In the Philippines, having access to quality healthcare is essential, but the cost can be a burden for many. This is where Health Maintenance Organizations (HMOs) come in handy. They provide Filipinos with affordable access to medical services and treatment, without having to worry about the high costs.
Also Read: Best HMO Prepaid Health Cards in Philippines
We will be discussing the top HMO providers in the Philippines, to help you make an informed decision when it comes to your healthcare needs.
OFWs and their families can greatly benefit from HMOs as they provide access to quality healthcare services at an affordable cost. HMOs offer various healthcare services, such as consultations, diagnostic tests, and hospitalization, which can greatly ease the financial burden of medical expenses.
OFWs can choose to include their families in their HMO coverage, ensuring that their loved ones also have access to medical care. Additionally, HMOs often have a wide network of accredited hospitals and clinics, making it convenient for OFWs and their families to access healthcare services even when they are in different parts of the country.
By enrolling in an HMO, OFWs and their families can have peace of mind knowing that their healthcare needs are covered, regardless of their location or financial situation.
How do HMOs work?
By paying a fee on a monthly, quarterly, semi-annual, or annual basis, members of an HMO can utilize a network of healthcare providers, such as doctors, dentists, hospitals, and clinics, through prepaid health products.
Benefits of Getting an HMO Plan
1. Comprehensive Healthcare Coverage
HMO plans offer comprehensive healthcare coverage that includes consultations, diagnostic tests, hospitalization, and even dental and vision services. This coverage can greatly ease the financial burden of medical expenses and ensure that you have access to the healthcare services you need.
2. Wide Network of Accredited Providers
HMOs have a wide network of accredited hospitals, clinics, and healthcare providers. This means that you can choose from a range of healthcare providers in your area, ensuring that you have access to quality medical care when you need it.
3. Cashless Transactions
HMOs often provide cashless transactions, meaning that you won’t have to pay upfront for medical expenses. Instead, the HMO will directly pay the healthcare provider on your behalf.
4. Preventive Healthcare
Many HMO plans include preventive healthcare services such as annual check-ups, vaccinations, and health screenings. This can help you maintain good health and catch potential health problems early on.
5. Affordable Monthly Premiums
HMO plans offer affordable monthly premiums that can fit into your budget. This allows you to have access to quality healthcare services without worrying about the high costs.
In summary, getting an HMO plan in the Philippines provides comprehensive healthcare coverage, a wide network of accredited providers, cashless transactions, preventive healthcare, and affordable monthly premiums. By enrolling in an HMO plan, you can have peace of mind knowing that your healthcare needs are covered, regardless of your financial situation.
Standard HMO Coverage in the Philippines
When it comes to healthcare, it is important to have access to a range of services to address different health concerns. HMOs offer various healthcare services, including out-patient care, in-patient care, emergency care, and preventive care. Here is a guide to these different types of healthcare services offered by HMOs in the Philippines:
- Out-patient Care: This includes consultations with healthcare professionals, as well as laboratory and diagnostic tests, such as X-rays, ultrasounds, and blood tests. HMOs typically cover the cost of out-patient care through their network of accredited providers.
- In-patient Care: This includes hospitalization, operating room and recovery room fees, and professional fees for doctors and nurses. HMOs cover the cost of in-patient care, including hospital room and board, up to a certain limit or as specified in the HMO plan.
- Emergency Care: This includes emergency room visits, professional fees, hospital bills, and medicines for treatment. HMOs provide coverage for emergency care, including ambulance services and emergency room fees.
- Preventive Care: This includes annual physical exams, immunizations, and other preventive healthcare services. HMOs often offer preventive care services at no additional cost or at a discounted rate to encourage members to stay healthy.
2 Types of HMO Plans
1. Comprehensive HMO Plans
These are traditional HMO products that offer a wide range of healthcare benefits, including out-patient care, in-patient care, emergency care, and preventive care. These plans often have higher annual premiums, ranging from Php 4,000 to Php 60,000, but provide comprehensive coverage for healthcare needs.
2. Prepaid Health Cards
Prepaid health cards are a more affordable option for low to middle-income earners in the Philippines. These cards offer HMO coverage in “tingi” or sachet amounts, similar to buying a small sachet of shampoo instead of a large bottle. These plans often have a one-time payment of around Php 100 to Php 5,000 and provide coverage for a single-use in a year.
