How to Get a Health Insurance in the Philippines

Last Updated on – Dec 18, 2020 @ 12:17 pm

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.

PhilHealth

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. 

Related: How to Get Business Insurance in the Philippines

HMO

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.

Health Insurance

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.

The most well-known private health insurance providers in the country include Manulife, PRU Life U.K., and Sun Life

Also Read: How to Get a Life Insurance: Top 10 Life Insurance Companies in the Philippines

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.


PhilHealthHMOHealth Insurance
ProviderGovernmentHMO companiesPrivate insurance companies
Governing AgencyDOH/GovernmentInsurance CommissionInsurance Commission
Age CoveredNo age limit*Senior citizens get free coverageUp to 65 years old16 – 75 years old
Policy termAs long as members are paying.*Seniors and PWD – indefiniteAnnual renewalFixed-term
PremiumConstant (Unless changes are mandated by the government)Increases as member agesIncreases as member ages
Transmittal of Subsidy or AssistanceAutomatic deduction from the hospital billJust 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 periodThe contribution goes to PhilHealth Fund Policy defaults after the calendar year whether or not annual limit is consumedMay 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:

  1. Inpatient and Outpatient services
  2. Ancillary services
  3. Catastrophic coverage
  4. Maternity benefits
  5. Surgeries

Included in the covered services of most HMOs are:

  1. Outpatient services
  2. Laboratory tests, medications, and other ancillary services
  3. Surgeries
  4. Hospitalization
  5. Dental services

Private health insurance companies offer a lot of features and benefits. Here are some of them: 

  1. Critical illness benefits
  2. Financial assistance for hospitalization and surgical expenses
  3. Ancillary services like laboratory tests and medication
  4. Financial assistance for loss of income in case of illness or accident
  5. Higher compensation (depending on the medical condition)
  6. 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 6 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. 

1. MediCard

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.

Medicard Health Check Card

Benefits & Features:

  • Unlimited check-ups with their primary care physicians and select specialists
  • 20% discount on labs and tests
  • One-time annual physical exam
  • Valid for one year at any MediCard free-standing clinic where the card was bought

Price: 

  • Php 500 for 1 year

My Medicard

Benefits & Features:

  • Unlimited check-ups with select MediCard-accredited doctors.
  • One-time oral prophylaxis

Price: 

  • Php3,600 for 1 year

Medicard Family Individual

Health insurance plan for individuals and families who want coverage for hospitalization, out-patient, preventive healthcare, emergency, financial assistance, and dental care.

Benefits & Features:

  • Hospitalization
  • Out-patient
  • Preventive healthcare
  • Emergency
  • Financial Assistance
  • Dental Care

Price: 

  • Starts at Php10,000 per 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.

Benefits & Features:

  • Daily Hospital Income Benefit
  • Long-term Hospitalization Benefit
  • Dread Disease Benefit
  • ICU Benefit
  • Surgical Expense Reimbursement
  • Death Benefit from the Term Insurance

Price: 

  • Premium is based on the age of insured

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.

Sun Fit and Well

Life and health insurance plan that provides critical illness and life insurance benefits until age 100 with bonus disease prevention programs.

Benefits & Features:

Health and wellness coverage

  • Preventive wellness benefit
  • Comprehensive critical illness benefit
  • Specific cancer booster benefit
  • Life insurance protection
  • Special bonus and dividend earnings
  • Limited payment period

Price: Varies, based on insured

SUN Healthier Life 

Convenient and affordable life and health solution that offers protection benefits for helping clients get through any stage of a critical illness.

Benefits & Features:

  • Health protection
  • Insurance coverage
  • Simplified issue offer (SIO)

4. Maxicare

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.

My Maxicare

A specialized program created for individuals and families, that can be customized to fit their budget and needs.

Benefits/Features

  • In-Patient Care
  • Out-Patient Care
  • Preventive Care
  • Emergency Care
  • Annual Check-Up (ACU)
  • Dental Care (Optional)
  • Maxicare’s International Assist Program
  • Dreaded Disease/Condition

MyMaxicare LITE

A prepaid health card that provides one-time Confinement coverage for eight (8) identified illnesses:  Dengue, Malaria, Cholera, Typhoid and Paratyphoid, Gastroenteritis, Pneumonia, Leptospirosis, and Chikungunya.

