dentures

• Re-cementation of jacket crowns, bridges, Inlays & Onlays

• Palliative treatment of simple mouth sores and blisters

• Oral incision and drainage

• Gum treatment for cases like inflammation and bleeding

• Covered up to MBL

  • • Pre-existing dreaded and non-dreaded conditions

    • Work-related cases based on conditions set by ECC (Employee Compensation Commission)

    • Motor or vehicular accident - subject to exclusions and limitations

    • Provoked/Non-provoked assault

    • Consultation for chronic dermatoses

    • Congenital conditions including physical therapy sessions and developmental disorders

• Covered up to PHP 20,000.00 per member per year (shared limit for IP and OP)

  • • Scoliosis - including necessary procedures except for physical therapy sessions, whether congenital, pre-existing, developmental, or acquired

• Sexually Transmitted Diseases (STDs), AIDS, and AIDS-related diseases - up to PHP 50,000.00

• Animal Bite Vaccines - up to PHP 35,000.00

• Electrocauterization - up tp PHP 10,000.00

• Maternity Coverage

  • • Normal delivery - up to PHP 10,000.00

    • Dilation and Curettage (D&C) - up to PHP 10,000.00

    • Caesarian - up to PHP 20,000.00

• Injuries arising from war or any combat-related activities while in military service

• Self-inflicted injuries

• Injuries from misconduct or gross negligence

• Medical emergencies from beautification procedures

• Chronic dermatoses (Psoriasis, skin asthma) except consultations

• Government-funded healthcare benefits

• Personal medical requirements

• Involvement in hazardous sports

• Non-insurable conditions

  • • Custodial, domiciliary, and convalescent care

    • Long-term rehabilitation and psychiatric care

    • Dental and maternity cases

    • Circumcision, sex transformation, diagnosis and treatment of fertility or infertility, artificial insemination, sterilization or reversal of such

    • All expenses incurred in the process of organ donation and transplantation, unless the member thereof is the recipient of such donation or transplantation

    • All physical deformities before enrollment

    • Experimental procedures, acupuncture

    • Hepatitis B screening and all diagnostic exams for members who have pre-existing Hepatitis B

• Additional charges

  • • Additional charges resulting from room upgrading, or additional personal comfort items not included in the room and board accommodation (TV, telephone, etc.)

    • Corrective appliances, artificial aids, prosthetic appliances

    • Take home medicines

    • Services obtained from non-accredited physicians and hospitals, or other providers of care, except under emergency care

    • Purchase or lease of durable medical equipment, oxygen dispensing equipment, and oxygen except during covered inpatient care

Based on the DOH Circular 2021-0374, the cap limit for RT-PCR is Php 3,360.00 whereas Philhealth coverage is Php 2,800.00, thus kindly be advised that Maxicare will cover only up to Php 560 per availment. Please be guided accordingly.

"COVID Testing will NOT BE COVERED if it is solely for screening purposes and not medically necessary."

Note: Make sure that the testing facilities are Maxicare, Philhealth, and DOH-Accredited