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KwikCare Max - PhilCare

This is a comprehensive medical insurance that covers inpatient, outpatient, and emergency services. Doctor prescribed tests and consultations are also included up to the maximum benefit limit. It offers no-cash-out in accredited clinics & hospital nationwide.

PhilHealthCare, Inc.

Provider

Up to ₱ 150,000

Inpatient, Outpatient, and Emergency Services

Coverage is available for the Principal, Spouse, and Parents aged 18 to 60, with renewals allowed up to 65. Children and Siblings are covered from 30 days to 22 years old.

Eligible age

Coverages

Medical Insurance

Maximum Benefit Limit

₱ 150,000

Room and Board

Regular Private

Access to all accredited hospitals and clinics including top 6

Included

Pre-existing conditions (covered after 6 months)

Covered up to 50% of Maximum Benefit Limit

Outpatient Benefits

Covered up to Maximum Benefit Limit

Inpatient Benefits

Covered up to Maximum Benefit Limit

Doctor Prescribed Laboratory and Diagnostic Tests

Covered up to Maximum Benefit Limit

Doctor Consultations and Teleconsultations

Covered up to Maximum Benefit Limit

KwikRewards Program Membership

Included

Important Notes

About the Product

This Product is underwritten by PhilHealthCare, Inc.



Excluded Coverages

  1. Care by Non-Accredited Physician in either Accredited or Non-Accredited Hospitals, except in emergencies wherein the Emergency Provision of the Agreement shall apply;
  2. Care by an Accredited Physician in a Non-Accredited Hospital or Clinic;
  3. Additional hospital charges and professional fees resulting from taking a room category higher than that specified in the member’s benefit schedule;
  4. Additional personal comfort items (e.g., telephone, television, additional food trays, admission kit, and such other items of the same nature)
  5. Procurement or use of corrective appliances, prosthesis, artificial aids, and durable equipment such as but not limited to the following: stents, prolene mesh, pins, screws, plates, wires, VP shunts, clips, hearing aids, intraocular lens, eyeglasses, contact lenses, balloons, valves, braces, crutches, pacemaker;
  6. All pregnancy-related conditions and complications relating to the mother and unborn child, requiring medical and surgical care, regardless of time/date of occurrence (during the actual time of pregnancy or thereafter);
  7. All sexually transmitted diseases;
  8. Circumcision, sterilization of either sex or reversal of such, artificial insemination, sex transformation, or diagnosis and treatment of infertility;
  9. Rest cures, custodial, domiciliary, and convalescent care. These pertain to care in a skilled accredited facility or an institution that meets certain standards for medical care and includes nursing care and therapeutic services following hospital confinement;
  10. Cosmetic procedure and surgery and oral surgery solely for purpose of beautification, except reconstructive surgery to treat functional defects due to disease or accidental injury;
  11. Blood screening, blood typing, cross-matching for potential donors in relation to blood donation and transfusion;
  12. Weight reduction programs, surgical operation, or procedure for treatment of obesity, including but not limited to gastric stapling;
  13. Dental examination, extractions, fillings and general dental attention and conditions and all complications arising there from, including oral surgery and prosthodontics procedures following accidental injury to teeth for purposes of beautification. Exceptions are treatment to the extent necessary for repair and or restoration of function of the covered person caused solely by accidental injuries;
  14. All forms of behavioral disorders whether congenital or acquired; developmental or psychiatric disorder; psychosomatic illness;
  15. Any injury, illness or condition which the Member may suffer after he/she has taken intoxicating drugs or alcoholic beverage as evidenced by clinical history or alcoholic breath duly determined by the examining physician/ medical personnel and/or as indicated in the police report and other official medical documents conditions or illnesses resulting from Alcoholism and Drug Addiction;
  16. Medical or surgical procedures that are experimental in nature and those that are not generally accepted as standard medical treatment by the medical profession, that may include but is not limited to, Chiropractic Services, Acupuncture, and Reflexology;
  17. Allergens used for hypersensitivity testing regardless of if administered as an outpatient or inpatient procedure;
