Sunday Inquirer Magazine
By Tessa SalazarInquirerFirst Posted 09:01:00 10/21/2007
MANILA, Philippines - Insurance companies can cover your life, your home and property, bank deposits, cars, and even specific body parts (remember Jamie Lee Curtis’ million-dollar legs?). So why shouldn’t you get your health covered? After all, next to death and taxes, illnesses are inevitable. And with medical expenses being what they are, ailing persons need all the help and assistance that a health maintenance organization (HMO) can offer, until they’re back on their feet.
Just how important is health insurance and HMOs? Isn’t the government’s Philhealth coverage enough? How do we choose which HMOs to entrust with our health?
Several doctors outside the HMO circle offer their views: cardiologist Dr. Willie T. Ong, general practitioner Dr. Liza Ong (both from the Movement of Idealistic and Nationalistic Doctors), pediatrician Dr. Philip Cruz, orthopedic surgeon Dr. Erickson Zoleta, and fellows from the website www.pinoy.md, a worldwide support group and advocate of Pinoy doctors here and abroad.
Yes, the doctors agree, we all need medical insurance in the Philippines, and here’s why: In 2005, the health sector got a measly 1.1 percent of the national budget. And, with the current exodus of health workers and the closing down of several government-owned hospitals, the public is left with no recourse but to get treatment in an understaffed, ill-equipped government hospital, or to pay through the nose at some privately-owned hospital.
There are three options to cover medical costs: out-of-pocket (patients have to pay their own way), HMOs/medical insurance, and Philhealth, the government’s version of medical insurance.
Can the ordinary Pinoy afford to pay his medical bills? Taking into account the skyrocketing costs of medical treatment, most likely they can’t. This is where medical insurance becomes crucial to give the typical Filipino family financial security when immediate medical attention is needed.
With medical insurance, companies can also provide more affordable health benefits for their employees and their dependents, cites Dr. Liza Ong. Unfortunately, she adds, being a Philhealth member is no longer tenable as far as covering medical expenses is concerned. Better to be a member of both Philhealth and an HMO, as this would assure bigger coverage, the GP advises.
Getting HMO coverage for one’s employees is also more cost-effective and limits the doctors’ fees as well, concurs Dr. Willie Ong.
So how do these complementary HMOs work together? Normally, the Philhealth coverage would be deducted from the treatment and room expenses, with the excess expenses to be covered by the company’s or the individual’s HMO. Any outstanding amount would then have to be paid for by the patient out-of-pocket.
A Philhealth voluntary member has a fixed contribution of P300 per quarter. Contributions or premiums from government and private employees range from P100 to P300 depending on their salary. The benefit packages for room and board range from P200 to P400 a day The Philhealth website http://www.philhealth. gov.ph/ provides a detailed contribution and benefits breakdown for its members.
Be advised, though, that there’s a limit to how much Philhealth will cover in medicine bills, with the maximum amount pegged at about P35,000. Most HMOs also require prospective members to become Philhealth members first.
So, how does one go about choosing the right HMO?
Cruz estimates that HMO premium contributions range from P300 to P500 a month for a coverage of P50,000 to P70,000. For dreaded diseases, he estimates the coverage to range from P100,000 to P300,000.
Ong advises prospective members to read the fine print in HMO contracts. Find out what diseases are covered and what aren’t. Some HMOs do not cover expenses for pregnancies, heart diseases, high blood pressure, congenital problems, or any medical condition pre-existing at the time one signs the contract. Prospective members must also find out if the HMO will cover accidents not related to work.
It is wise as well to do background checks on HMOs. “Ask your friends who have had experiences with a particular HMO if they are good payers, if they keep good doctors, and if member-patients get to choose which doctors to go to,” GP Ong cautions. “Are they widely accessible and are available in many hospitals and shopping malls? During health crises, the nearer the health facility, the better,” she points out.
Cruz and Zoleta explain that one type of medical insurance policy, generally called the “indemnity coverage,” means that the insured can go to any doctor, hospital or health care provider, and the insurance company and the patient would share the tabs.
In addition to indemnity plans, there are basically three types of managed care plans: PPOs, HMOs, and POS plans. Preferred Provider Organizations (PPOs) are similar to an indemnity plan. A PPO has arrangements with doctors, hospitals and other care providers who have agreed to accept lower fees from the insurer for their services. As a result, the patients’ incurred costs should be lower than those outside the network.
HMOs offer members a range of health benefits, including preventive care, for a set monthly fee. There are many kinds of HMOs. If doctors are employees of the health plan and you visit them at central medical offices or clinics, it is a staff or group HMO. Other HMOs go into contracts with physician groups or individual doctors who have private offices. These are called individual practice associations (IPAs) or networks.
