Maxicare reimbursement process 

(As of October 6, 2021)

Dear members,

Please be guided of Maxicare’s updated reimbursement process.


Important reminders:

• As standard process, members are still required to submit the original (hard copy) official receipts for Maxicare to release the payment or check.
• Members must file the reimbursement claims within 30 days upon discharge or availment. Failure to file your reimbursements within this period will lead to disapproval of claims.

• Reimbursements are only allowed for emergency cases availed at non-accredited hospitals or clinics.
• All reimbursements are subject for approval and not all procedures may be reimbursed (i.e., consultations).

For outpatient reimbursement:

• Customer Information Form (CIF)
• Accomplished Claims Reimbursement Form (signed by both patient and doctor)

• Original Official Receipt with TIN
• Medical Certificate with Diagnosis (is required if the doctor failed to sign the Reimbursement Form)

For emergency availment reimbursement

• Customer Information Form (CIF)
• Accomplished Claims Reimbursement Form (signed by both patient and doctor)

• Original Official Receipt with TIN
• Medical Certificate with Diagnosis (is required if the doctor failed to sign the Reimbursement Form)
• Hospital Statement of Account

For inpatient reimbursement:

• Customer Information Form (CIF)

• Accomplished Claims Reimbursement Form (signed by both patient and doctor)
• Original Official Receipt with TIN
• Medical Certificate with Diagnosis (is required if the doctor failed to sign the Reimbursement Form)
• Hospital Statement of Account (both Detailed and Summary SOA) and corresponding charge slips
• Clinical Abstract

• Medical Certificate to include complete final diagnosis
• Surgical/Operative report, if an operation was done
• Police report, if due to accident or medico-legal case
• Incident report why the member was confined in a non-accredited hospital or proof that HMO accredited doctor was not available during the time of confinement.

Online Reimbursement via Member Gateway
Step 1. Go to https://membergateway.maxicare.com.ph/ and enter your username and password.
Step 2. Click “Okay” button in the pop-up message that prompts the member to update his or her contact information.
Step 3. The Member ID, Company Name, Name, Birthdate, Gender, Mobile No. and Email Address are automatically copied once page is clicked.
Step 4. Make sure to fill out all required fields or those items marked with an asterisk (*).
Step 5. Once the transaction is successful, the Reimbursement form can be downloaded. Note: Members should include the printed form along with the original copies of the scanned documents when submitting claims to Maxicare.
Step 6. An autogenerated email will be sent to the member upon successful registration or submission of the reimbursement claim.
Step 7. Wait for the validation from Maxicare.
Step 8. Once the reimbursement request is validated, please submit all original required documents to Maxicare. Members may submit the required documents below:

Metro Manila and Luzon
Maxicare Healthcare Corporation
c/o Claims Reimbursement Receiving Unit
Ground Floor CIBI Center # 3308 Zapote St.
Brgy. Sta. Cruz, Makati City

Visayas
Maxicare Healthcare Corporation
c/o Claims Reimbursement Receiving Unit
8th Floor, Apple One - Equicom Tower, Mindanao Avenue cor. Biliran Road
Cebu Business Park, Cebu City 6000

Mindanao
Maxicare Healthcare Corporation
c/o Claims Department
3rd Floor, FTC Tower, Mt. Apo Street,
Davao City
Approved reimbursements will only be issued via cheque and is only available for pick-up after 10 working days from the approved date. Request for depositing to their personal bank accounts are subject to approval.
Note: Members with issued Maxicare card will receive their reimbursements via the cash card.

Online submission of claims is subject to evaluation, and original documents must be submitted. Claims will not be credited if original documents are not submitted.

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 consultation)