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Health and medical costs grow by about 8 percent every year. In 2017, the Philippines’ health expenditure reached about P684 billion.
Of this amount, P373 billion was paid by patients out of their pockets.
Only 20 percent was covered by the government (both local and national), 17 percent was covered by PhilHealth, 5 percent was covered by HMOs or Health Maintenance Organizations, 2 percent by private health insurance, and 2 percent by other means.
With the cost of treatment for serious illnesses like cancer and stroke rising, it’s a wonder why health insurance is not considered a priority in most Filipino households.
One of the reasons may be the lack of information about health insurance and its benefits.
Well, this article will tell you the basics that you need to know about health insurance, including a list of the top health insurance companies in the country and how you can get coverage.
What is Health Insurance?
According to Investopedia, health insurance is an insurance coverage type that is specifically for the coverage of medical or surgical expenses of the insured.
It can either pay the hospital directly or reimburse the insured for their expenses. Health insurance is usually part of the benefit packages offered by companies to their employees.
What is the Difference Between Health Insurance, PhilHealth, and HMO?
There are three types of medical insurance in the Philippines that you can choose from.
Let’s take a look at what each offers and what their differences are.
The Philippine Health Insurance Corporation or PhilHealth is a government-run insurance provider. Compared to private providers, this type of insurance is more affordable.
PhilHealth has an established insurance program that provides financial assistance to Filipino citizens who are employed or otherwise, and in need of medical attention or surgery.
If you are an employee, half of your monthly contribution will be shouldered by your employer and the other half will be deducted from your salary.
Senior citizens aged 60 and over are automatically covered by PhilHealth, and recently, the Republic Act 11228 has been passed, which means Persons with Disabilities in the country will also receive special benefits from PhilHealth.
How much financial assistance will you get as a PhilHealth member? It depends on the illness or medical condition.
HMO or Health Maintenance Organizations are private organizations providing healthcare insurance to members.
Their difference from private health insurance is that they have a network of doctors and healthcare providers. Their members can only avail of the benefits from those within that network.
The plans that are offered by HMOs are often customizable but there is usually a limit to how much financial assistance you can get in a year. The higher the premium you are paying, the bigger your annual allowance will be, too.
There are several HMO providers in the country but the most popular ones are Maxicare and MediCard. HMO membership is usually provided by private companies to their employees on top of their PhilHealth contribution.
Unlike HMOs that offer access to a limited network of healthcare providers, private health insurance companies offer access to a more extensive network.
It is not that common for companies to offer this type of insurance as a part of their benefits package, although there are a few that do.
Private health insurance premiums can be a little pricey. They are fully paid for by individuals voluntarily if they want to be insured.
If you want your family members to be covered, that would be at an additional cost. Note that this only applies to immediate family members.
These private health insurance companies are comparable to international ones and some of their policies still apply even when the insured member is out of the country.
PhilHealth, HMOs, and private health insurance providers share the same goal of covering their member’s medical bills and expenses.
It is their approach or their method of transmitting their services that vary. Take a look at this table to better understand how each health insurance provider works.
|Provider||Government||HMO companies||Private insurance companies|
|Governing Agency||DOH/Government||Insurance Commission||Insurance Commission|
|Age Covered||No age limit*Senior citizens get free coverage||Up to 65 years old||16 – 75 years old|
|Policy term||As long as members are paying.*Seniors and PWD – indefinite||Annual renewal||Fixed-term|
|Premium||Constant (Unless changes are mandated by the government)||Increases as member ages||Increases as member ages|
|Transmittal of Subsidy or Assistance||Automatic deduction from the hospital bill||Just present HMO Card and the bill will be charged against the consumable limit of your HMO coverage.||Reimbursement|
|What happens in case policy is not used in a year or contract period||The contribution goes to PhilHealth Fund||Policy defaults after the calendar year whether or not annual limit is consumed||May earn dividends that are withdrawable|
What are the Benefits & Features of Health Insurance
The three health insurance providers offer almost the same benefits but since there are a few differences, let’s talk about what each offers.
Philhealth offers coverage and medical benefits that include:
- Inpatient and Outpatient services
- Ancillary services
- Catastrophic coverage
- Maternity benefits
Included in the covered services of most HMOs are:
- Outpatient services
- Laboratory tests, medications, and other ancillary services
- Dental services
Private health insurance companies offer a lot of features and benefits. Here are some of them:
- Critical illness benefits
- Financial assistance for hospitalization and surgical expenses
- Ancillary services like laboratory tests and medication
- Financial assistance for loss of income in case of illness or accident
- Higher compensation (depending on the medical condition)
- Life insurance savings (this is offered only by some providers)
You might be thinking that what each type of health insurance offers is pretty much the same, which makes choosing a difficult or at the very least, confusing thing.
They do have ‘strengths’ of their own that should help you in making a decision.
PhilHealth is like your default insurance as anyone who is employed has this. It may not be at par with the other two when it comes to benefits, but its Z-benefits sure can be helpful in case of a critical illness.
