Maxicare 2010 Group Program

Employers, take note:

While plaques & accolades are nice to

have…

Filipino workers – more than their

counterparts in Southeast Asia would

rather have job security than recognition

& appreciation

Jobstreet.com Survery November 2007

Jobstreet Online Survey composition:

� 20-30 years old (52%)

� 30-40 years old (31%)

� 40 and above (15%)

Employers, take note:

• Filipinos prefer to have long tenures with their employers• 33% saying, 5 years or more is reasonable in contrast to

Malaysians & Singaporeans who lean towards stints of 2-3 years

• Reality though is Filipinos tend to change employers quite often• 41% have worked for 3 or more companies in the last 5 years

• 50% are actively looking for a job

• Younger jobseekers (below 25) are keener to explore new paths while the more mature job seekers were less inclined

• Late 20s, more concerned on promotion opportunities

• 40 years & older, issues with lack of recognition & appreciation

Top 5 reasons why Filipinos leave their jobs

33.0%42.7%16.6%

Lack of recognition or

appreciation

17.3%16.0%26.6%Seek better job security

32.7%27.5%28.4%Promotion opportunities

29.7%30.4%30.3%Explore different career path

38.9%41.4%40.6%

Seeking greater challenges, job

growth and experience

57.9%44.9%64.4%

Issues with Compensation

(salaries & benefits)

MalaysiaSingaporePhilippines

“A high rate of employee turnover remains a critical issue for many companies as it hampers productivity, quality and profitability”

- Grace Colet

JobStreet.com Country Manager

Employers should proactively address these concerns by providing a challenging and rewarding work atmosphere, positive succession planning and better overall strategic and operational management

Our alliance…

� not just a supplier/contractor-client relationship

� But of assisting you in providing a healthy & peaceful atmosphere

We believe…

� The Maxicare name will not just make your benefit package better

� But contribute to the company’s brand equity as a whole

T O P I C S

Our Corporate Credentials

Our Premium Quality Care Guarantees

Maxicare Premium Services

� Efficient and Effective Healthcare Delivery System

�Administrative Services Only Program

Company Profile

Maxicare Healthcare Corporation

� Over 300,000 members nationwide

� More than 528 Accredited hospitals and clinics Nationwide

� Over 10,500 Affiliated Specialists, Fellows and Diplomates

� Most extensive Customer Care Network

Today, our extensive quality Medical Provider Network, responsive Customer Care Unit, and increasing membership base continue to make us the preferred healthcare provider in the country.

Ultimately, it is only at Maxicare where you

experience… “healthcare at its finest”

Our VISION

To be the leading Health MaintenanceOrganization preferred by customers

because of Superior Services.

Our MISSION

To help people achieve “PEACE of MIND”through quality healthcare.

Over Over 30 years of healthcare service via Makati Medical Center & Cebu Doctor’s Hospital

Group of Doctors and Businessmen Group of Doctors and Businessmen Provides financial expertise and tremendous distribution opportunities

People Behind /Stockholders

Board of Directors

Chairman of the Board Roberto K. Macasaet, MD

Director Mr. Antonio L. Go

President & CEO Mr. Jose Pastor Z. Puno

Mr. Rene L. Buenaventura

Mr. Eduardo Katigbak

Mr. Federico Leelin, MD

Mr. Sostenes L. Campillo, Jr.

Mr. Justice Wenceslao I. Agnir

Ms. Nelia V. Carlos

Ms. Teresita M. Alegre

Mr. Pedro Sen

Mr. Gertrudo L. Mirasol, MD

Amb. Cesar Bautista

Mr. Darwin Bawar

Years of Service, Extent of Expertise

of SOLID Healthcare Expertise

Cardholders nationwide

HMO of Choice

Best Employers in Asia / Philippines

Top 2,000 Companies in the Country

Value Proposition

Best Employers in Asia/PhilippinesBest Employers in Asia/Philippines

Banking & Finance IndustryBanking & Finance Industry

Business Processing Business Processing –– Outsourcing/ Outsourcing/

Contact CentersContact Centers

Manufacturing IndustryManufacturing Industry

Food & Retail IndustryFood & Retail Industry

The Maxicare Intelligent Card

� Real-time validation of

membership during availments

� Swipe facility using hospitals and

clinics’ POS units nationwide

� Immediate activation & de-

activation of memberships within

24 hours

� Cards need not be replaced

on a yearly basis

Access to our Vast Network of Providers

More than 10,000 Top-Caliber Accredited Doctors (Consultants, Fellows & Diplomates)

Over 500 Accredited Hospitals and Clinics nationwide

(65% are Tertiary Hospitals)