A POS (point of service) plan of health insurance is the hybrid of HMOs and PPOs. With POS, the patient may choose a primary care physician, and can still be covered even if he/she chooses a provider out of the system, for special care. This type of plan is cheaper than a PPO as far as premiums go; but the out of pocket expenses, should the patient decide to go outside his approved network of healthcare providers, would be much higher.
There is no “best” plan for any individual. It depends on one’s medical needs at the moment and in the future, and on one’s capacity to pay. But before you do sign that health insurance policy, read and understand the health manuals/booklets that the HMOs and other health plan organizations hand out. The benefits of being in good health, and the costs of being in a health crisis situation, could lie in the fine print.
List of Clearance to Operate-HMO Health Maintenance Organizations CY 2007Source: Bureau of Health Facilities and Services, Department of Health
1. Medicard Philippines, Inc. (http://www.medicardphils.com)
2. Getwell Foundation, Inc.
3. Mancare Health Systems, Inc.
4. Medocare Systems Inc. (http://www.medobserver.com/mar2005/indnews.html)
5. Fortune Medicare, Inc. (http://www.fcarehmo.com.ph/)
6. Blue Cross Health Care Inc
7. Metro Care Health Systems Inc.
8. Asalus Corp (Intellicare)
9. Kaiser International Healthgroup Inc (http://kaiserhealthgroup.com/images/faq.htm)
10. Philamcare Health Systems Inc. (www.philamlife.com.ph/philamcare/html/corp/aboutus/companybg.html
11. St. Patrick’s Healthcare Systems, Inc (SPCARE) (http://www.spcare-ph.com/)
12. Maxicare Healthcare Corp
13. Medical Services Marketing and Development Inc. (MedServ) (http://medserv.com.ph/index.php)
14. Prudentialife Healthcare Inc. (http://www2.prudentialife.com/prudentialifecare/acc_hospitals_clinic.asp)
15. Value Care Health Systems, Inc (http://www.valucare.com.ph/)
16. Health Maintenance, Inc. (first HMO in the country)
17. Insular Life Health Care Inc (http://www.insularlife.com.ph/wwa7.html)
source:
http://showbizandstyle.inquirer.net/sim/sim/view/20071021-95769/Homing-in-on-the-right-HMO
By Tessa SalazarInquirerFirst Posted 09:01:00 10/21/2007
MANILA, Philippines - Insurance companies can cover your life, your home and property, bank deposits, cars, and even specific body parts (remember Jamie Lee Curtis’ million-dollar legs?). So why shouldn’t you get your health covered? After all, next to death and taxes, illnesses are inevitable. And with medical expenses being what they are, ailing persons need all the help and assistance that a health maintenance organization (HMO) can offer, until they’re back on their feet.
Just how important is health insurance and HMOs? Isn’t the government’s Philhealth coverage enough? How do we choose which HMOs to entrust with our health?
Several doctors outside the HMO circle offer their views: cardiologist Dr. Willie T. Ong, general practitioner Dr. Liza Ong (both from the Movement of Idealistic and Nationalistic Doctors), pediatrician Dr. Philip Cruz, orthopedic surgeon Dr. Erickson Zoleta, and fellows from the website www.pinoy.md, a worldwide support group and advocate of Pinoy doctors here and abroad.
Yes, the doctors agree, we all need medical insurance in the Philippines, and here’s why: In 2005, the health sector got a measly 1.1 percent of the national budget. And, with the current exodus of health workers and the closing down of several government-owned hospitals, the public is left with no recourse but to get treatment in an understaffed, ill-equipped government hospital, or to pay through the nose at some privately-owned hospital.
There are three options to cover medical costs: out-of-pocket (patients have to pay their own way), HMOs/medical insurance, and Philhealth, the government’s version of medical insurance.
Can the ordinary Pinoy afford to pay his medical bills? Taking into account the skyrocketing costs of medical treatment, most likely they can’t. This is where medical insurance becomes crucial to give the typical Filipino family financial security when immediate medical attention is needed.
With medical insurance, companies can also provide more affordable health benefits for their employees and their dependents, cites Dr. Liza Ong. Unfortunately, she adds, being a Philhealth member is no longer tenable as far as covering medical expenses is concerned. Better to be a member of both Philhealth and an HMO, as this would assure bigger coverage, the GP advises.
Getting HMO coverage for one’s employees is also more cost-effective and limits the doctors’ fees as well, concurs Dr. Willie Ong.
