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Maxicare and PhilHealth Coverage for COVID-19

(As of November 2020)

The Philippine Health Insurance Corporation (PhilHealth) will shoulder the cost of treatment for patients with COVID-19 based on a case-rate package. The state-run insurance agency has also clarified that patients may use their health insurance coverage and mandatory discounts, such as senior citizen and PWD discounts, to help substantially cover the cost of treatment.

As your partner in healthcare management, ActiveLink reached out to Maxicare on how the HMO policy will apply for the duration of the community quarantine period. For your guidance, please refer to the information below:
1. Will Maxicare cover availments for COVID-19?
Maxicare will continue to provide coverage for COVID-19 provided that the patient availed the services within the Maxicare-accredited network. HMO benefits will be deducted first before applying the PhilHealth benefits for medical expenses related to Probable and Confirmed COVID-19 cases inpatient care.


2. Will Maxicare cover RT-PCR testing costs?

Maxicare will cover the cost of RT-PCR test if all parameters are met:
  • If your employee is symptomatic or is manifesting known signs and symptoms of COVID-19 (e.g., dry cough, sore throat, fever, body malaise, loss of taste/smell, diarrhea, shortness of breath).
  • Test is prescribed by a Maxicare-affiliated physician, Maxicare TeleConsult doctor, or any Maxicare-accredited doctor in an accredited provider, subject to the benefits of the HMO plan.

Covered:
  • Symptomatic
  • Asymptomatic or for clearance prior to release from quarantine. Only if the following conditions are met:
    • Initial RT-PCR test was positive
    • Requested by an Maxicare-accredited doctor prior to release from quarantine

Not Covered:
  • Positive IgM or total antibody test
  • Exposed or with close contact
  • Rapid testing since this is considered a screening test

Tests done at a non-affiliated provider can be reimbursed:
  • Symptomatic: Maxicare may reimburse net of PhilHealth deductions if there is no Maxicare-affiliated or DOH-accredited provider in the area.
  • Asymptomatic: Maxicare may reimburse net of PhilHealth deductions if there is no Maxicare-affiliated or DOH-accredited in the area, and Positive RT-PCR result.
  • Reimbursement for RT-PCR testing not to exceed P5,000 net of PhilHealth deductions.


Members are advised that a referral from a Maxicare-accredited doctor must be secured prior to availment of COVID-19 RT-PCR testing.

3. Will Maxicare cover the RT-PCR test if member is asymptomatic but was exposed to a COVID-19 positive patient?
RT-PCR testing will not be covered. However, if the result is positive, this can be reimbursed, net of PhilHealth deductions.


4. If the treatment was done in a government hospital, will Maxicare allow reimbursement?

No. Maxicare will not cover treatment availed in government hospitals.

5. How much will PhilHealth cover for COVID-19 treatment?
For patients who were admitted starting April 15, 2020, PhilHealth will cover the admission cost based on a case rate package:

SEVERITY
PACKAGE AMOUNT (PHP)
HOSPITAL CATEGORY
Mild pneumonia in the elderly or with comorbidities
43,997
Levels 1-3 hospital, private room
Moderate pneumonia
143,267
Levels 1-3 hospital, private room
Severe pneumonia
333,519
Levels 2-3 hospital, private room, ICU
Critical pneumonia
786,384
Levels 2-3 hospital, private room, ICU (capable of ECMO, RRT)


6. I have other questions regarding COVID-19. Whom can I contact?

Should you have further concerns or clarifications; you may get in touch with:

  • Maxicare's Customer Care Support:
    • Maxicare 24/7 Call Center: (02) 8582-1900 or (02) 7798-7777
    • Maxicare 24/7 Teleconsult Hotline: (02) 8582-1980 (for online consultations)
  • ActiveLink:
    • Dedicated Helpdesk
    • ActiveLink Mobile Application's Admin Connect

You may also call the following COVID-19 dedicated hotlines:
  • Department of Health: (02) 894-26843 or dial 1555
  • Philippine National Police:
  • Globe: 0917 312 5626
  • Smart: 0998 894 0013
  • Philippine General Hospital (Telemedicine Hotline): Dial 155200
  • Philippine Red Cross: Dial 1158
Should you have other questions, please don’t hesitate to reach us.

Thank you!

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