Over 1,000 Accredited Dental Clinics nationwide

Over 500 Affiliated Hospitals & Clinics1,000 Dental Providers NATIONWIDE

NCRNCR

HOSPITALSHOSPITALS 5656

CLINICS 153CLINICS 153

REGION 3REGION 3


CLINICSCLINICS 44

REGION 4REGION 4


CLINICSCLINICS 1515

REGION 6REGION 6


CLINICSCLINICS 33

REGION 1REGION 1


CLINICSCLINICS 66

REGION 2REGION 2


CLINICSCLINICS 11

REGION 5REGION 5

HOSPITALS 11HOSPITALS 11

CLINICSCLINICS 77

REGION 8REGION 8


REGION 7REGION 7


CLINICSCLINICS 66

REGION 9REGION 9

HOSPITALSHOSPITALS 44REGION 10REGION 10

HOSPITALS 9HOSPITALS 9REGION 12REGION 12


CLINICSCLINICS 11

REGION 11REGION 11

HOSPITALS 15HOSPITALS 15

CLINICS 1CLINICS 1

REGION 13REGION 13


Professional and Extensive Customer Care Network

CEBU

DAVAO

BACOLOD

ILOILO

GENERAL

SANTOS

Customer Care

Network

CAGAYAN

DE ORO

On-siteCorporate-Based

24/7 Call Center

On Call Roving Customer CareTeam in key Hospitals

Hospital based On-linePrimary & Customer

Care Centers

Primary Care CentersPrimary Care Centers

MAXICARE

Headquarters

Makati Med

St. Luke’s

De Los Santos

Cebu City

SM Megamall

Medical City

•• Exclusive toExclusive to MaxicareMaxicare Members OnlyMembers Only

•• Easy access to Internal MedicineEasy access to Internal Medicine

•• Quality lab exams @ the least possible costQuality lab exams @ the least possible cost

•• Unlimited number of consultationsUnlimited number of consultations

•• Efficient & effective Efficient & effective ““gategate--keeping systemkeeping system””

•• Strategically & conveniently located @Strategically & conveniently located @

major hospitalsmajor hospitals

Advantages of the OnAdvantages of the On--Line Line

MaxicareMaxicare Primary Care CentersPrimary Care Centers

24/7 Maxicare Access Numbers

Provincial Toll-Free

Number

24/7 Customer Care Call

Center

Maxicare SMS Inquiry

SMS Inquiry Service0918-889MAXI (0918-8896294)

• accredited providers per area

• accredited doctors per specialization• doctors’ schedules and contact numbers

1) To register your number in the program

Key in: reg <space> Maxicare ID Number

Example: reg 050123456700

2) Inquiry on Accredited HospitalKey in: prov <space> hos <space> location

Examples: prov hos makati

prov hos bacolod

3) Inquiry on Accredited ClinicKey in: prov <space> clinic <space> location

Examples: prov clinic makati

prov clinic ortigas

3) To request list of accredited doctors per specializationper hospital

Key in: doc <space> hospital name <slash> specialization

Examples: doc makati med/gastro

doc riverside/cardio

4) To request doctor’s schedule and contact number per hospitalKey in: sked<day> <space> hospital name <slash>

doctor’s surname

Key words for each day: mon, tue, wed, thu, fri, sat, sun

Examples: skedmon medical city/flandes

skedsat makati med/genuino

Maxicare Database Management SystemMaxicare Database Management System

Linux Java

Solaris Operating

System

Hospitals’ Bills

MemberCompany

Doctors’ Fees

Clinics’ Bills

Processed DataProcessed Data

Utilization Report on . . .Utilization Report on . . .

� ICD 10 Coding System for Illnesses

� Per Member Medical History

� Hospitals/Clinics Accessed

� Attending Physicians

� Cost Per Availment

� Date of Availment

� Management Information System

�Statistical reports

�Health Profile Analysis

…… thruthru MaxicareMaxicare’’s s Claims Management SystemClaims Management System

““The FlexiThe Flexi--ClaimsClaims””

On Time Utilization Report & AnalysisOn Time Utilization Report & Analysis

Dental

*Inclusive of assumption for claims that have not yet been processed

ANNUALIZED PROJECTION

MONTHLY AVERAGE

TOTAL

Reimbursement

In-Patients

Out-Patients & Medical Services

TOTALDEPENDENTPRINCIPALBREAKDOWN OF SERVICES

Sample Utilization Report & AnalysisSample Utilization Report & Analysis

Statistical Reports, Analysis & RecommendationsStatistical Reports, Analysis & Recommendations(In Tables and Graphs for cost and frequencies)(In Tables and Graphs for cost and frequencies)

� Top medical conditions

� Top availers

� Most availed hospitals/clinics/ doctors

� Cost Drivers

� Benefit enhancement opportunities

Objectives :• Design wellness programs for the main drivers of utilization• Establish a Wellness committee that would spearhead implementation

and sustain the wellness programs.