When choosing between these two options, it’s important to consider your healthcare needs and budget. Comprehensive HMO plans offer more extensive coverage for a higher premium, while prepaid health cards provide more affordable coverage for a limited range of healthcare services.
The Difference between HMO, PhilHealth & Health Insurance
HMOs, PhilHealth, and health insurance plans all provide healthcare benefits to Filipinos, but they differ in their service providers, regulating government agencies, cost, standard benefits, and benefit availment.
HMO companies like Maxicare, Intellicare, and MediCard are the service providers for HMO plans. They are regulated by the Insurance Commission and offer a wide range of benefits that cover out-patient care, in-patient care, emergency care, and preventive care. HMO plans have an annual cost ranging from Php 100 to Php 60,000+ for self-employed members, and they offer immediate use in any accredited healthcare provider upon presentation of an HMO card.
PhilHealth is a national government agency that regulates the PhilHealth health insurance plan. PhilHealth provides standard benefits that cover out-patient care, in-patient care, maternity, and certain diseases through the Z benefits program. The annual cost for PhilHealth ranges from Php 2,400 to Php 3,600 for self-employed members. Benefit availment for PhilHealth involves reimbursement of healthcare costs in some cases, while in other cases, it is directly deducted from the hospital bill.
Health insurance plans are provided by life insurance companies like Sunlife, Manulife, AXA Life, and PruLife. They are regulated by the Insurance Commission and offer benefits that cover out-patient care, in-patient care, and critical illness. Health insurance plans also provide life insurance and savings benefits. The cost for health insurance plans starts at Php 40,000 annually, and benefit availment involves reimbursement.
In summary, the main differences between HMOs, PhilHealth, and health insurance plans in the Philippines include their service providers, regulating government agencies, cost, standard benefits, and benefit availment. By understanding these differences, Filipinos can make informed decisions on which health insurance plan best fits their healthcare needs and budget.
List of Popular HMO Providers in the PH
1. Maxicare HealthCare
Maxicare is one of the largest and most reputable HMO providers in the Philippines, offering its services to over 1 million members across the country. Maxicare has partnered with more than 1,000 hospitals and 56,000 affiliate doctors and specialists.
Maxicare provides in-patient, out-patient, preventive, and emergency care, as well as an annual check-up. Maxicare also offers additional benefits such as dental care, Maxicare’s International Assist Program, and coverage for dreaded diseases/conditions.
Maxicare’s maximum benefit limit is Php 200,000. Maxicare’s monthly premiums start at Php 18,000 based on an annual payment amount.
Best for: Individual and family plans, corporate HMO sponsorship.
2. Intellicare
Intellicare is one of the pioneers of HMO in the Philippines, and its focus is on providing reasonable HMO plans for employees of companies and business owners. Intellicare provides annual physical exams, in-patient and out-patient care, emergency care/confinement, and additional benefits covering lab tests and similar procedures.
Intellicare also offers optional dental care. Intellicare’s maximum benefit limit varies depending on the HMO package selected by the company, and the monthly premiums also vary based on the HMO package.
Best for: Small and medium-sized business owners and corporate accounts.
3. Medicard Philippines
Medicard has almost four decades of experience in providing healthcare services and has established itself as one of the most recognized names in HMO in the Philippines. Medicard has multiple plans that cater to various needs (OFW, family, corporate, etc.).
Medicard members only pay for what they use, as unused funds are returned. Medicard provides hospitalization, outpatient services, preventive care services, annual physical exams, and lab tests for blood chemistries. Medicard also offers optional dental services.
Medicard’s maximum benefit limit is up to Php 150,000 for its Kabayan plan and Php 95,000 for its Select plan. Medicard’s monthly premiums start at Php 3,000 per year.
Best for: Individuals and OFWs.
4. Caritas Health Shield
Caritas Health Shield has been operating for over 20 years with 76 branches and 15 Clinica Caritas all across the country. Caritas Health Shield has a network of 14,000 doctors and has served more than 800,000 members.
