PowerPoint Presentation

[Audio] SALIENT FEATURES. SALIENT FEATURES.

[Audio] COVERAGE OF THE HEALTHCARE PROGRAM Salient Features Annual Check-up Outpatient Care Inpatient Care Emergency Care Dental Care.

[Audio] Who are eligible under the Health Care Program? ✓ Employees aged 65 years old and below ✓ Dependents of employees ✓ Must Follow Hierarchy Status of employee, Married. allowed dependent/s, spouse & children. Age requirement dependent/s, up to 65 years old 0 days old to 21 years old. Status of employee, single. allowed dependent/s, parents. Age requirement dependent/s, up to 65 years old. Status of employee, single parent. allowed dependent/s, children parents. Age requirement dependent/s, 0 days old to 21 years old up to 65 years old.

[Audio] Annual Check Up Physical Examination Urinalysis Fecalysis Chest X-ray Complete Blood Count ECG for members 35 yrs old and above Pap Smear for female members 35 yrs old & above Note: Annual Check-up should be for scheduling.

[Audio] Outpatient Care COVERAGE COVERAGE Regular Consultations Ears, Nose, Throat Treatment Pre and Post Natal Consultations Treatment of minor injuries Minor surgeries not requiring confinement X- ray, Laboratory, Exam, Routine and other Dianostic procedures limits Up to ABL Eye Laser Therapy (including cataract removal except cost of lens) Lasik/PRK treatment – non covered Limits Up to P10,000 per eye / member / year.

[Audio] COVERAGE Cauterization of warts (except genital warts) it limits P1,000/member/year Sclerotherapy - removal of Varicose veins (must be prescribe by an accredited vascular surgeon) limit Up to P5,000 per leg /member Allergy Testing it limits P2,500 /member /year Speech therapy (medically necessary and on a imbursement basis) Covered as Charged up to P10,000 Tuberculin Test it limits P600 /member /year Physical therapy / Occupational therapy Note: Therapy of one (1) body area shall be considered as one (1) session. OP: Up to 12 sessions subject to ABL Therapeutic Procedure (IV Chemotherapy, Dialysis, etc) Up to 12 Sessions Subject to ABL.

[Audio] The services that the maxicare offers is consultations and laboratory procedures Consultations. Under its channel are Maxicare primary care clinic. Maxicare telemedicine 24/7 teleconsult voice call. Maxicare telemedicine videoconsult video call and last maxicare-accredited clinics nationwide. Laboratory procedures. Under its channel are maxicare primary care linic, health clinic, maxicare home care and last maxicare-accredited clinics nationwide..

[Audio] Outpatient availment procedure Step 1: Acquire LOA by presenting your Maxicare card and valid ID thru the following: maxicare Helpdesk , coordinator of any accredited hospital and memver gateway MaxiHealth app Step 2: Present LOA/referral slip to a preferred Maxicare-accredited doctor/specialist Step 3: Avail of services Consultation of services and laboratory exams If laboratory exams are required, Repeat step 1..

[Audio] Inpatient Care Room and Board accommodation ( based on your plan type and entitlement) Use of Recovery Room and Intensive Care Unit (ICU) Professional Fee of attending doctors & nursing services Drugs and medicines for use in the Hospital Whole blood/human blood products & 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.

[Audio] Non-coverage of miscellaneous charges for all affiliated providers These miscellaneous include, but not limited to the following: Infection Control Care Fee Hepa Filter and Humidifier Fee Disinfection Fee Covid Care Fee Other miscellaneous charges of the same nature Maxicare shall no longer cover the charges for miscellaneous items which are not directly related to the treatment of our member's condition.

[Audio] In-patient availment procedure Step 1: Get an admitting order from your Maxicare Doctor Step 2: Acquire LOE at the admitting section by presenting yor Maxicare ID and one valid ID Step 3: Avail for the In-patient services or treatment Step 4: File Philhealt Documents and settle the non-coverable charges prior to discharge.

