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The Lowdown on PhilHealth, HMOs, and Health Insurance in the Philippines

Good health shouldn't be complicated. Here, we break down how healthcare works.
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Suck at money? Congrats. You’re part of the 99 percent of people in their 20s floundering when it comes to finance. Adulting is hard, and money is harder—especially when it’s your own and not your parents. My Two Cents is here to break down everything you need to know about finance, business, and entrepreneurship. We’ll tackle all the basics, from how to get a business permit to how to invest in stocks, to educate the fledgling adults on how to not go broke.

Welcome to the idiot’s guide to money. Lesson No. 17: Understanding health insurance in the Philippines.

Adulting comes with aging. And aside from the white hairs and crow’s feet, the real downside with aging is the fact that we get sick. We’re not in the prime of our youth anymore. Our college-level immunity to every sort of cold and cough is gone (along with our alcohol tolerance). The real cost of adulating hits us hard when we end up in the hospital with a huge bill to pay and no way to cover it. And that’s where healthcare providers come in.

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Blame it on capitalism all you want, but there’s no changing the fact that healthcare is a business. And it’s all about finding the right company to fund your health and fitness (yes, we know how messed up that sounds).

Understanding the Different Types of Healthcare Providers in the Philippines

Before we get started, there are three types of healthcare in this country: First, there’s the mandatory Philippine Health Insurance Corporation or PhilHealth, which everyone becomes a member of upon employment. The small monthly contribution is deducted from one’s salary every month. It covers maternity benefits, a portion of a hospital room, and free inpatient services in government hospitals. There’s no age limit for PhilHealth coverage, and costs as little as P1,400 to P6,600 per year. The small payment means PhilHealth’s coverage is limited, which is why many opt for an additional healthcare provider.

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The fact of the matter is, PhilHealth is often not enough to cover all your medical expenses. Getting sick is expensive, and the sicker you are, the bigger the dent in your wallet. It’s a sad reality, but that’s why health maintenance organizations (HMO) exist to help fund healthcare in exchange for a higher monthly premium. Not all companies provide HMO upon regularization, and the ones that do can offer it free of charge or as an optional deduction from your salary. If the latter is your current situation, it might be better to find and pay for your own HMO or look for health insurance instead (we’ll get to the difference later).

HMOs offer a certain sum that can be consumed by an individual over one year. It’s handy for checkups, emergency room visits, medicine, and lab tests, but these benefits are only available at the hospitals and clinics that are part of your HMO’s network. HMO premiums can range from P10,000 to P60,000 per year, and it can cover anywhere from P50,000 to P700,000 a year. Think of it as a prepaid card for your hospital bills.

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Meanwhile, health insurance operates on a reimbursement system, so you’ll need a credit card or readily available cash. Health insurance covers practically everything, from long term hospital stays to expensive surgeries. You can even get health insurance plans that come with life insurance as well. This is the most comprehensive type of healthcare, but it comes at a cost. There is no cheap health insurance plan. The lowest plan available for any health insurance provider is around P40,000 per year.

How to Choose the Right Healthcare Provider

Now we’ve established the different types of healthcare, the next step is deciding which one is right for you.

1| Assess your health

The first step should be to analyze your health and the history of your family’s health. If you’re relatively healthy and trust you won’t ever get into a serious accident (which is impossible to predict), you can get by on PhilHealth. If you have a history of mild sicknesses, like allergies or asthma, HMOs are convenient, cover emergencies, and more affordable than health insurance. But if you have a history of cancer, diabetes, or chronic illnesses in your family, the wisest choice is health insurance.

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2| Determine what you need

Think of your healthcare plan as a postpaid phone plan (as much as it pains us to say it). What do you want to be covered in your plan? Consultation fees, medication, lab tests, inpatient and outpatient services, surgery, hospital stays, and maybe even dental. Prioritize your needs so you know what to look for in HMO and health insurance plans.

3| Consider your doctor

If you already have a trusted general or specialized doctor, then you need to consider if you’re willing to have someone else treat you, especially if you have serious illnesses that your current doctor specializes in. If you want to stay with your doctor, find out what healthcare providers his or her office accepts.

4| Determine your budget

How much are you willing to shell out for your current and future health? The smaller your premium, the smaller the coverage. You can never predict whether you’ll have a serious illness or accident in the future, but if you do (knocks on wood), it would be extremely helpful to have a financial backup plan with HMOs or health insurance.

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5| Scout for healthcare providers

Ask your friends and family what healthcare providers they subscribe to. You can always Google healthcare companies, but it wouldn’t hurt to pick up the phone to call a company’s customer service to hear all the benefits a plan has to offer.

6| Ask around regarding their reputation

Reputation is everything when it comes to healthcare. Search for reviews, testimonials, and even experiences from friends, family, and co-workers. Don’t put your life on the line with a company with a terrible reputation and questionable service.

7| Look at their network

Particularly with HMOs, you need to know how broad a company’s network is. Some HMOs have a small network with only a few accredited clinics. In case of emergencies, having a wide network is imperative.

8| Consider the hype, which is sometimes right

When it comes to healthcare, you can’t fake reputation. Some of the biggest and most successful healthcare companies are also some of the best. These are the top HMO companies of 2018 in the Philippines: Maxicare HealthCare, Intellicare, Medicard Philippines, Caritas Health Shield, Philheath Care, Value Care Health System, Eastwest Health Care, Avega Managed Care, Insular Health Care, and Pacific Cross Health Care.

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And these are the top health insurance companies in the Philippines: Pacific Cross Insurance (Blue Cross), Philippine British Assurance, QBE Seaboard Insurance, Paramount Lief and General Insurance, PGA Sompo, Insurance Co. of North America, New India Assurance, FPG Insurance, Prudential Guarantee, and Pacific Union Insurance. There are also notable life insurance companies that provide quality health insurance: PhilAm Life, AXA, Sun Life, Manulife, and PRU Life U.K.

Good health shouldn’t be optional, so we hope this breakdown of PhilHealth, HMOs, and health insurance in the Philippines was useful in understanding the local healthcare system.

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About The Author
Anri Ichimura
Staff Writer, Esquire Philippines
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