Maxicare PRIMA Silver – Outpatient Benefit Card – Prepaid Health Card – HMO

Maxicare PRIMA Silver

• Unlimited lab tests, diagnostics and consultations for individuals 0 to 59 years old

Highlights

• Unlimited prescribed lab tests and diagnostics

• Unlimited consultations

• Valid at any Maxicare Primary Care Clinics (PCC)

• Single usage per type of dental service

• Eligible for newborns to 59 years only

• Valid for 1 year from activation date

• Covers preexisting conditions

• No preliminary checkup and paperwork needed

Coverage

• Any life-threatening or unexpected onset of a condition or illness, which requires the immediate alleviation of pain or discomfort within 24 hours including confinement in a regular private room.

Includes

Consultation and Diagnostics

• Ear-Nose-Throat (ENT)

• Medical Dermatologist

• Internal Medicine (IM)

• Obstetrician-Gynecologist (OB-GYN)

• Ophthalmologist

• Pediatrician

• Laboratory and diagnostic Procedures (as prescribed by a Maxicare-affiliated physician)

*Consultation and prescribed laboratory and diagnostic out-patient procedures are only available at Maxicare Primary Care Clinics

Dental Service

• FREE Dental Care Services with MetroDental (once within a year)

• Mild oral prophylaxis (cleaning)

• Full mouth panoramic X-Ray

• Dental consultation

• Emergency relief of dental pain through medication

• Cosmetic or oral rehab treatment planning

• Dental nutrition and counseling

• Dental health education

• Preparation of dental certificates

• Safekeeping of dental records as required by law or client

• Fluoride gel

Teleconsult

• Access to Maxicare Telemedicine 24/7 Teleconsult Voice Call at (02) 8582-1980

Videoconsult

• Access to Maxicare Videoconsult powered by Doctor Anywhere (available once promo codes have been sent via email)

Excludes

• Hospital admission or confinement

• Emergency care coverage

Exclusions and Limitations

1.Services obtained for emergency conditions from non-affiliated physicians
and hospitals

2.Injuries, infections or conditions resulting from:

-negligence

-alcoholic liquor intake

-unauthorized use of prohibited drugs or regulated drugs

-violation of law or ordinance or unnecessary exposure to imminent danger,

-direct or indirect participation in the commission of crime,

-direct participation in riots, strikes, and other civil disturbances,-

-war or any combat-related activities while in military service-,

-extreme sports,

-developmental disorders,

-circumcision and sex transformation,

-tattoos,

-body piercing,

-attempted suicide,

-acupuncture,

-congenital, genetic and hereditary conditions,

-chronic dermatoses

3. HIV and AIDS-related diseases, sexually transmitted diseases

4. All pregnancy and maternity-related conditions

5. Epidemic or pandemic infectious diseases

6. Psychiatric and/or psychological disorders

7. Aesthetic, cosmetic and reconstructive surgery

8. Oral surgery and dental treatments

9. All types of vaccines except for animal bites vaccine administration

10. Pregnancy test

11. Take-home medicines

12. Medico-legal fees

13. Ambulance service