Does Maxicare cover an emergency room?

Yes, Maxicare covers emergency room treatments across its standard HMO programs and prepaid emergency cards (such as LifesavER and EReady).

What Emergency Room Services Are Covered?

Maxicare emergency care typically includes:

• Doctor's services and professional attendance
• Emergency room fees
• Medicines used for immediate relief and treatment in the ER
• Oxygen, IV fluids, and blood products
• Dressings, casts, and sutures (stitches)
• X-rays, laboratory tests, and diagnostic exams related to the emergency condition
• Initial treatment for animal bites (within 24 hours of the bite)

Where Can You Use It?

• Maxicare-Affiliated Hospitals: Full or primary coverage applies up to your plan's limit or Maximum Benefit Limit (MBL). Major partner hospitals include networks like Makati Medical Center, St. Luke’s Medical Center, and The Medical City, depending on your specific tier or card type.
• Non-Affiliated or Unaccredited Hospitals: Coverage may involve partial reimbursement (such as 80% up to ₱30,000 for domestic non-affiliated hospitals under certain regular accounts), or specific terms depending on if it is an emergency prepaid card vs. a full corporate/individual HMO account.

Yes, Maxicare covers emergency room (ER) visits depending on your specific healthcare plan or prepaid card.

Standard HMO Plans (e.g., MyMaxicare)

• Affiliated Hospitals: Full coverage for 24-hour emergency treatment and confinement at Maxicare accredited hospitals.
• Non-Affiliated Hospitals: Local emergency treatments in non-affiliated Philippine hospitals are reimbursed at 80% (up to ₱30,000 for the first 24 hours).

Prepaid Cards (e.g., LifesavER / LifesavER+)

• Coverage Limit: Provides up to ₱50,000 in emergency medical coverage for ER treatments, medicines, doctor services, and diagnostic tests.
• Hospital Access: Valid at nationwide affiliated facilities, though standard prepaid variants exclude six major networks (Asian Hospital, Cardinal Santos, Makati Medical Center, St. Luke's BGC/QC, and The Medical City Ortigas) unless you hold a higher-tier card like LifesavER+.
• Exclusions: Non-emergency cases, routine care, and elective treatments are typically not covered.

Maxicare standard health maintenance organization (HMO) plans do not cover cosmetic procedures, alternative medicines, and certain self-inflicted or high-risk conditions.

Common Exclusions and Not-Covered Services

• Aesthetic and Cosmetic Surgery: Procedures done purely for beautification, except when needed to fix a functional defect from a covered accident.
• Alternative Medicine: Treatments like acupuncture, chiropractic care, herbal medicine, and faith healing.
• Dental Care: Routine checkups, extractions, and fillings, unless specifically added to your plan or resulting from a sudden accidental injury to teeth.
• Self-Inflicted Injuries: Injuries from suicide attempts, self-harm, or participation in illegal acts, hazardous sports, or military combat.
• Specialized Eye Corrections: Vision correction procedures like Lasik and PRK.
• Certain Pre-Existing Conditions: Depending on the specific prepaid card or corporate tier (such as basic lightweight emergency cards), major pre-existing illnesses like advanced cancer may face specific caps or exclusions.

Maxicare is partnered with over 1,300 accredited hospitals and clinics across the Philippines, including major medical institutions.

Major Accredited Hospitals in Metro Manila (NCR)

• Makati Medical Center (Makati City)
• St. Luke’s Medical Center (Bonifacio Global City & Quezon City)
• Asian Hospital and Medical Center (Muntinlupa City)
• Cardinal Santos Medical Center (San Juan)
• The Medical City (Pasig City)
• Chinese General Hospital and Medical Center (Manila)
• Manila Doctors Hospital (Manila)
• University of Santo Tomas (UST) Hospital (Manila)
• Philippine Heart Center and National Kidney and Transplant Institute (Quezon City)

Provincial and Regional Coverage

• Rizal: Antipolo Doctors Hospital, Manila East Medical Center
• Benguet / Baguio: St. Louis University Hospital of the Sacred Heart, Notre Dame de Chartres Hospital
• La Union: Lorma Medical Center, Bethany Hospital
• Visayas & Mindanao: Affiliated locations across Cebu, Davao, Bacolod, and Cagayan de Oro.

Note: Certain prepaid plans (like Maxicare LifesavER) exclude the six major top-tier hospitals listed above. You can look up specific facilities or check real-time affiliations using the Maxicare Find Doctors, Clinics and Hospitals search tool.

The amount covered by Maxicare depends entirely on the specific plan you have, but standard comprehensive plans generally provide a Maximum Benefit Limit (MBL) ranging from ₱60,000 to ₱250,000 per illness, per year.

Because Maxicare primarily utilizes an MBL system rather than a single annual pool, your coverage limit resets for every completely separate, unrelated medical condition or injury you experience within the year.

1. Standard Comprehensive Plans (MyMaxicare Individual & Family)

For full-risk HMO plans, coverage amounts vary by your chosen tier, which dictates your room and board category and your benefit cap:

2. Corporate & SME Business Plans

If you are covered through an employer, corporate and Small and Medium Enterprise (SME) programs offer different limits:

• Maxicare Starter & Plus Plans: Provide coverage from ₱60,000 up to ₱500,000 MBL per member depending on the corporate package selected by your company.
• Maxicare Business Essential: Uses an Annual Benefit Limit (ABL) ranging from ₱70,000 to ₱250,000, which caps all claims combined for the entire year instead of per illness.

3. Prepaid Health Cards (Fixed-Amount Coverage)

If you purchased a one-time prepaid card, coverage limits are fixed and limited to specific use cases:

• Maxicare LifesavER / LifesavER+: Covers emergency room medical costs up to ₱25,000 or ₱50,000 for a single usage.
• Maxicare PRIMA (Access / Elite / Screen): Does not cover hospital confinements but provides unlimited doctor consultations and specific laboratory packages at Maxicare Primary Care Clinics.

What is included within your limit?

For comprehensive plans, the MBL covers up to 100% of costs at Maxicare-affiliated hospitals for:

• Inpatient Care: ICU, operating room usage, doctor/surgeon fees, and medicines during confinement.
• Outpatient Care: Diagnostic tests, laboratory procedures, and specialist consultations.
• Emergency Care: 100% covered at affiliated hospitals. If you visit a non-affiliated hospital in the Philippines, it usually reimburses up to 80% of the bill up to ₱30,000.

Note: Pre-existing conditions (PECs) may have separate sub-limits (e.g., restricted to smaller amounts like ₱5,000 to ₱25,000) during your first year of an individual plan. Check your specific policy certificate or contact your HR department to verify your exact tier.