Real Hospital Coverage, Zero Guessing Games

No. Maternity care and all pregnancy-related conditions, including pre and post-natal consultations, are excluded from MyMaxicare HMO. We flag this upfront so it's never a surprise at claim time.

No. Long-term rehabilitation, psychiatric care, and psychological conditions (including anxiety and behavior disorders) are excluded, along with developmental disorders like ADHD and Autism Spectrum Disorders.

Pre-existing condition simply means: any illness or health issue you already had, or already knew about, before your Maxicare plan started. Think of it like buying car insurance after you already have a dent — the insurer needs a separate way to handle that dent.

Maxicare sorts pre-existing conditions into two buckets:

Non-Dreaded = usually minor, manageable, one-time-fixable conditions. Examples: cataracts, hemorrhoids, uncomplicated hypertension, uncomplicated hernia, migraine, sinusitis.

Dreaded = chronic, progressive, or life-threatening conditions that typically need lifelong management and can't be "cured" outright. Examples: cancer, stroke, heart disease, chronic kidney disease, diabetes complications, lupus.

The difference matters because of how much Maxicare will pay toward treating that specific condition — see the amounts below.

Year 1 of your membership — both Dreaded and Non-Dreaded pre-existing conditions are covered, but only up to a capped amount per illness per year:

From your 2nd year onward: Non-Dreaded conditions open up to your FULL Maximum Benefit Limit (MBL) — no more small cap. Dreaded conditions stay capped at the Year 1 amounts above UNLESS Maxicare classifies it as "acquired" (meaning it started after you enrolled, not before) — acquired dreaded conditions also get covered up to your full MBL.

In plain terms: the caps above exist to protect against conditions you already had walking in. Anything that develops after you're a member gets full coverage, same as anyone else.

The tiers differ by Room & Board type and Maximum Benefit Limit (MBL) per illness per year: Silver (Semi-Private, ₱100k), Gold (Regular Private, ₱150k), Platinum (Regular Private, ₱200k), Platinum Plus (Large Private, ₱250k). Core in-patient, out-patient, and ER benefits are the same across all tiers.

Rates are based on age bracket at the time of application — the picker above covers 15 days old to 60 years. Book a consultation and I'll confirm your exact premium and payment terms (annual or semi-annual).