Wellness Strategies :

1) Health Awareness Campaign through Interactive Sessions & Medical Bulletins to promote prevention:

a. Common Infectious Diseases: URTI, UTIb. Cardiovascular diseases: HPN, Vascular headachec. GI diseases: Acute Gastroenteritis, Acid-related disorders

2) Formulation of “Hypertension Club” - Cholesterol and FBS screening3) Vaccination events: Flu, pneumonia, typhoid immunization program4) Overall Health Maintenance of the workforce:

a. Ergonomics program

b. Weight management

c. Smoking Cessation

Sample Utilization Management/Wellness ProgramSample Utilization Management/Wellness Program

Lifestyle Partners

Discounts 10% - 50%

2% Discount

up to 20% Discount

Special Discounts on the following Vaccines: Influenza, Hepatitis A & B, Typhoid, Measles/Mumps/Rubella, Chickenpox/Varicella, etc.

corporate vaccination program

MAXICARE GROUP PROGRAM

Full-Risk Program

(Premium-based, Comprehensive Healthcare Program)

MAXICARE Healthcare ProgramMAXICARE Healthcare Program

Out-Patient Care

In-Patient Care

Preventive Care

Annual Check-Up

Emergency Care

Special Benefits

Out-Patient Care� Medically necessary consultations during regular clinic hours, except prescribed

medicines

� Ear, Nose & Throat (ENT) Treatment

� Unlimited Pre & post natal consultations

� Treatment of minor injuries such as lacerations, mild burns, sprains

� Minor surgery not requiring confinement

� X-ray, laboratory exams, routine, and diagnostic procedures as prescribed by an

accredited physician

� Physical/Occupational Therapy covered up to 12 sessions/member/year.

� Sclerotherapy for varicose veins covered up to 5,000/leg/member/year

� Cauterization of warts covered up to 1,000/member/year from head to feet

(except genital warts & condyloma acuminata)

� Therapeutic Procedures ( Chemotherapy, Radiotherapy ( cobalt, iodine,

radioactive cesium, linear accelerator therapy, brachytherapy ) Dialysis up to up

to MBL

� Laser therapy for retinal detachment and glaucoma are covered ( excluding eye

correction e.g. lasik & PRK ) up to 10,000/member/year

Out-Patient Care…cont� Allergy Testing/ allergy screening and other related examinations up to Php 2,500

/member /year

� Tuberculin Tests up to Php 600 /member /year (reimbursement basis) prescribed

by an Affiliated Physician to be availed at the Maxicare Primary Care Centers

� Speech Therapy for Stroke Patients up to P10,000 /member /year (reimbursement

basis, consultations treated as sessions)

� Annual Check up Coverage for employees and dependents

� Cataract Extraction except cost of lens up to MBL

InIn--Patient CarePatient Care

� Room and Board Accommodation

� Use of operating and recovery rooms

� Use of the intensive care unit (ICU)

� Professional fees of the attending doctor/s

� Drugs & medicines for use in the hospital

� Whole blood/human blood products & IV fluids

� X-ray, Laboratory tests & diagnostic tests

� Dressings, casts & sutures

� Anesthesia, Oxygen & its administration

� Standard nursing services and admission kit

� Other supplies/services directly related to the

medical management of the patient

Preventive CarePreventive Care

� Immunization, except the cost of vaccines

� Periodic monitoring of health problems

� Health Education & Counseling on diets and exercise

� Family Planning Counseling

� Anti rabies active and passive vaccines up to

18,000/member/year

� Anti tetanus active and passive vaccines up to

18,000/member/year

� Anti venom active and passive vaccines up to

18,000/member/year

Annual CheckAnnual Check--UpUp

Routine:

� Physical Examination

� Urinalysis

� Fecalysis

� Chest X-ray

� Complete Blood Count

� ECG (for members 35 years & above)

� Pap Smear (for female members 35 yrs & above)

Emergency CareEmergency Care

� Doctor’s Services

� Emergency room fees

� Medicines used for immediate relief & during treatment

� Oxygen, I.V. fluids, whole blood & human blood products

� Dressings, casts, sutures

� X-ray, laboratory & diagnostic exams

� Ambulance Services reimbursable up to Php 2,500 per conduction

(hospital to hospital transfer only)

� Coverage for Passive and Active vaccines for anti venom, anti

tetanus and anti rabies up to P18,000./member/year

� If room assignment is unavailable, upgrading of one higher room is

allowed within 24 hours

Emergency Care (NonEmergency Care (Non--Affiliated)Affiliated)

Within and outside the Philippines� Maxicare shall reimburse 80% of the Hospital Bills

and Professional Fees based on Maxicare’s rates incurred during the first 24 hours not to exceed 30,000 per case per member per year

� Ambulance service from non accredited hospital to accredited hospital reimbursable up to 2,500/conduction

