Does Maxicare give free medicine?

Maxicare does not generally provide free routine or take-home medicines, but certain emergency, special home care, or partnered discount programs do cover or reduce the cost of specific medications.

When Medicines are Covered or Discounted

• Emergency Treatment: Emergency medicines used for immediate relief and during active treatment at a hospital or emergency room are typically covered. However, regular take-home maintenance medications are usually excluded.
• Special HomeCare Programs: Specialized programs (such as specific COVID-19 home care packages in designated areas) may include free medication and delivery as part of a bundled treatment plan.
• Medicine Discounts: Certain plans, like Maxicare PRIMA variants, offer partnered discounts (such as up to 50% off select medicines through providers like MedGrocer) rather than entirely free supplies.

Yes, Maxicare provides free maintenance medicines through its exclusive Best Life Program for eligible members.

Key Details of the Free Medicine Benefit

• Target Conditions: The program covers free maintenance medicines for chronic conditions like hypertension, diabetes, and high cholesterol.
• Eligible Plans: Available to select corporate, individual, and SME comprehensive HMO members. Prepaid cards (such as Maxicare PRIMA or ER-focused cards) generally do not qualify.
• How It Works: Qualified members undergo an evaluation by a Maxicare doctor, submit required lab results or prescriptions, and receive a 3-month supply of maintenance medicines delivered directly to their home for free.

Yes, Maxicare does reimburse out-patient medicines if they are part of an approved benefit and covered under your specific healthcare plan.

Requirements for Out-patient Medicine Reimbursement

To successfully claim a refund for medicines, you must submit original copies of the required documents through the Maxicare Member Gateway or to a Maxicare office.

• Duly accomplished Maxicare Claims Reimbursement Form
• Medical certificate indicating the diagnosis from your attending physician
• Original doctor's prescription showing the date, patient's name, doctor's details (name, license number, and TIN), along with the drug name, dosage, and quantity
• Original BIR-registered sales invoice or cash/official receipt with the drugstore's TIN and itemized breakdown/charge slips

Important Rules to Remember

• Filing Deadline: You must submit your reimbursement claim within 30 days from the date of availment or purchase, otherwise the claim will be forfeited.
• Plan Limits: Out-patient medicine coverage depends entirely on your specific corporate or individual HMO contract limits. Preventative or non-prescribed vitamins/supplements are generally 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.

Yes, you can get free maintenance medicine from MedGrocer if you are a qualified Maxicare member enrolled in the Best Life Wellness Program.

Program Details

• Covered Conditions: Hypertension (high blood pressure), diabetes, and high cholesterol.
• Included Benefits: Free maintenance medications, free laboratory tests, and teleconsultations with no deduction from your regular Maxicare benefit limit.
• Eligibility: Typically available to select Maxicare cardholders under corporate or company plans who meet the health criteria.

How to Apply

1. Prepare Requirements: You need a recent laboratory result (taken within the last 90 days) showing your lipid profile, HbA1c, or creatinine, plus a prescription from a Maxicare-accredited doctor.
2. Register Online: Fill out the enrollment form and upload your documents at the Best Life Enrollment Portal.
3. Wait for Approval: A MedGrocer or Best Life doctor will review your results and contact you to verify your details before scheduling your medicine delivery.