  18. All expenses incurred by the Member in the process of donating organs;
  19. Treatment of injuries or illnesses resulting from the voluntary participation of a member in any hazardous sport or activity that may include but is not limited to bungee jumping, scuba diving, hang-gliding, mountain climbing, parachuting, surfing, rock climbing, airsoft, paint balling, boxing, wrestling, martial arts (such as taekwondo, judo, karate, etc.), gymnastics, motor sports (drag racing, jet skiing), wakeboarding, water skiing and all such other voluntary activities which pose a grave danger to life and limb, except those related to or directly connected with the Member’s occupation as declared in the application for health care coverage under the Agreement;
  20. All injuries or conditions that are self-inflicted or inflicted on the Member with his or her consent, or injuries or conditions attributed to participation by the Member in any activity where the Member utilizes procedures, techniques, instruments or products that substantially increase the risk of harm or damage;
  21. Physical examinations, certification of results/fitness and other related services required for obtaining or continuing employment, insurance application, government licensing, travel clearances, school clearances, sports and competition clearances, company promotions or not related to the health maintenance of the client;
  22. Treatment of injuries or illnesses due to military service or suffered under conditions of war;
  23. Executive check-ups and confinement which are for purely diagnostic purposes except as specified in the Agreement;
  24. Treatment of injuries or illnesses wherein the care or reimbursement of services is provided by law or a government program, up to the stipulated limits;
  25. Treatment of any injury which is proven to be attributable to the Member’s own misconduct such as negligence, intemperate use of drugs or alcoholic liquor, direct or indirect participation in the commission of a crime, whether consummated or not, violation of a law or ordinance, unnecessary exposure to imminent danger or hazard to health, infections or complications as a result of tattoos and piercing of the ear or any body part, whether self-inflicted or done by a third party, or attempted suicide or self-destruction, whether sane or insane. Self-inflicted fireworks related injuries are included in the general exclusion list;
  26. All cases of assault perpetrated by the Member including domestic violence which result in harm or injury to the Member perpetrator; Charges by physicians and health professionals, whether or not accredited by PHILCARE, on the difference between their charged rate and PHILCARE standard professional fees for specific medical services;
  27. Take-home medicines, preventive and /or non-therapeutic drugs, such as but not limited to vitamins, supplements, hormonal preparations, medicines, or drugs during confinement which are not available in the Philippines, immunizing agents and all other medicines/drugs not approved by the Bureau of Food and Drugs (BFAD);
  28. Outpatient medicines, with the exception of intravenous chemotherapy medicine and those administered during an emergency treatment;
  29. Vaccines whether elective or administered during an emergency treatment unless covered by the plan;
  30. All hospital charges and Professional Fees incurred after the day and time the discharge from the hospital has been duly authorized;
  31. Diagnosis and Treatment of Error of Refraction (EOR) conditions such as myopia, astigmatism, and the like and its complications (e.g. retinal detachment), including laser treatment for the purpose of corrective eye refraction;
  32. Outpatient Pain Management is not covered except in cases of emergency. InPatient Pain Management necessitating specialized pain management team and/or the use of specialized equipment are likewise not covered;
  33. Complications arising from non-covered procedures and surgery;
  34. All diseases declared as epidemic by the Department of Health and any other recognized health agencies.
  35. Medico Legal Fees – these are professional fees of a medico-legal consultant to whom the patient is referred primarily for the issuance of a medical certificate for legal purposes including performance of autopsies.
  36. Procedures and/or services considered screening methods; and
  37. Congenital anomalies and conditions and their complications unless specified;
  38. Access to Manila Adventist Medical Center, Notre Dame De Charles Hospital, and Philippine Orthopedic Institute unless included in the policy;


