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Gov Employee Maxicare Unli Consult & LifeSaver

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₱3,298.00

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DESCRIPTION:

Here is the combined product description for the Gov Employee Maxicare Unli Consult & LifeSaver bundle, structured to highlight the features, coverage, and strict exclusions for each component of the plan:

Gov Employee Maxicare Unli Consult & LifeSaver

Combined Value: ₱3,298.00

Target Age: 15 days old to 65 years old (for LifesavER); All ages from newborns to seniors (for PRIMA Consult) Validity: 1 year from activation date

Overview: This health package offers a complete starter healthcare net by combining unlimited preventive/routine consultations via Maxicare’s specialized primary care clinics with a one-time use safety net for critical, life-threatening emergencies at major hospitals.

1. Routine Outpatient Care: PRIMA Consult by MaxiHealth

This component serves as your day-to-day outpatient care package, giving you unlimited access to medical consultations and basic diagnostics at Maxicare Primary Care Clinics (PCCs).

What is Included:

  • Unlimited Consultations: Unlimited visits to any Maxicare PCC to consult with General Practitioners (GPs) and specialists including Internal Medicine, Pediatrics, OB-GYN, ENT, Dermatology, Cardiology, and more. (Note: Specialist visits require an initial referral from a GP or IM doctor).

  • Annual Physical Exam (Basic 5): Includes a Physical Exam, Complete Blood Count (CBC), Routine Urinalysis, Routine Fecalysis, and Chest X-ray (PA).

  • Pre-existing Conditions: Covered without hassle or exclusions during consultations.

  • Out-of-Pocket Discounts: Preferential rates for Set A/B/C laboratory tests, Ultrasounds, ECGs, X-rays, vaccines, physical therapy, and psychiatry at PCCs.

What is NOT Included (Exclusions for PRIMA Consult):

  • Outside Clinics: Outpatient consultations and procedures done outside of Maxicare Primary Care Clinics (PCCs) are strictly excluded.

  • Emergencies & Confinement: Emergency cases, hospital admissions, and confinements are not covered under this specific voucher (use the LifesavER voucher instead).

2. Emergency Care: Maxicare LifesavER

This single-use card offers emergency coverage for life-threatening conditions, illnesses, and injuries that require immediate medical assistance within 24 hours.

What is Included:

  • Emergency Coverage Limit: Up to ₱25,000 coverage for outpatient emergency room treatment.

  • Major Hospital Access: Nationwide access to Maxicare-affiliated hospitals, including the 6 major premium hospitals (Asian Hospital, Cardinal Santos, Makati Medical Center, St. Luke’s BGC, St. Luke’s QC, and The Medical City).

  • Covered ER Services: Doctor’s services for emergency treatment, ER fees, emergency medicines for immediate relief (no take-home meds), oxygen/IV fluids, blood products, dressings/casts/sutures, X-rays, and lab exams.

  • Bites & Tetanus: Initial treatment for animal bites for the first 24 hours, and initial vaccinations for tetanus and animal bites.

  • Life Insurance: Includes a Group Life with Accidental Death, Dismemberment & Disablement (ADD&D) benefit up to ₱50,000.

What is NOT Included (Exclusions for LifesavER):

  • Confinement: Hospital admissions, confinements, and ambulance services.

  • Chronic & Pre-existing Illnesses: Absolutely NO coverage for chronic and pre-existing illnesses, including Diabetes Mellitus, Hypertension, Lipidemia, Gallbladder stones, and Neoplasm.

  • Non-Emergencies: Services obtained for non-emergency conditions.

  • Maternity & Reproductive: Maternity care, pregnancy-related conditions, fertility treatments, and sexually transmitted diseases (including HIV/AIDS).

  • Mental & Developmental: Psychiatric care, long-term rehabilitation, and developmental disorders (e.g., Autism, ADHD, Bipolar).

  • Self-Inflicted & High Risk: Injuries from attempted suicide, drug/alcohol negligence, criminal violations, riots/war, or professional sports.

  • Congenital & Infectious: Congenital/hereditary diseases (except hernias), infectious diseases declared as epidemics/pandemics, and Hepatitis B.

  • Other Services: Take-home or out-patient medicines, routine physical exams, vaccines/immunizations (unless specified for tetanus/bites), cosmetic/aesthetic procedures, and dental treatments/oral surgery (unless due to accidental injury).