Maxicare Individual Quotation

Thank you for your interest in a health insurance package. Please fill up the form, and we will revert to you within 3 hours.

*Required

*NAME


*Email address


*Birthday (Date-Month-Year)


*Mobile Number
Landline Number (if available)


*Should we have any queries, what is your preferred Mode of Communication
Call Via Mobile PhoneCall Via LanlineWhatsAppEmail


Occupation


PLAN TYPE Room & Board Accomodation MAXIMUM BENEFIT LIMIT (Per Treatment)
Platinum Plus Large Private Php 200,000.00
Platinum Regular Private Php 150,000.00
Gold Regular Private Php 100,000.00
Silver Semi - Private Php 60,000.00
*Preferred Plan Type
SilverGoldPlatinumPlatinum Plus


*Purchasing for yourself or family?
MyselfMyself & Family


If for Yourself & Family, please state D.O.B for each member:


*Dental Coverage:
NoYes