Dental CareDental Care

� Oral Prophylaxis once a year

� Simple tooth extractions

� Temporary Fillings - as needed

� 2 Permanent Lightcure Fillings

� Emergency Dental Treatment

� Comprehensive Restorative & Prosthodontic

Treatment

� Desensitization of Hypersensitive teeth

� Simple Adjustment of Dentures

� Recementation of loose crowns, inlays or onlays

� Dental Nutrition and Counseling

� Dental Health Education

� Annual oral examination & consultation

Pre Existing ConditionsPre Existing Conditions

Principals - Existing

�Covered up to MBL

Principals – New & Additional


Dependents – Existing


Dependents – New & Additional


Additional FeaturesAdditional Features

� Lithotripsy and Laparoscopy covered up to MBL

� Coverage for Coronary Angiogram up to MBL

� Coverage for Congenital Illnesses up to Php 20,000/member/year

� Coverage for Scoliosis up to Php 20,000/member/year, whether congenital,

pre-existing or acquired

� Coverage for provoked and unprovoked assault up to MBL.

� Coverage for work-related conditions up to 20,000 based on ECC

� Coverage for Motor Vehicular Accidents up to MBL

� Coverage for Provoked and Unprovoked Asssault up to MBL

� Coverage for accepted modalities up to your P5,000.

� Financial Assistance for Life, Accidental Death and Dismemberment up to P

25,000./year

MEMBERSHIP GUIDELINESMEMBERSHIP GUIDELINES

AGE ELIBILITY

� Principals/Employees – 18 to 65 years old

� Adult Dependents – 18 to 65 years old

� Minor Dependents – 90 days up to 21 years old

HIERARCHY OF ENROLLMENT FOR DEPENDENTS

� Married Employees

� Legal spouse followed by the eldest up to the youngest child

� Single Employees

� Mother first, then Father followed by the eldest sibling to the youngest sibling

� Single Parents

� Either children from eldest to the youngest OR Parents, mother first then father

Rates assume that employees are Philhealth Members. Hospitalization expenses are

shared by Philhealth and Maxicare. Non Philhealth members must pay additional

P1,800.00

MEMBERSHIP GUIDELINESMEMBERSHIP GUIDELINES

�No processing or additonal fees

�Application Forms are waived

�Medical Requirements are waived

� Requirement for enrollments are:

�Masterlist

�Signed Conforme

2010 Membership Fees

Rates for all types include Makati Medical Rates for all types include Makati Medical CenterCenter, St. , St. LukesLukes Hospital, Hospital,

The New Medical City, Asian Hospital & Cardinal Santos. VAT InclThe New Medical City, Asian Hospital & Cardinal Santos. VAT Inclusiveusive

Plan

Type

Room and

Board

Annual

Check

Up

Maximum

Benefit

Limit

AnnualSemi

AnnualQuarterly

Platinum 1Suite up to 4,000 Routine 200,000 19,703 10,640 5,517

Platinum 2Large Private Routine 150,000 15,012 8,106 4,203

Gold 1 Regular Private Routine 150,000 13,676 7,385 3,829


Silver Semi Private Routine 75,000 10,643 5,747 2,980

Plan Type Room and BoardAnnual

Check Up

Maximum

Benefit

Limit

AnnualSemi

AnnualQuarterly

Platinum 1Suite up to 4,000 Routine 200,000 26,736 14,437 7,486

Platinum 2Large Private Routine 150,000 20,237 10,928 5,666



Silver Semi Private Routine 75,000 14,091 7,609 3,945

Principals

RATES FOR EMPLOYEES PER HEAD

RATES FOR DEPENDENTS PER HEAD

TO APPLY NOW:TO APPLY NOW:

Mark Gastardo, Corporate Account Executive

Telephone: (02) 496 4690

Mobile: (0922) 604 7864

Email: [email protected]

YM: slime_ateneo

http://maxicareinquiry.blogspot.com

Mark Gastardo has been a corporate account executive for a number of years. He has served numerous individual and family memberships. He has also handled corporate HMO clients including:

Starbucks (Rustan Coffee), Banco Filipino Mortgage & Savings Bank, Shopwise (Rustan Supercenters, Inc), Reyes Haircutters, Chikka.com, SitelPhilippines, Consolidated Industrial Gases, Inc (CIGI), New Iloilo Supermarket, Tiaong Rural Bank, Better Buildings, Inc, Cara Celine Dormtel, James Hardie, Fujielastomers Manila Corporation, Direct with Hotels, C&E Publishing, Solutions Interactions, The Master’s Academy, Biopath Clinical Diagnostics, PIPC Corporation, AMMIC Corporation & Belden Ship Management, SEO Brand Media, Magic Potions and Austin Alba Consulting

Thank you very much!

Documents

Maxicare 2010 Group Program