How To Enroll Benefits Request Medicines FAQ

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Enrollment

Please ensure that the information provided below is correct.

Member Details
Health Screening
Laboratory Tests

Member Details

First Name

Last Name

Middle Initial (Optional)

Mobile Number

Viber Number

Email
Please input your personal email address. We will send program updates and documents to your registered email.

Birthday

birthday year

YYYY

birthday month

MMM

birthday date

DD

Sex

Male

Female

Employer of Maxicare Principal

Maxicare Member Type

Principal

Dependent

Maxicare Card Number

Landline (Optional)

Secondary Contact Name
Who would you like us to contact in case you can’t be reached? This person will serve as your Authorized Informant.

Secondary Contact Mobile Number

Where did you hear about the Best Life Wellness Program?

Email

Viber

SMS

Social Media (i.e Facebook, Instagram)

Primary Care Clinics

HR/Co-workers

Friends, Family, or Doctor

Others (please specify)

Delivery Address

Please note that the Best Life Wellness Program is only open to certain areas covered by Maxicare's Primary Care Clinic and HomeCare service. If you are unable to find your province and city while inputting your address, your location is outside the program's service.

Address Type

House Number

Street Address

Province

Metro Manila

City

Select city

Barangay

Select barangay

Delivery Notes (Optional)