Excluded Industries/Nature of Business


a. Government Associations, Government Agencies, Government Financial Institutions, Government and Government Owned and Controlled Corporations, and company related to Government.


b. Health Services (including veterinary clinics, dental clinics, and schools related to hospitals).


c. Non-legally established groups, groups formed for the purposes of acquiring insurance and open groups.


d. Hazardous occupations are not covered such as, but not limited to blasters, stuntmen, pilot, armed forces, police, odd job laborers, mining, etc.


e. Agricultural sectors


f. Unemployed; except dependents


g. Employees of associations, cooperatives, non-profit organizations will be allowed if provided proof or certification from the authorized signatory that coverage is an employee


Want to Know More?

To learn more about the product, read the Policy Wording.

To learn more about KwikRewards program, read the Terms & Conditions

Frequently Asked Questions

The service will be activated 15 days after the inception date, which is one day from the date of purchase.

  • Purchase date: January 01, 2025
  • Inception date: January 02, 2025
  • Activation date: January 16, 2025
For any emergency accident-related cases, the service can be used twenty-four (24) hours from date of purchase.
  • Purchase date: January 01, 2025
  • Activation date: January 02, 2025
For pre-existing conditions coverage, the client will be covered after six (6) months of continuous subscription.
  • Purchase date: January 01, 2025
  • Activation date for PEC: July 01, 2025

All new purchase from January 21, 2025, pre-existing conditions will be covered after six (6) months of continuous subscription, up to 50% of the MBL.

For renewing members, PEC is covered up to MBL from 2nd year onwards.

Emergency accidental cases that will be covered during the fifteen (15) days waiting period are injuries sustained from vehicular accidents (with police report), acts of nature, struck by falling objects, drowning, and burns.

The health subscription plan will be automatically cancelled if client will not be able to pay on time.

Within 60 Days: Reinstatement is allowed, provided any arrears are settled promptly. Subscription will undergo an activation period of seven (7) days before the subscriber can use its services such as consultations, laboratory, and diagnostic tests, etc.

After 60 Days: Reinstatement is no longer permitted; a new policy must be purchased, and the PEC waiting period and coverages will be reset.

For group administered enrolments, the HR Admin must be the one to enroll their employees.

For individual enrolment, employees can enroll on their own in the portal.

For group administered employees, billing will be sent to the company, thus it is the company who will pay for the subscription.

For individual enrolment, the employee or individual is the one who will pay for the subscription.

All payments should be processed exclusively through our official online channel to ensure security and accuracy. If anyone from our affiliates or advisors requests that payments be sent directly to them, please contact us immediately so we can ensure everything is properly accounted for.

Yes, employees or individuals who wish to enroll their dependents can do so.

Dependent may be enrolled with the type of plan that is same or lower plan than his principal’s plan.

Dependents must be enrolled simultaneously or within thirty (30) days from enrollment of the Principal Member except for cases involving marriage or the birth of a child wherein enrollment must be made within thirty (30) days from their eligibility date (i.e. child may be enrolled from 30-60 days old).

When the principal member's coverage ends, the dependent's coverage also ends.

Dependents must be enrolled simultaneously or within thirty (30) days from enrollment of the Principal Member except for cases involving marriage or the birth of a child wherein enrollment must be made within thirty (30) days from their eligibility date (i.e. child may be enrolled from 30-60 days old).

You may wait for your annual renewal, to add new dependents.

Yes, Philhealth is necessary. For those enrollees who do not have Philhealth, you can still continue with the enrollment and may opt to do the following:

  • Enroll voluntarily under Philhealth
  • Pay for the additional Philhealth portion of the bill when confined
  • Pay an additional Php4,032.00 (VAT inclusive) premium per head

No, since this is a cashless transaction, clients don’t need to bring money to the hospital (affiliated hospitals and clinics) when using the services.

Since this is an app-based health subscription plan, clients don’t need to bring cards in the hospital. All they need to do is present their e-card issued to them that can be found in their mobile app.