[Audio] Emergency Care Doctor's services Emergency room fees Medicines used for immediate relief and during treatment Initial treatment of animal bites Covered up to ABL (For the first 24 hours from the time of bite) Passive and active vaccines for animal bites Succeeding Dose of Animal vaccines covered up to Php18,000 /Member /Year; 2nd dose onwards must be Out patient availment Ambulance services Within the network - Subject to ABL Outside the network Reimbursable up to P2,500 per Conduction Involuntary for room upgrade - Covered for first 24 hours.

[Audio] Emergency availment procedures For accredited hospitals Step 1: go to emergency room of the nearest hospital. Step 2: present maxicare card and valid ID Step 3: avail of treatment at the emergency room For non-accredited hospitals Step 4: secure pertinent document (medical certificate receipts and others) Step 5: forward maxicare for reimbursement within 30 days from date of discharge. Follow in-patient availment steps. *If emergency case leads to confinement.

[Audio] Emergency care (for non-affiliated Availment in Non- accredited hospital within the Philippines Maxicare shall reimburse 80% of the hospital bills and professional fees, based on maxicare standard rates up to P30,000/availment/member/year for the first 24 hours Outside the Philippines Maxicare shall reimburse 100% of the hospital bills and professional fees, based on actual cost up to P30,000 availment/member/year Areas without affiliated hospitals within the Philippines Maxicare shall reimburse the 100% of hospital bills and professional fees, based on Maxicare standard rates subject to ABL..

[Audio] Claims and reimbursement procedure (maxicare reimbursement card) All claims must be submitted to Member Gateway within 30 days from date of discharge from the hospital. The following are the required documents for reimbursement: Claim Reimbursement Form for MRC (with filled out SMS number and email); Original receipts of all hospital bills & professional fee of the Doctor; Original charge slips (with itemized breakdown of charges); Clinical , admitting history and medical certificate; • Histopath/Surgical Report (if surgical operation was done); • Police Report in case of accident and medico legal cases: Scanned copy documents will be processed for now. However, members will still be required to submit hard copy within 90 days from submission date, as this is a BIR requirement. Processing of Claims will be 15 days from receipt of complete documents. Reimbursement Status can be checked thru Member Gateway.

[Audio] Member gateway online reimbursement Click the okay tab on the pop-up message that prompts the user to update his contact information. The member ID, company name, name, birthdate, gender, mobile no. and email address are automically populated once page is clicked. Make sure to fill-out required fields (all items marked with*) Once transaction is successful, reimbursement form can be downloaded. An auto email will be sent to the user and reimbursement team upon successful registration of reimbursement claim. Submit the reimbursement document (hard copy) to maxicare tower. Members should include the print-out form along with the original copies of the scanned documents when submitting the reimbursement claims to maxicare. Online submission is for initial evaluation, original documents still need to be submitted, claim proceeds will not be credited if original document are not submitted..

[Audio] CLAIMS AND REIMBURSEMENT PROCEDURE (MAXICARE REIMBURSEMENT CARD) Where will the members submit the original documents? Luzon: Maxicare Healthcare Corporation c/o Claims Reimbursement Receiving Unit Ground Floor CIBI Center #3308 Zapote St. Brgy Sta Cruz, Makati City Visayas: Maxicare Healthcare Corporation c/o Claims Reimbursement Receiving Unit 8th Floor Apple One - Equicom Tower Cebu Business Park, Cebu City 6000 Mindanao: Maxicare Healthcare Corporation c/o Claims Department 8th Floor FTC Tower, Mt Apo Street,Davao City.

[Audio] Claims and reimbursement procedure Your card will be activated to cash card and you will receive an SMS notification of your PIN and approved reimbursement amount. *your SMS number must be correctly reflected in the claims reimbursement form. Member may withdraw the amount from equicom ATMs or Bancnet, Expressnet or Megalink ATMs Member may also use the amount to purchase from any of the bancnet accredited merchants.