So how do these complementary HMOs work together? Normally, the Philhealth coverage would be deducted from the treatment and room expenses, with the excess expenses to be covered by the company’s or the individual’s HMO. Any outstanding amount would then have to be paid for by the patient out-of-pocket.
A Philhealth voluntary member has a fixed contribution of P300 per quarter. Contributions or premiums from government and private employees range from P100 to P300 depending on their salary. The benefit packages for room and board range from P200 to P400 a day The Philhealth website http://www.philhealth. gov.ph/ provides a detailed contribution and benefits breakdown for its members.
Be advised, though, that there’s a limit to how much Philhealth will cover in medicine bills, with the maximum amount pegged at about P35,000. Most HMOs also require prospective members to become Philhealth members first.
So, how does one go about choosing the right HMO?
Cruz estimates that HMO premium contributions range from P300 to P500 a month for a coverage of P50,000 to P70,000. For dreaded diseases, he estimates the coverage to range from P100,000 to P300,000.
Ong advises prospective members to read the fine print in HMO contracts. Find out what diseases are covered and what aren’t. Some HMOs do not cover expenses for pregnancies, heart diseases, high blood pressure, congenital problems, or any medical condition pre-existing at the time one signs the contract. Prospective members must also find out if the HMO will cover accidents not related to work.
It is wise as well to do background checks on HMOs. “Ask your friends who have had experiences with a particular HMO if they are good payers, if they keep good doctors, and if member-patients get to choose which doctors to go to,” GP Ong cautions. “Are they widely accessible and are available in many hospitals and shopping malls? During health crises, the nearer the health facility, the better,” she points out.
Cruz and Zoleta explain that one type of medical insurance policy, generally called the “indemnity coverage,” means that the insured can go to any doctor, hospital or health care provider, and the insurance company and the patient would share the tabs.
In addition to indemnity plans, there are basically three types of managed care plans: PPOs, HMOs, and POS plans. Preferred Provider Organizations (PPOs) are similar to an indemnity plan. A PPO has arrangements with doctors, hospitals and other care providers who have agreed to accept lower fees from the insurer for their services. As a result, the patients’ incurred costs should be lower than those outside the network.
HMOs offer members a range of health benefits, including preventive care, for a set monthly fee. There are many kinds of HMOs. If doctors are employees of the health plan and you visit them at central medical offices or clinics, it is a staff or group HMO. Other HMOs go into contracts with physician groups or individual doctors who have private offices. These are called individual practice associations (IPAs) or networks.
A POS (point of service) plan of health insurance is the hybrid of HMOs and PPOs. With POS, the patient may choose a primary care physician, and can still be covered even if he/she chooses a provider out of the system, for special care. This type of plan is cheaper than a PPO as far as premiums go; but the out of pocket expenses, should the patient decide to go outside his approved network of healthcare providers, would be much higher.
There is no “best” plan for any individual. It depends on one’s medical needs at the moment and in the future, and on one’s capacity to pay. But before you do sign that health insurance policy, read and understand the health manuals/booklets that the HMOs and other health plan organizations hand out. The benefits of being in good health, and the costs of being in a health crisis situation, could lie in the fine print.
List of Clearance to Operate-HMO Health Maintenance Organizations CY 2007Source: Bureau of Health Facilities and Services, Department of Health
1. Medicard Philippines, Inc. (http://www.medicardphils.com)
2. Getwell Foundation, Inc.
3. Mancare Health Systems, Inc.
4. Medocare Systems Inc. (http://www.medobserver.com/mar2005/indnews.html)
5. Fortune Medicare, Inc. (http://www.fcarehmo.com.ph/)
6. Blue Cross Health Care Inc
7. Metro Care Health Systems Inc.
8. Asalus Corp (Intellicare)
9. Kaiser International Healthgroup Inc (http://kaiserhealthgroup.com/images/faq.htm)
10. Philamcare Health Systems Inc. (www.philamlife.com.ph/philamcare/html/corp/aboutus/companybg.html
11. St. Patrick’s Healthcare Systems, Inc (SPCARE) (http://www.spcare-ph.com/)
12. Maxicare Healthcare Corp
13. Medical Services Marketing and Development Inc. (MedServ) (http://medserv.com.ph/index.php)
14. Prudentialife Healthcare Inc. (http://www2.prudentialife.com/prudentialifecare/acc_hospitals_clinic.asp)
15. Value Care Health Systems, Inc (http://www.valucare.com.ph/)
16. Health Maintenance, Inc. (first HMO in the country)
17. Insular Life Health Care Inc (http://www.insularlife.com.ph/wwa7.html)
source:
http://showbizandstyle.inquirer.net/sim/sim/view/20071021-95769/Homing-in-on-the-right-HMO
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