For check-ups, clients can use their app to set a schedule with the doctor and generate LOA.

Pre-existing conditions are any illnesses, injuries, or conditions that are pre-existing any time prior to the effective date of the member’s coverage which will start after six months of continuous subscription.

- If member had professional advice or treatment for a certain condition; 

- If there are symptoms that are evident in any way to the member; 

- If any of the conditions below is diagnosed before or within the first six months of subscription: 

  • asthma, pleural effusion, or other chronic airway obstruction conditions;  

  • benign cyst/tumor and malignant conditions;  

  • chronic gynecologic conditions;  

  • hemorrhoids and other chronic colonic and ano-rectal illnesses;  

  • disease tonsils requiring surgery, cataracts and other ophthalmo-otolaryngologic conditions;  

  • pathological abnormalities of nasal septum and turbinate;  

  • sinus condition requiring surgery;  

  • chronic neurologic conditions;  

  • calculus cholecystitis/cholelithiasis and/or urolithiasis;  

  • chronic conditions of the genitourinary system;  

  • polyps, ulcers, liver cirrhosis and other chronic gastrointestinal diseases;  

  • endocrine illnesses;  

  • seizure disorders;  

  • moderately to far advanced tuberculosis;  

  • chronic musculo-skeletal malignancies  

  • malignancies of the blood and bone marrow  

  • hypertension, coronary artery disease/myocardial ischemia, cerebro-vascular accident and other chronic cardiac diseases  

  • collagen/connective tissue diseases;  

  • diseases of the immune system.  

No, even if a client opts to pay in advance, they will not be qualified to be covered by the pre-existing coverage if they haven’t been subscribed to the program for six (6) consecutive months of subscription.

Life-threatening cases such as but not limited to heart attack, stroke, severe asthma attack, sudden paralysis, elevation in blood pressure, and seizure disorders only. Coverage for emergency cases is for expenses within the emergency room and is limited to doctor fees, treatment, and medicine. Surgical operations and room & board related to pre-existing conditions are excluded even if they are brought about by emergencies.

Clients who wish to pay for an annual subscription can do so by contacting our customer service support for the payment link.

Yes, our plans are accredited in all major hospitals including Makati Medical Center, St. Luke’s Global City & Quezon City, Asian Hospital Medical Center, The Medical City, etc.

  • Principal Plan Members- regular/probationary employees, full-time/part-time employees, freelancers, or business owners 18 years old up to 65 years old.

 

This plan accepts initial enrollment only up to the age of 60 years old. Renewal accounts are eligible for coverage for individuals aged 61 to 65 years old. 

Coverage automatically ends on the day before the employee celebrates his 66th birthday or retires from employment, whichever is earlier. 

 

Coverage for minors (0-17 years old) will only be enrolled as an immediate dependent of an employee. Minor dependents must be fully dependent on the employee, unmarried, and unemployed. 

 

  • Immediate Dependents
    • For Married Employees
      • Start with the LEGAL SPOUSE who are not more than 65 years old (coverage automatically ends on the day before the spouse celebrates 66th birthday);
      • Followed by CHILDREN who are single, unemployed, and at least 30 days up to 22 years old (coverage automatically ends on the day before the children celebrate their 23rd birthday).
      • Legally adopted children can also be covered. Stepchildren who are yet to be adopted legitimately
    • For Single Parent Employees
      • Starts with CHILDREN who are single, unemployed, at least 30 days old up to 22 years old (coverage automatically ends on the day before the children celebrate their 23rd birthday).
      • Followed by PARENTS up to 65 years old (coverage automatically ends on the day before the spouse celebrates 66th birthday);
    • For Single Employees
      • Start with PARENTS up to 65 years old (coverage automatically ends on the day before the parents celebrate their 66th birthday);
      • Followed by SIBLINGS who are single, unemployed, and at least 30 days old up to 22 years old (coverage automatically ends on the day before the siblings celebrate their 23rd birthday);
      • Coverage for minors (0-17 years old) will only be enrolled under immediate dependent of employees. Minor dependents must be fully dependent to the employee, unmarried, and unemployed.

