Company deducted Maxicare from his salary but he never received any card

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Today, I have received a call from my uncle asking for advice. Apparently, his company had deducted from his payslip a portion alloted for Maxicare. This happened in December 2013. He was never regularized nor was he given a Maxicare card.  He now no longer works for that company and he wants his money back.

First, let's start that the issuance of Maxicare cards is dependent on the company policy. The company policy may either be the date of regularization, date of hire or standard cut offs. This company policy must be made known by the company to Maxicare prior to entering into an agreement so that Maxicare can execute those enrollment guidelines once the contract has started. The contract between Maxicare and the company will stipulate the company policy of issuing cards. The timing of the issuance of Maxicare cards is not Maxicare's policy but the company's policy and that Maxicare is just there to execute.

After initial verification, my uncle was never enrolled in Maxicare, which means 1) his name was never submitted for enrollment or 2) his name was submitted but never processed by Maxicare. Granting that the former is correct, the company may have charged him in advance. He must file for a claim from his former employer and not Maxicare.

Collections between Maxicare and a company is not done individually. The contract is between the company and Maxicare and not between the member and Maxicare. A lump sum cheque is issued by the company to Maxicare. The manner as to how this lump sum amount was derived is internal to the company, whether this was paid for by the company in full or the employees had a portion of the share. Any deductions from your payroll or receivables from your last pay must be settled internally.

Useful Tips in Choosing the Right HMO: Maxicare Philippines

Health insurance has been considered a necessity by many. Illnesses are inevitable and immediate medical attention is not at all cheap. For people who have high salaries, medical check-ups and hospital admission may not be a problem. But for some people who have so many financial responsibilities and income that is only sufficient for their needs, getting sick is not an option. If you are always worried of catching a disease because of budget constraints, fret no more because here's an option that can help you. Health maintenance organizations can offer you medical assistance and other amazing benefits. In choosing the right company, take note of the following tips.
Identify the reasons why you want to sign up for health insurance like Maxicare Philippines.
Before picking a dependable health maintenance organization, make sure that you are clear on the reasons why you want to get a health insurance plan. List the items that are important for you in health plan coverage because this will be your basis in choosing a health maintenance organization and which among their plans will address your health needs.
Know your budget!
Compute all the bills that you have to pay and check the amount that you can spare in paying the premium for an HMO plan. There are HMOs that offer plans that are tailored according to the potential member's monthly budget. Maxicare Philippines provide this amazing deal too. Not only will you be worry-free when you get sick, you will also feel relieved because your dues will not ruin your budget.
Study the company's background.
In choosing the right health maintenance organization, you have to make sure that you will get the services of a company that has a clean track record and a good reputation in the industry like Maxicare Philippines. The company was established in 1987 proving its excellence in the past 25 years. Affiliated with trustworthy businessmen and well-commended group of doctors, Maxicare Philippines ensures reliability and stability.
Talk to an agent or any personnel from the HMO.
Although most of the information that you will need is provided in the website, the best way to clarify all your questions is to speak to a personnel who knows the company's background and how to explain the plans they offer. Before talking to an agent, list all your questions to make sure that you won't miss out on anything.
Choose the Maxicare Philippines plan that suits you best.
Ask for a quotation from the company. If you have set a meeting with their personnel, discuss your needs and be clear on your expectations. Make sure that you will choose the plan that will address your needs. Upon receiving the company's proposal, read the coverage carefully and determine whether it can meet your requirements. Be clear on the benefits that they offer and ask about the claiming process. It will also be beneficial if you seek the advice of another person to look over the forms to make sure that you will make the right decision.
Contact a Maxicare Philippines counsellor now! 

Source: http://goarticles.com/article/Useful-Tips-in-Choosing-the-Right-HMO-Maxicare-Philippines/7042427/

 

MAXICARE PRE EXISTING NON DREADED AND DREADED CONDITIONS

PRE EXISTING NON DREADED AND DREADED CONDITIONS*

* Applies to Family and Individual Accounts

* These conditions are waived under Maxicare's Corporate Plans

NON DREADED CONDITIONS are as follows, but not limited to:

1. All tumors (benign masses)

2. Anal Fistulae

3. Arthritis

4. Bronchial Asthma

5. Buergher’s Disease

6. Cataract and Glaucoma

7. Cholecystitis, Cholelithiasis, Cholecystolithiasis

and Choledocholithiasis

8. Ear-Nose-Throat conditions requiring surgery

(except cancers which are considered dreaded

conditions)

9. Endometrioses/Dysfunctional Uterine Bleeding

(except if caused by uterine malignancies)

10. Gastric or Duodenal Ulcers

11. Hallux valgus

12. Hemorrhoids

13. Hernias (Congenital Hernia will have coverage

as listed in the Congenital Clause)

14. Migraine

15. Muscular Dystrophies (Duchenne, Becker,

limb girdle, facioscapsulohumeral, myotonic,

oculopharyngeal, distal, and Emery-Dreifuss)

16. Ovarian cysts (except Ovarian Malignancies)

17. Peripheral Nervous System Diseases (except

Multiple Sclerosis and GBS)

18. Tuberculosis (Pulmonary or Extrapulmonary

including Pott’s disease)

19. Uncomplicated Hypertension

20. Urinary Tract Stones/Calculi

21. All complications resulting from above list of

conditions

DREADED CONDITIONS are as follows, but not limited to:

1. All cancers (malignant masses) including

carcinoma in situ and related conditions

2. Blood Dyscrasias (Leukemia, Idiopathic

Thrombocytopenic Purpura, etc)

3. Central Nervous System Infections

(Poliomyelitis/Meningitis/Encephalitis)

4. Cerebrovascular Accident (Stroke, Cerebral,

Cerebellar and all Intracranial Hemorrhage)

and related conditions

5. Chronic Cardiovascular Diseases

(Complicated Hypertension and related

conditions, Aortic Dissection, Abdominal Aortic

Aneurysm, etc.)

6. Chronic Endocrine Disorders and their

complications (Dyslipidemia, Impaired Fasting

Glucose, Impaired Glucose Tolerance,

Obesity, Diabetes Mellitus, Hormonal

Dysfunctions, etc.) excluding surgical

treatment/procedures for obesity-exclusion

7. Chronic Gastrointestinal Diseases (ex. Irritable

Bowel Syndrome, Crohn’s disease)

8. Chronic Genito-urinary Disorders

9. Chronic Kidney Disease/Failure

10. Chronic Liver Parenchymal Diseases (Liver

Cirrhosis, Chronic hepatitis, etc)

11. Chronic Pulmonary Diseases except asthma

(COPD, emphysema, and other chronic lung

disease)

12. Collagen-Vascular/Connective Tissue/

Immunologic Disorders

13. Complications of immuno-compromised state

(except HIV/AIDS)

14. Injuries incurred prior to and up to one year

from date of effectivity and their subsequent

complications

15. Systemic Lupus Erythematosus including

Lupus Nephritis

16. Thyroid conditions (Hypothyroidism,

Hyperthyroidism) except Thyroid masses

17. Valvular Heart Diseases (except for surgeries

for valve correction, ie valvuloplasty)

18. Any illness other than above which would

require Intensive Care Unit Confinement

19. All complications resulting from above list of

conditions

For more information about Maxicare’s Pre Existing Conditions coverage, you may inquire at (02) 6228892; 09178046275 or email us at maxicareinquiry@gmail.com

Thank you.

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Individual, Family & Corporate
Direct Line: (02) 6228892 Mobile: 09178046275

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