A duly licensed physician medical practitioner as Maxicare may designate in an Affiliated Hospital to direct and supervise the provision of medical services to Members in that particular hospital with whom Member may also seek medical consultation, and from whom the Member may request for prescription, referrals to specialist, request for laboratory examination and hospitalization arrangement.

• The membership card issued by Maxicare to a Member which serves as the gateway for the Member to avail of his / her benefits.

• The Maxicare Multifunction Card has three (3) functions:

• • 1. Health Card – for the needed medical services
  • 2. Privilege Card – for the special privileges offered by Maxicare Lifestyle Partners
  • 3. Cash Card – for approved reimbursements

• The maximum liability that Maxicare shall assume illness/injury per year on a certain Member, not including Annual Check-Ups (ACU) and consultations. In other words, the In-Patient Benefits (PF, HB, ER charges) and Outpatient Routine Diagnostic and Therapeutic procedures done within the one-year term of the Agreement with respect to any particular illness/injury shall be charged against the MBL. MBL is replenished upon renewal.

• A medical service which is:

– Consistent with the diagnosis and customary medical treatment of the condition;

– In accordance with the standards of good medical practice; and,

– Performed in the least costly manner required by the medical condition

• A Member shall mean an individual who:
•  

– Applied to Maxicare for membership in any of its offered healthcare program;

– Accepted by Maxicare after complying with all the requirement of the membership;

– Entitled to the benefits of membership as stated in the agreement; and,

– Has not forfeited status as Member by termination, lapsation, non – payment premium, voluntary abandonment, exhaustion of benefits or some other cause

The card issued by Maxicare to a Member containing the latter’s name and signature, ID reference number, and other matters relevant to Membership.