Caritas Health Shield offers coverage for special diagnostic procedures, hospitalization benefits, medical expense benefit outpatient services, emergency care, annual physical examination, preventive health care, dental care, membership privileges outpatient services, and 4-way insurance benefits.
Caritas Health Shield’s maximum benefit limit varies based on computation, and the monthly premiums can be obtained by visiting their website.
Best for: Individuals looking for 6 or 10-year HMO coverage. They also have a Kiddie Health Plan that provides coverage for 10 years.
5. Philhealth Care (PhilCare)
PhilCare is one of the first HMO providers in the Philippines, established in 1982 as Philippine Health Systems.
PhilCare offers comprehensive healthcare coverage, including preventive care, outpatient care, emergency room care, hospitalization, pre-existing conditions coverage, PhilCare also provides access to a wide network of healthcare providers across the country, giving members flexibility and convenience when seeking medical care.
Best for: People seeking a comprehensive healthcare package that prioritizes their overall well-being and encourages a healthy way of life.
6. ValuCare Health System
ValuCare is ideal for family accounts and offers affordable quality healthcare with over 1,300 accredited hospitals and clinics, 990 dental clinics, and 19,000+ medical specialists.
Their services include Out-Patient, In-Patient, Emergency, Preventive Health, Dental Benefits, Valu+Features, Financial Assistance, and Special Modalities. To get a quote on their monthly premiums, visit their website.
Best for: Families, ValuCare Health System also provides HMO plans for corporate accounts with a minimum of 20 regular employees.
7. Eastwest Health Care
Eastwest Health Care offers efficient health care options at affordable prices with practical coverage. It’s best for individuals and families looking for a budget-friendly HMO plan.
Their services include In-Patient Care, Out-Patient Care, and Life Insurance up to Php250,000. The monthly premium starts at Php8,371 based on the annual payment amount.
Best for: those seeking a reasonably-priced HMO package for themselves or their families.
8. Avega Managed Care
Avega is ideal for corporate HMO services and offers medical services to client-companies that need health plans for their workforce. They work with 800 hospitals and have 12,000 doctors/medical specialists in their network.
Their services include Annual Physical Exam (APE), In-Patient Care, Out-Patient Care, Emergency Care/Confinement, and additional benefits covering lab tests and other similar procedures. The monthly premium and maximum benefit limit vary depending on the HMO package selected by your company.
Best for: Corporate HMO services
9. Insular Health Care (InLife)
InLife offers affordable HMO packages perfect for budget-conscious individuals who want decent medical coverage.
Their services include Doctor’s professional fee, Laboratory and diagnostic procedures, Emergency room care, Regular private room accommodations, Medicines as medically necessary, Surgery and surgeon’s fees, Use of operating room, recovery room, and ICU, and Special modalities of treatment.
The monthly premium starts at P700 for a one-time payment only and the maximum benefit limit is up to 100,000.
Best for: individuals who are mindful of their budget and seeking an HMO card that can be used on an as-needed basis in case of emergencies.
10. Pacific Cross Health Care
Pacific Cross provides HMO, Medical, Travel, and Personal Accident Insurance with a focus on the ASEAN region. Their services include Basic hospital benefits, Coverage abroad, Critical Care, Surgical Fees, Emergency Out-patient, Emergency Dental services, Emergency local ambulance service, Daily hospital allowance, Recreational Contact Sports Coverage, and Worldwide emergency assistance.
It’s best for frequent travelers. The monthly premium starts at P23,000 annually for the Lifestyle Plan, and the maximum benefit limit is up to P250,000 per illness per lifetime.
Best for: Frequent flyers
11. CareHealth Plus
CareHealth Plus is a subsidiary of Metro Pacific Investments Corporation, one of the largest conglomerates in the Philippines. CareHealth Plus offers affordable healthcare plans that cover preventive care, inpatient and outpatient services, emergency care, and specialty treatments like maternity and dental care.
CareHealth Plus also provides access to a growing network of healthcare providers nationwide, making it easier for members to access quality healthcare services.
Best for: individuals looking for an HMO that provides optimum LifeCare benefits through customer-driven health care programs, and is committed to maintaining high ethical and professional standards.
