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Zennya Home Phlebotomy Program Terms and Conditions (T&Cs)
These Terms and Conditions is the contract between you as a Member and Maxicare as the provider of the services. We therefore advise you to review these terms and conditions carefully and indicate whether you agree or disagree with them by clicking on the corresponding box towards the end of this document. Maxicare reserves the right to modify the Terms and Conditions or their policies for availment from time to time.
1. By using the Zennya mobile application (“Zennya app”) and your availment of the medical services through the Zennya app, whether currently existing or to be offered in the future, through the use of a Maxicare Letter of Authorization (“LOA”) issued by Maxicare Call Center, Help Desks, Primary Care Centers, Customer Care Representatives, Affiliated Coordinators and Partners, Maxicare Kiosk, Member Gateway, Maxicare electronic systems, or such other entities affiliated or accredited by Maxicare or you signify that you agree to abide by all these Terms and Conditions and the Service Agreement between you and Maxicare or the Service Agreement between your employer and Maxicare, as the case may be, including any materials available in the Zennya app such as, but not limited to, the privacy and security policies, which are hereby incorporated by reference, subject to changes and notices in the Member terms and conditions that are maintained and published via Maxicare website athttps://maxicare.ph/member-terms.As such, your signature may not be required to signify your consent.
2. All your representations, warranties and undertakings are material and have been relied upon by Maxicare. Consequently, you shall be directly and solely responsible for the accuracy of any and all information that you submit to Maxicare. They shall survive the effectivity of these Terms and Conditions and the consummation of the Service Agreement.
3. You agree and understand and will continue to agree and understand that in the course of providing service/s to you, Maxicare shall engage the services of, and/or interact with, other third parties, such as, but not limited to its parent company, affiliated companies, subsidiaries, financial advisors, affiliated third parties or independent/non-affiliated third parties and service providers, whether local or foreign (collectively referred to as "Representative").
4. You agree and understand and will continue to agree and understand that Zennya Inc., (“Zennya”) is one of the Representatives of Maxicare. Zennya employs the Zennya app wherein Maxicare members may register and manage their Personal Health Records, and avail of certain Maxicare services such as, but not limited to, home vaccination, and home phlebotomy and diagnostics. Thus, you understand and fully agree that once you use and register to the Zennya app, you must accept and agree to the Terms and Conditions of Zennya as posted in the Zennya app prior to your use of the same. In case you do not have the Zennya app installed on your mobile device but you choose to avail of the services of Zennya as requested through Maxicare’s Customer Service Department, you undertake that you will accept and agree to the Zennya’s Terms and Conditions prior to the actual administration of the home vaccination and/or home phlebotomy and diagnostics, as the case may be.
5. You understand that Maxicare shall not be responsible for the payment of charges/expenses resulting from:
a. Availment of the medical services/treatment/procedures (diagnostic and therapeutic):
i. not included in the identified list of tests/procedures (Set A and Set B)
ii. those rendered by non-affiliated physicians/specialists or a reliever physician;
iii. those without prior authorization of Maxicare;
iv. those miscellaneous items outside of your healthcare benefit plan;
v. co-payment and/or coinsurance defined for the service.
b. Failure to file PhilHealth benefit claim, if mandated, to cover all PhilHealth costs incurred
c. Amount in excess of your allowable benefit limit in the professional fee of attending doctor/s with whom you had prior agreement;
d. Amount in relation to the service fees of Zennya with regards to the Home Phlebotomy Program
e. Benefit availment found to be not covered and deemed excluded by the Service Agreement executed by and between Maxicare and you (the "Service Agreement" or "Product Manual”), including concealment, even if unintentional or unrelated to the current availment, of relevant medical information, and those in excess of Benefit Limits set out in the agreement, even if conditionally approved by Maxicare. If at the time of issuance of the LOA or its equivalent, the amount of you or your dependent’s previous availment is not reflected yet, Maxicare reserves the right to re-adjudicate the Member’s coverage based on the total remaining balance of the benefit limit; and
f. Other expenses and charges analogous to the foregoing.
Maxicare shall collect from you the expenses incurred relative to any availment, if upon post verification by Maxicare, any of the above-mentioned circumstances shall be found present. Your request for LOA may likewise be denied outright in the event that the availment is not coverable by Maxicare.
6. In lieu of signing the LOA, you may confirm the availment of the medical services through electronic confirmation of the transaction via personal identification number (PIN), email, or other electronic confirmation which the facility shall allow. It is your responsibility to ensure that any changes in your contact information are duly communicated to Maxicare to enable you to receive the electronic notifications for the transaction accordingly.
7. You confirm that the benefits and coverage requiring the services of a physician shall only be performed by an Affiliated Physician or Specialist referred by Maxicare. You are aware that there are agreed standard Professional Fees for specific medical services between the Physicians and Maxicare. Any private arrangement with the Physician or Specialist for higher Professional Fee/s shall be for your account. In no case can you demand for reimbursement from Maxicare for the higher Professional Fee/s.
