Get Maxicare Policy

Filling out the Maxicare policy application online is a straightforward process designed to facilitate your enrollment in their healthcare program. This guide will walk you through each section of the application form step-by-step to ensure that you complete it accurately and efficiently.

Follow the steps to successfully complete your Maxicare policy application

1. Click ‘Get Form’ button to obtain the Maxicare application form and open it for editing.
2. Start by entering your date received, effective date, ID number, employee number, corporate code, and corporate name at the top of the form. Ensure that these details are from the appropriate source to avoid errors.
3. Fill in the section labeled 'Applicant Information.' Specify if you are a new applicant, additional applicant, reapplying, or a transferee. Also, indicate the type of coverage you require: individual, family, or group/corporate.
4. Select your plan type from the options available: Platinum Plus, Platinum, Gold, Silver, or Bronze. Note that certain options may not apply depending on your coverage type.
5. Choose your preferred mode of payment: annual, semi-annual, quarterly, or monthly. Ensure that you understand the implications of each payment plan on your overall membership.
6. Complete the principal/payor section with personal information, including last name, first name, middle initial, date of birth, age, blood pressure, civil status, nationality, height, weight, sex, TIN number, number of children, job title, and office/business information.
7. Provide your contact details, including mobile number, residential phone number, email address, and the complete residence address.
8. If applicable, fill out your spouse's information, including their name, date of birth, nationality, job title, and nature of business.
9. List all proposed members for coverage, arranging their names chronologically based on age, and include necessary details such as date of birth, age, sex, height, weight, civil status, dental coverage preference, and occupation.
10. Answer the medical questionnaire in Part 2.A, providing accurate details on any past or current health issues for each proposed member. Remember that failure to declare illnesses may invalidate future claims.
11. If you answered 'yes' to any questions in the medical questionnaire, complete Part 2.B with the relevant diagnosis, medication details, inclusive dates, and the name of the hospital or doctor.
12. Confirm your conditions of enrollment and read all authorizations outlined in Part 3. Make sure you understand that benefits will not be available for any conditions that existed before your effective date unless specified.
13. Sign the application form with the date. If the application includes a spouse, ensure they also sign where indicated.
14. Finally, save your changes, then download, print, or share the completed application as required.

Complete your Maxicare policy application online today to secure your healthcare coverage.