CareHealth Guide

Guide on Different HMO Coverage

The Philippine HMO (health maintenance organization) is a company that offers health insurance, allowing people to get the medical help at less out-of-pocket cost in exchange for paying a periodic fee. However, according to studies, over half of the country’s total healthcare costs are paid out-of- pocket, which means many of us Pinoys are uninsured. The costs of getting treatment for cancer, stroke and heart disease are rising and can easily run up to several million pesos.

The health maintenance organization or HMO is a company that allows people to be insured to avail medical services for a fixed monthly or annual fee. It acts as the middleman between the client and the healthcare providers such as hospitals, clinics, laboratories, doctors, therapist, etc.

The company can lower overall costs by being able to offer large number of potential clients to hospitals and physicians. They can negotiate for lesser prices on treatment, services, and medicines. In return, healthcare providers have a database of customers that would avail of the services. HMO companies offer various plans. A standard HMO package might include outpatient care and hospitalization. Prepaid cards are also becoming popular recently. They are cheap and offer specific coverage such as one-time expenses for emergency care. Others might also offer a co-pay where the bill is split between the company and the customer.

Some might offer to provide coverage that can be hard to insure, such as pre-existing conditions, or to people usually refused for insurance such as senior citizens and those with pre-existing conditions. But why pay for an HMO plan when we can go directly to a doctor for a check-up or hospital for confinement? Why do you need to buy insurance? The reason is that medical expenses can be huge. When you are admitted in a hospital, the bills can run up to tens of thousands to millions of pesos. An admission to an emergency ward to get immediate medical attention, undergoing surgeries, or receiving intensive care can be costly too.

It’s good if we have the money to pay for them. And even if we do have savings, it may not be enough to cover the bills. For most of us Filipinos, that’s just not the case. We can become poor or even poorer, forced to sell properties, borrow money, declare bankruptcy, or even refuse to be admitted for fear of being a burden to the family. An HMO plan is a safety net from the personal crisis of being sick. In exchange for a fee and as a form of insurance, it pays the hospital bill up to a certain benefit limit. Plan-holders generally don’t have to pay any deposit for admission especially when admitted in hospitals within the network of healthcare providers accredited by the HMO company, while those who don’t have a plan might be asked to pay a deposit amount upfront.