  1. What is the KwikRewards Program?

    KwikRewards is a loyalty program that provides KwikCare Subscribers the opportunity to earn KwikRewards Tokens by helping promote a healthy lifestyle and our products and services.

  2. Who are eligible to join the program?

    Only KwikCare Subscribers are eligible to join the KwikRewards program as the monthly membership is part of the inclusions in a KwikCare Subscription.

  3. How do I register to the program?

    You will receive a welcome email 8 days after your purchase. This is after the free-look period of KwikCare Subscription.

  4. Can my dependents register in the program?

    Only principal subscribers will be registered in the program. However, the dependents will also automatically earn KwikRewards Tokens should principal members accomplish token-earning activities. The tokens will be emailed to the principal.

  5. How much is KwikRewards monthly membership?

    It is free to KwikCare Subscribers. It is part of the KwikCare Subscription inclusions.

  6. What are KwikReward Tokens?

    KwikRewards Tokens are used to redeem reward credits in the KwikRewards Portal. Each token has a value of P500 credits. They are stackable (can be accumulated) and can be used to claim different reward amounts.

  7. What is the KwikRewards Portal?

    It is the website where KwikRewards Tokens can be redeemed and exchanged for Credits to be used in the website. Members can choose from different categories:

    • Travel
    • Entertainment
    • Wellness
    • Coming Soon (Dining, Learning, Services)
  8. How are KwikRewards Tokens earned?

    KwikRewards Tokens are earned by participating in activities that promote a healthy lifestyle and our products each month. We will email qualified members each month about token-earning opportunities.

  9. When are KwikRewards Tokens disbursed?

    Tokens are disbursed based on the accomplishment of tasks and its submission dates of accomplished token-earning activities:

    Accomplishment and SubmissionToken Release
    On or before 7th13th of same month
    On or before 14th20th of same month
    On or before 21st27th of same month
    On or before 28th6th of following month
  10. What do I do with KwikRewards Tokens?

    They are used as credits in the KwikRewards Portal.

  11. What happens after I claim rewards in the KwikRewards Portal?

    You will receive the actual rewards vouchers which you may use in our partners’ websites, apps, and establishments.

  12. Are KwikRewards Tokens transferrable?

    Yes, they may be transferred as long as they are not yet claimed/exchanged in the KwikRewards Portal.

  13. Are partners’ rewards vouchers transferrable?

    This depends on our partners’ terms and conditions. It is best to check first before exchanging your credits for the vouchers.

  14. When do KwikRewards Tokens and Credits expire?

    They will expire on May 31, 2026.

  15. When will Partners’ Rewards Vouchers expire?

    This depends on Partners’ Terms and Conditions upon claiming of voucher.

In the event that an applicant did not declare mentioned illnesses reflected in our medical declaration form, coverage will be denied at point of availment

The corresponding plan premium for each member will depend on the declared condition.

All other pre-existing conditions will be covered after six (6) months of continuous subscription, up to 50% of the MBL.

For renewing members, PEC is covered up to MBL from 2nd year onwards.

Starting January 22, 2025, all new applications and annual renewal will have the following minor benefit modification:

(1) Pre-Existing Condition (PEC)

    a. New Applications: 1st coverage year: 50% of MBL with 6 months contestability period , 2nd coverage year onwards: Waived, full PEC up to MBL
    b. Existing members / renewal - 2nd coverage year: up to MBL

(2) Physical Therapy – 6 sessions only subject to MBL

(3) Animal bites vaccines – 1st dose only subject to P18,000 aggregate limit

Summary

Item

Premium


Basic Premium

1,334.82

Premium Tax/VAT

160.18


Gross Premium

₱ 1,495.00

* Kindly see Important Notes section