Guide to Choosing the Right HMO Provider
Choosing the right HMO provider can be a daunting task, but it is essential to make an informed decision to ensure that you get the best healthcare coverage for you and your loved ones. Here are some guidelines to help you choose the right HMO provider:
- Evaluate your healthcare needs: Start by assessing your healthcare needs and those of your family members. Consider your medical history, current health condition, and the type of services that you may require in the future. This will help you narrow down your options and choose an HMO provider that offers the services you need.
- Research HMO providers: Conduct research on the HMO providers available in your area. Check their websites to find out about their services, network of healthcare providers, and the cost of their plans. Read reviews from their current and past clients to get an idea of their reputation and the quality of services they offer.
- Check the HMO’s network of healthcare providers: Ensure that the HMO provider has a wide network of healthcare providers, including hospitals, clinics, and specialists in your area. This will ensure that you have access to quality healthcare services whenever you need them.
- Consider the cost: Compare the cost of HMO plans from different providers to find one that fits your budget. Look for any hidden costs, such as co-payments, deductibles, and exclusions in the plan, to avoid any surprises later on.
- Check the coverage: Make sure that the HMO plan covers the services you need, such as preventive care, prescription drugs, laboratory tests, and hospitalization. Look for any restrictions or limitations in the plan, such as pre-existing conditions or waiting periods.
- Customer service: Choose an HMO provider with excellent customer service. They should be responsive to your inquiries, complaints, and feedback. Check if they have a 24/7 customer service hotline or online support to address your concerns promptly.
- Accreditation: Ensure that the HMO provider is accredited by the relevant government agency or industry association. This will guarantee that they comply with the minimum standards and regulations for HMO providers.
Frequently Asked Questions
1. What is an HMO provider in the Philippines?
An HMO provider in the Philippines is an insurance company that offers health care services to its members. HMO providers offer medical services through a network of doctors, hospitals, and other healthcare providers.
2. What services do HMO providers in the Philippines offer?
HMO providers in the Philippines offer a wide range of health care services, including preventive care, medical consultations, diagnostic tests, hospitalization, and other medical treatments. They also provide dental services, vision care, and prescription drug benefits.
3. What are the benefits of getting an HMO plan in the Philippines?
The benefits of getting an HMO plan in the Philippines include access to quality healthcare services, lower out-of-pocket costs, and financial protection from unexpected medical expenses. HMO providers also offer preventive care services that help members maintain good health and prevent illnesses.
4. How do I choose the right HMO provider in the Philippines?
When choosing an HMO provider in the Philippines, consider the network of doctors and hospitals, the range of services offered, the cost of the plan, and the reputation of the company. It’s also important to consider the exclusions and limitations of the plan to ensure that it meets your healthcare needs.
5. How much does an HMO plan cost in the Philippines?
The cost of an HMO plan in the Philippines varies depending on the coverage and the level of benefits offered. Generally, the more comprehensive the plan, the higher the cost. It’s important to choose a plan that fits your budget and healthcare needs.
6. Can I choose my own doctor with an HMO plan in the Philippines?
HMO plans in the Philippines have a network of doctors, hospitals, and other healthcare providers. Members can choose a healthcare provider within the network. However, some HMO providers may allow members to choose their own doctor outside the network, but at a higher cost.
7. What is the difference between an HMO plan and a health insurance plan in the Philippines?
An HMO plan in the Philippines provides access to healthcare services through a network of doctors, hospitals, and other healthcare providers. Health insurance plans, on the other hand, provide financial protection for medical expenses, but may not offer access to healthcare services. Some HMO providers also offer health insurance plans as part of their product portfolio.
8. Are pre-existing conditions covered under an HMO plan in the Philippines?
Pre-existing conditions may or may not be covered under an HMO plan in the Philippines. It’s important to review the terms and conditions of the plan before enrolling to ensure that pre-existing conditions are covered, or to understand any exclusions or limitations that may apply.
Summary
In conclusion, healthcare is a critical aspect of every Filipino’s life, and having access to quality medical services can be financially challenging. The good news is that HMOs offer affordable options to access medical services and treatment. By choosing the right HMO, Filipinos can gain peace of mind knowing that they have access to the best healthcare services without the burden of high costs. This blog aims to help readers navigate the top HMO available in the Philippines, empowering them to make informed decisions about their healthcare needs.
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