Of course, its affordability makes it easier for Filipinos to be members, especially those from low-income families.
HMO coverage works perfectly during emergencies. You can just go to any of their accredited clinics or hospitals if you need medical attention and present your HMO card.
There will be no need to fill out long forms only to wait for days for their response nor will you need to worry about having to pay upfront just to get treated or checked.
Health insurance offers more comprehensive coverage, especially for serious illnesses for which they give higher compensation.
Being covered by a private health insurance provider will come in handy, should there be a need for a long term hospitalization or expensive medical procedures and treatments.
Then there are those additional plans and investments that come with the premium, which are not bad at all.
If your financial state allows it, availing all three is a really good idea, but if you need to choose, you have to carefully consider the coverage each provides.
What’s the Average Cost of Health Insurance in the Philippines?
PhilHealth, which is the most affordable of the three will cost you P1,400 to P6,600 a year.
This depends on how much you earn, and whether you are under the formal or informal (voluntary) bracket. If you are employed, half of the contribution should be covered by your company.
The cost of HMO premiums vary depending on the coverage you’re getting. The plans would cost anywhere from P10,000 to 60,000 per year.
As for private health insurance, the lowest plan you can get would cost you P40,000 per year.
Top 5 Health Insurance Companies in the Philippines?
As we have already explained some of the basics about PhilHealth, it won’t be included in this list anymore.
Of course, it’s still worth noting that it’s the only health insurance organization for you if you prefer one that’s run by the government and not a private company.
Medicard is considered as one of the best HMOs in the country that has an extensive network of accredited healthcare providers across the country.
They are partners with no less than 40,000 doctors and dentists and over a thousand clinics and hospitals.
They offer prepaid health cards that can be purchased without any medical exams and are valid for a year.
2. PRU Life U.K.
This life and health insurance company offers a comprehensive health insurance product called PRUWellness which can provide you with either daily or lump sum cash benefits to cover hospitalization costs.
The cash benefit you’ll get is double if you are confined due to a critical illness. You’ll also get extra funds if you need surgery or an ICU confinement.
3. Sun Life
Sun life is a known insurance company in the Philippines that offers a variety of products from insurance for education, life, retirement, and of course health.
They have a number of plans for health insurance including SUN Fit and Well, SUN Senior Care, SUN LifeAssure, SUN Healthier Life, SUN First Aid, and more. You will surely find one that fits your needs from their offerings.
Maxicare is among the HMO pioneers in the country and remains one of the top health insurance companies.
They have excellent healthcare programs and a large network of medical providers nationwide.
They have over 56,000 doctors and 1,000 partner hospitals and clinics offering services that you can benefit from. They cater to individuals, families, and companies of all sizes.
5. Caritas Health Shield
Caritas Health Shield is best known for its multi-year plans that their members get.
Their programs include the MAX Health Care Program, Enhanced Core 6 & 10 Health Care Program, Supreme Health Care Program, KIDDIE Health Care Program, and Ultra Health Care Program.
How to Get a Health Insurance in the Philippines
For most of the health insurance products or programs in the country, you can apply online.
You would be contacted by a representative and depending on the product and company, you might have to go through some medical examinations.
If you are working, your human resources department will provide you with assistance or take care of it all for you.
What’s more challenging is choosing the right insurance if you plan to avail of one voluntarily.
These tips should make the selection process easier for you.
1. Create a list of your top HMO or private health insurance providers.
Make sure that you check with hospitals and clinics in your area if they are accredited health providers of those on your list.
2. Assess the coverage offerings of your top choices and compare them with your medical needs.
For instance, if you have a pre-existing condition or you are planning to have children in the future, you should get a plan from an insurance provider that offers coverage for those.
3. Contact their representatives, ask for a quote and compare.
Don’t hesitate to talk to health insurance agents to know more about their products and specifically, how much they cost. Most agents will be happy to help you decide on the best plan based on your needs and preferences.
4. Consider your budget.
Everybody wants a premium health insurance for sure but it might not be practical if it’s going to eat up a huge chunk of your earnings and if you don’t need some of those benefits anyway.
It would only go to waste if you sign up for an expensive plan and end up not being able to pay for it.
5. By now you should have the list cut down to two or three choices.
It’s time to ask around about them and find out about their reputation. It’s likely that there are conversation threads about them on online forums and social media, so you can check those too.
Getting feedback from real members will help you decide which one to choose.
Health insurance is a great investment – a safety net if you will. It’s something that you can depend on in case of a medical emergency or any unforeseen health situations in the future.
If you find yourself in a situation where you or a family member is dealing with an illness, the last thing you want to think about is how you would pay for the cost of the hospitalization, surgeries, and more.
Having health care insurance will give you peace of mind knowing that you won’t have to worry about that. So go ahead, find the right HMO or health insurance for you and your family, and someday you’ll be glad you did.