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Maxicare claim reimbursement form 2025

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The document is a Claims Reimbursement Form for Maxicare Healthcare Corporation, outlining the process for submitting reimbursement claims. It includes instructions for filling out the form, required information from the member, mandatory supporting documents, and specific requirements based on claim types (in-patient, out-patient, dental, optical). The document emphasizes the importance of timely submission and completeness of documents to avoid forfeiture of claims. It also includes authorizations related to personal information handling in compliance with data privacy regulations.

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Click ‘Get Form’ to open the maxicare claim reimbursement form in the editor.
Begin by filling out the 'Member General Information' section. Enter the patient’s name, Maxicare ID number, company name, email address, and mobile number of the principal member.
Select the appropriate claim type by checking one of the options: Out-patient (OP), In-patient (IP), Out Patient medicines, Dental, or Optical.
Attach all mandatory supporting documents as specified in the form. Ensure you include charge slips and official receipts. For specific claims like inpatient or outpatient, provide additional required documents such as medical certificates or police reports.
Review all entered information for accuracy. Make sure that all fields are completed before submitting your form to Maxicare Healthcare Corporation within 30 days from the date of availment.

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Versions	Form popularity	Fillable & printable
2022	4.8 Satisfied (204 Votes)
2020	4.1 Satisfied (31 Votes)
2019	4 Satisfied (35 Votes)
2015	4 Satisfied (48 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I file a Maxicare reimbursement claim?

Reimbursement filing procedure Download the Claims Reimbursement Form. Fill-up the Form and secure required documents based on your availment. Attach your Medical Certificate OR have your doctor sign the Claims Reimbursement Form.

What can be reimbursed from Maxicare?

Reimbursement up to 80% of the actual hospital bills and 80% of the Professional fees (based on Maxicare rates) incurred during the first twenty-four (24) hours of treatment up to ₱30,000.00 / availment / member.

How do I claim my reimbursement?

How to Raise a Reimbursement Health Insurance Claim Intimate the Insurance Company. We understand that in times of medical crisis, you may find it difficult to docHub out to the insurance company right away. Pay Bills and Collect Documents. Submit the Claim Form and Documents. Let the Insurance Company Verify and Enquire.

Is Maxicare convertible to cash?

Any excess will be covered by the member, and the balance amount is not convertible to cash. Members can only avail from one Maxicare-affiliated hospital within 24 hours.

Can I use Maxicare outside the country?

Medicare Does Not Cover You Outside the United States.

What is not covered by Maxicare?

Does it cover any type of hospitalization? Hospicash does not cover hospitalization of accidents and/or illness that are part of Maxicares list of exclusions in the terms conditions (ex. Attempted suicide, overdose, etc.). Maternity is also an exclusion except for Maxicare accounts with maternity coverage.

How long does it take for Maxicare to reimburse?

Reimbursement/s released via check will be available within 30 working days upon the receipt of complete and valid requirements at the Maxicare Head Office.

Maxicare claim reimbursement form 2025

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