[Audio] Additional coverage COVERAGE 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 the limit is up to ABL Pandemic coverage Congenital Conditions Except physical therapy sessions and development or acquired Scoliosis including necessary procedures, except physical therapy sessions, whether congenital, pre-existing, developmental or acquired The limit is Up to P20,000/member/year (shared limit for IP and OP) Note: Physical Therapy sessions shall form part of the Physical therapy/ Occupational therapy limits Wellness Program is Up to 6 session/s.

[Audio] Claims Member Journey:Daily Hospital Income Benefit CLAIM IN 3 EASY STEPS 1. IF HOSPITALIZED Member gets hospitalized and Inpatient Specialist informs the member of the Hospicash Daily Income Benefit upon admission 2. ACCOMPLISH GOOGLE FORM Member or Member's representative to fill up the Hospicash Google Form provided by the Inpatient Specialist 3. GET CASH Member receives the Hospicash Daily Hospital Income Benefit in their provided bank account If hospitalized No required documents needed Encourage to fill up before discharge to receive the Cash Benefit 4 days after discharge. Deadline to accomplish the form: up to 90 calendar days after discharge *Receive 4 working days after discharge. Accomplishment of the Google Form is a prerequisite..

[Audio] Dental care Oral Prophylaxis - Twice a year Simple tooth extractions Temporary fillings - covered as needed Permanent fillings – 2 teeth Emergency dental treatment Re-cementation of Jacket Crowns, Bridges, Inlay and onlay Palliative Treatment of Simple Mouth Sores And Blisters Gum Treatment For Cases Like Inflammation Or Bleeding Desensitization of hypersensitive teeth – 2 teeth Simple adjustment of dentures.

[Audio] Member sets an appointment by calling (02) 8582-1900*. *Members can also directly call their preferred dental clinics for scheduling..

[Audio] GENERAL EXCLUSIONS. GENERAL EXCLUSIONS.

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[Audio] What are the general enclusions 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 Additional charges.

[Audio] What counts as additional charges? Additional charges resulting from room upgrading, or additional personal comfort items not included in the room & board accommodation ( T.V., telephone, etc.) Corrective appliances, artificial aids, prosthetic appliances Take home medicines Services obtained from Non and hospitals or other provider of care, except under emergency care. Purchase or lease of durable medical equipment, oxygen dispensing equipment, and oxygen except during covered in-patient care..

[Audio] What counts as non-insurable condition? Custodial, domiciliary and convalescent care. Long-term rehabilitation and Psychiatric care. 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 prior to enrollment Experimental medical procedures, acupuncture Hepatitis B screening and all diagnostic examinations for Members who have pre-existing Hepatitis B..

[Audio] Improving your life at every connection 24/7 customer care hotline: (02) 8582-1900 / 7798-7777 24/7 SMS inquiry service: (+63) 922 110 1733 24/7 non-voice support: customercare@maxicare.com.ph Product inquiry hotline: (02) 7798-7770 Corporate trunkline: (02) 7908-6900 For facebook /maxicarehealthcarecorp For Instagram, @maxicarehealthcare For twitter, @maxicareHMO For website, www.maxicare.com.ph.

[Audio] Healthcare that puts you first.

[Audio] RECOMMENDED ACTION ITEMS MAXIMIZE BENEFIT LIMIT 1. FPT- MAXICARE Wellness Programs to address common illness per recent APE and utilization 2. Only utilize hospital if no available procedure in clinic or accredited partner is quite far (hospital cost x3 or more) ELIGIBLE DEPENDENTS BASED ON STATUS: 1. SINGLE EMPLOYEE - Parents (not more than 65 years old) 2. SINGLE PARENT EMPLOYEE - Child/ren (below 21 years old) and Parents (not more than 65 years old) 3. MARRIED EMPLOYEE - Spouse (not more than 65 years old) and child/ren below 21 years old.

[Audio] Thank you and let's all stay healthy and keep safe everyone!.