8. You agree and understand that, at the time of the effectivity of the Agreement and the effectivity of coverage of your membership, Maxicare has obtained from you and your Dependents the required consents pursuant to Republic Act No. 10173, otherwise known as the Data Privacy Act of 2012, including its Implementing Rules and Regulations and other issuances of the National Privacy Commission (collectively, the “Data Privacy Laws”) authorizing Maxicare and its Representatives, the Company and any of their stockholders, directors, officers, employees, agents, brokers or representatives (collectively, the “authorized representatives”) to:
a. Obtain, examine, process, collect, record, organize, store, update or modify, retrieve, consult, use, consolidate, block, erase, destroy or do any operation or set of operations (collectively “process” / “processing”) the Member’s and his Dependent/s’ personal information, including sensitive personal information and privileged information, medical records, or any other information or material, i.e., picture, video and voice recording, fingerprints, CCTV and etc., (collectively “personal data”) relative to the Member and his Dependents’ application and membership with Maxicare, availment of the Services and eHealth, hospitalization, consultation, and treatment or any medical advice in connection with the benefit/claim availed under the Agreement, as may be deemed necessary by Maxicare. Except as otherwise stated in these T&Cs, any personal data obtained relative to the authority herein given shall be kept strictly confidential. The extent of the processing of the Personal Data shall be limited to what is necessary, appropriate or incidental to the performance of the Services and eHealth contemplated in the Agreement and these T&Cs.
b. Process and disclose such Personal Data to Maxicare and its Representatives, the Company, and their authorized representatives as well as relevant government agencies in compliance with the Republic Act No. 11223 otherwise known as the “Universal Health Care Act”, its Implementing Rules and Regulations, Republic Act No. 11332 otherwise known as the “Mandatory Reporting of Notifiable Diseases and Health Events of Public Health Concern Act” and other relevant issuances of the Department of Health and/or Philippine Health Insurance Corporation, and any amendments to such laws, rules, regulations and issuances for any legitimate business purpose as Maxicare may deem appropriate, including but not limited to outsourced processing of Maxicare transactions, billing of co-pay arrangements or Administrative Services Only (ASO), lifestyle and rewards partners/providers, profiling or historical statistical analysis, providing advice or information which Maxicare,its Representatives and their authorized representatives believe may be of interest to the User/Member or the Company, to effectively administer or manage my account, enhance customer services, or to communicate with such User-Member for any marketing purposes.
For clarity, processing would include both manual and automated handling, storage and transfer of personal data using various means and methods whether physical or electronic (via information and communications systems employed by Maxicare and its Representatives.You retain the right to be informed, to object, access, complain, and rectify, to request for filtering of certain information, and to the corresponding damages in case of violation of your rights within the corresponding limitations as set forth in the pertinent laws.
9. In order to provide the services contemplated in the Service Agreement between you and Maxicare, or between your employer and Maxicare, as the case may be, the authorities herein provided shall be valid and existing during the term of the agreement, including any extensions thereof, and until necessary for the establishment, exercise or defense of any claims arising from the said agreement.
10. You hereby warrant that you understand your rights and obligations pursuant to the Data Privacy Act and its implementing rules and regulations, as may be amended. Consequently, you and your dependents hereby agree to hold Maxicare and its Representatives free and harmless from and against any and all suits or claims, actions, or proceedings, damages, costs, and expenses, including attorney's fees, which may be filed, charged, or adjudged against Maxicare or any of its directors, stockholders, officers, employees, agents, or Representatives in connection with or arising from the use, processing and disclosure by Maxicare or its Representatives of the aforementioned information pursuant to Maxicare’s reliance on your consent that your Employer, its representatives, agents and brokers, Maxicare and its Representatives have the authority to examine, use, process, store or disclose, as the case may be, said information for the above-mentioned purposes.
11. Maxicare shall not be liable for any loss or damage of whatever nature in connection with the implementation of transactions covered by this Terms and Conditions in the following instances:
a. Disruption, failure or delay which are due to circumstances beyond the control of Maxicare, fortuitous events such as but not limited to prolonged power outages, breakdown in computers and communication facilities, typhoons, public disturbances and calamities, and other similar or related cases;
b. Loss or damage you may suffer due to theft or unauthorized use of your or your dependent’s Maxicare Card, passwords, personal data, or violation of other security measures with or without your participation; and
c. Inaccurate, incomplete or delayed information you received due to disruption or failure of any communication facilities.
12. These Terms and Conditions are governed by the laws of the Philippines and all suits to enforce the agreement between you and Maxicare or its Representatives shall be settled in the proper courts of Makati City.
13. In case of breach of any of the provisions of the Service Agreement, these Terms and Conditions, as well as the warranties and representations stated herein, Maxicare shall be entitled to the amount of Two Hundred Thousand Pesos (P200,000.00) as minimum damages, in addition to any other damages which it may be entitled under the law, and attorney's fees in the amount of One Hundred Thousand Pesos (P100,000.00) in the event that it shall be constrained to engage the services of counsel to prosecute its claim.
14. Maxicare shall not be liable for any loss, liability, damage or expense arising out of or in connection with the use of the Zennya, unless such loss, liability, damage or expense shall be proven to result directly from the gross and willful misconduct of Maxicare or its Representatives. In no event will Maxicare be liable for special, indirect, punitive or consequential damages. Under no circumstances will the liability of Maxicare exceed, in the aggregate, the fees actually paid pursuant to the Service Agreement.
15. We reserve the right to amend these Terms and Conditions at any time without the need of prior notice or approval.
I have read and fully understood the Terms and Conditions and hereby agree to be governed by the said terms and conditions.