MAXICARE OPTICAL BENEFITS and COVERAGE PROCESS

Please see below for Optical Benefit assistance guidelines:

1. The doctor’s request with a diagnosis needs to be issued by an accredited physician
with Maxicare (Ophthalmologist).
2. Coverage is for those patients with medical diagnosis or with an error of refraction.
3. Coverage: Eyeglass Lens (frames not included) and contact lenses.
4. The cost of eyeglasses/ contact lenses can be filed through reimbursement and needs to
be availed in accredited optical providers. See attached list of optical providers for your
reference.

Below are the requirements for the optical benefit reimbursement:

1. Fill out the Claims Reimbursement form.
2. Medical Certificate indicating the diagnosis.
3. Original BIR registered Official Receipt(s)/Sales Invoice with TIN.
4. Prescription for eye glasses or contact lens (with name of patient, date, eye grade, name
of doctor, license number and TIN).
5. Detailed/Itemized breakdown of charges.
6. Photocopy of 2 valid ID with 3 specimen signatures.
7. Fill out the Claims Information form.
8. However, if incase that the principal does not have their physical card on hand yet,
disregard the Claims Information Form (Number ) and fill out this Auto Credit
Arrangement Authorization Form (ACA form) instead. (form attached to this email) -
Please be advised that crediting of the approved reimbursement to the provided bank
account is 30 working days from the date the reimbursement is approved.

Please be advised that all reimbursement is still subject for claims evaluation and
approval.

Attached is the list of accredited Optical providers for your reference, Kindly schedule an
appointment with the preferred doctor prior to availment. Please note that the status of provider
accreditation listing may change without prior notice.

Once all of the requirements are complete, you may submit and file reimbursement online thru
Maxicare Member Gateway: https://membergateway.maxicare.com.ph

Turnaround time for claims processing is 30 working days upon receipt of the claims
department.
If the submitted reimbursement is approved, send your completed Claims Reimbursement Form
along with the Original supporting documents to our Claims offices:

LUZON:
Maxicare Healthcare Corporation
℅ Claims Reimbursement Receiving Unit
Ground Floor CIBI Center, 3308 Zapote Street, Brgy. Sta. Cruz Makati CIty
Contact Number: (02) 908-6900 local 1404-05

VISAYAS:
Maxicare Healthcare Corporation
℅ Claims Reimbursement Receiving Unit
8th Floor AppleOne - Equicom Tower, Mindanao Avenue corner Biliran Road, Cebu Business
Park, Cebu City
Contact Number: (032) 402-7905 local 9117-19

MINDANAO:
Maxicare Healthcare Corporation
℅ Claims Department
3rd Floor FTC Tower, Mt. Apo Street, Davao City
Contact Number: (082) 322-1900 local 9216-17

For additional queries and concern, kindly contact css.cloudstaff@maxicare.com.ph