Maxicare

Member

A Principal and/or Dependent who is eligible, has been accepted for Membership by Maxicare after complying with the Membership Eligibility, and is currently enrolled under this Agreement.

Medically Necessary

A Medical Service, as determined by Maxicare, which is (a) consistent with the diagnosis and customary medical treatment of the condition, (b) in accordance with the standards of managed care and good medical practice, (c) not for the convenience of the Member or the...

Maximum Benefit Limit (MBL)

The maximum liability that Maxicare shall cover and assume per covered illness or injury of a Member within the one-year term of this Agreement, including all Out-patient, In-patient and Emergency Care Benefits for any one-year period with respect to any particular...

Maxicare Multifunction Card

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:  Health Card – for the needed medical services  Privilege Card – for the special...

Maxicare Coordinator

A duly licensed medical practitioner designated by Maxicare in an Affiliated Hospital or Affiliated Medical Clinic to direct and supervise the extension of Medical Services to Members, and who may render medical advice, prescribe medication or treatment, issue...