As of October 17, 2022

1. Are RT-PCR tests for COVID-19 covered by my HMO?

Yes. Maxicare will cover COVID-19 RT-PCR testing if you are (1) symptomatic and (2) test is availed at a Maxicare- and DOH-affiliated facility. This is following the cap limit of RT-PCR test based on DOH circular 2021-0374 net of PhilHealth.

2. Are COVID-19 Antigen testing covered by my HMO? 

Yes, Maxicare will only cover antigen testing if:

• You consulted with a Maxicare Primary Care Network (PCN) physician; and 

Otherwise, the testing cost will be an out-of-pocket expense 

Based on DOH Circular 2021-0374, the cap limit for RT-PCR costs is Php 3,360. PhilHealth will cover Php 2,800, while Maxicare will cover Php 560.  

Note that HMO benefit is integrated with PhilHealth. Meaning, all tests compensable by PhilHealth must be net of PhilHealth benefit first before the HMO benefit is applied. Further, PhilHealth coverage only applies to PhilHealth-accredited facilities. 

Yes. All Maxicare members suspected to have COVID-19 may consult via Maxicare’s Telemedicine Hotline or the Doctor Anywhere app. The Primary Care Network (PCN) physician will then assess your condition and order a rapid antigen/RT-PCR test to diagnose COVID-19. 

RT-PCR testing for asymptomatic patients will not be covered, while antigen tests may be covered if required by a Maxicare Primary Care Network Physician. 

No. RT-PCR test as clearance requirement will only be covered for members who have autoimmune disorders, HIV, cancer/malignancies, or is bed-ridden.