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HELPFUL TERMS
A.

A duly licensed hospital included in the list of affiliated hospitals of Maxicare with which Maxicare has an existing and valid service agreement where a Member can avail of Medical Services pursuant to this Agreement.

A duly licensed medical health care facility included in the list of affiliated medical clinics of Maxicare which has an existing and valid affiliation agreement with Maxicare where a Member can avail of Medical Services pursuant to this Agreement.

A group of medical practitioners and other allied health professionals who are affiliated and authorized by Maxicare to deliver the required Medical Services to Members.

  • A duly licensed physician or specialist affiliated by Maxicare and named in the list of Maxicare’s affiliated physician with whom Maxicare has made arrangements to provide the required services under this Agreement.

This Service Agreement, including all schedules, attachments, endorsements, addenda, Conforme Letter, Membership Application Form, and any other contracts or documents relevant to the relationship between the Member, Client and Maxicare.

  • This is defined as therapeutic practices which are not currently considered an integral part of conventional allopathic medical practice. Alternative medicines include, but are not limited to the following disciplines: folk medicine, herbal medicine, diet fads, homeopathy, faith healing, new age healing, chiropractic, acupuncture, naturopathy, massage, and music therapy.

Annual Benefit Limit – the maximum liability that Maxicare shall assume for all covered services rendered to a Member within the term of this Agreement. The covered services include in-patient benefits, out-patient benefits, preventive healthcare benefits and emergency benefits but excluding Annual Check-up (ACU). ABL is replenished upon renewal of this Agreement but not during extension.

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