OUT-PATIENT MEDICINE REIMBURSABLE AMOUNT
*NOTE: This additional benefit applies to all EMPLOYEES ONLY (Principal Members)
OUT-PATIENT MEDICINE CLAIM REIMBURSEMENT PROCESS
General Guidelines
Outpatient medicine claims must be submitted through Member Gateway within 30 calendar days from the date of purchase.
Processing of claims will be 1 - 2 months from receipt of complete requirements.
Only take-home and prescribed medicines are allowed for reimbursement.
Kindly keep all original receipts as you will need to submit them to your Maxicare representative.
Approved Reimbursement shall be credited to your Maxicare card.
Additional Guidelines
All reimbursement claims require original copies of Official Receipts or Sales Invoices with the Authority to Print from the Bureau of Internal Revenue or Sales Invoices with TIN.
Cash Invoices, order slips, and similar documents are not valid.
Receipts that are unreadable, soiled, or tampered with will not be accepted.
Receipts should show the official receipt number, purchase date, breakdown of items purchased, and subtotal per item.
Receipts with names not named to the HMO enrolled employee will not be processed.
For submitted receipts that require further clarification, Maxicare will reach out to the relevant members.
Failure to provide the required documents within the prescribed TAT would merit disapproval of the request.
Standard TAT for normal reimbursements will apply.
General Exclusions
Vitamins
Food Supplements
Alternative medicines like herbal / non-conventional treatments
Pre and Post Natal medicines
Contraceptive Pills
Injectable medicines (such as but not limited to chemotherapeutic drugs, vaccines, and immunomodulators)
Beautifications / Cosmetic Drugs (such as but not limited to slimming and skin whitening products, creams, ointments, solutions, and lotions for derma cases)
Soap / Cleanser for skin diseases
Requirements
CLAIMS REIMBURSEMENT FORM (CRF)
CUSTOMER INFORMATION FORM (CIF)
ORIGINAL COPY OF RECEIPTS
DOCTOR’S REQUEST/PRESCRIPTION
(2) Valid ID’S WITH (3) SPECIMEN SIGNATURES