Plan 1999 – Access to all Maxicare-affiliated hospitals excluding six (6) major hospitals

Plan 2499 – Access to all Maxicare-affiliated hospitals including six (6) major hospitals

Benefits/Features

  • Up to Php 25,000 coverage for confirmed cases of the following eight(8) common viral diseases
  • Easy registration via SMS. No preliminary check-up, no paperwork needed.
  • One-time availment only
  • Membership valid for 1 (one) year upon registration
  • Room and Board Accommodation – Regular Private
  • Use of Operating Room, Intensive Care Unit (ICU), Isolation Room and Recovery Room
  • Professional Fees
  • Standard nursing services
  • Medicines while in confinement
  • Whole blood products and IV fluids transfusion
  • X-ray laboratory tests and diagnostic tests
  • Anesthesia, oxygen and its administration
  • 10% discount on selected Metro Dental Services.

Maxicare EReady

This prepaid health card provides one-time coverage for illnesses or injuries that require immediate medical assistance.

Titanium Php 699 – Access to all Maxicare-affiliated hospitals excluding the 6 major hospitals.

Titanium Php 899 – Access to all Maxicare-affiliated hospitals including the 6 major hospitals.

Benefits/Features

  • Provides up to Php 15,000 one – time coverage on illnesses or injuries that arises from medical-related emergency conditions
  • Eligible for individuals from 15 days old to 65 years old
  • One-time availment, but up to two enrollment registration per person per year
  • Easy registration via SMS and Online! – No preliminary check-up, no paperwork
  • Nationwide ER access to over 1000 Maxicare-affiliated hospitals
  • Member can avail in one accredited hospital only within 24 hours
  • Card Validity is up to one (1) year upon activation
  • Doctor’s Services for Emergency Treatment
  • Emergency Room Fees
  • Medicines used for immediate relief and during treatment
  • Oxygen, IV fluids, whole blood, and human blood products
  • Dressings, casts, sutures
  • X-ray, laboratory, and diagnostic exams

Maxicare EReady Advance

A prepaid health card that provides a one-time coverage for Emergency related cases including those requiring confinement with unlimited Outpatient Consultations within Maxicare’s network of Primary Care Center (PCC).

Platinum Php 2950 – Access to all Maxicare-affiliated hospitals excluding the 6 major hospitals.

Platinum Php 3950 – Access to all Maxicare-affiliated hospitals including the 6 major hospitals.

Benefits/Features

  • Provides up to ₱50,000 coverage on emergency treatment including those requiring confinement, in a regular private room
  • Eligible for individuals from 15 days old to 65 years old
  • One-time use only
  • Easy registration via SMS and Online! – No preliminary check-up, no paperwork
  • Nationwide ER access to Maxicare-affiliated hospitals
  • Card Validity is up to one (1) year upon activation

Emergency Room Coverage: 

  • Doctor’s Services for Emergency Treatment
  • Emergency Room Fees
  • Medicines used for immediate relief and during treatment
  • Oxygen, IV fluids, whole blood, and human blood products
  • Dressings, casts, sutures
  • X-ray, laboratory, and diagnostic exams

Inpatient Care Coverage 

  • Room and board accommodation in a regular private room
  • Use of Operating Room, Intensive Care Unit (ICU), Isolation Room (if prescribed by the accredited attending physician), and Recovery Room
  • Standard nursing services
  • Medicines when in confinement
  • Whole blood products, and IV fluid transmission
  • X-ray, laboratory, and diagnostic tests
  • Anesthesia, oxygen and its administration

Additional Benefit

  • Free and unlimited consultations in Maxicare Primary Care Centers nationwide
  • Access to Maxicare 24/7 TeleConsult
  • 10% discount on selected Metro Dental services. (www.metrodental.com.ph)
  • Emergency medical evacuation for members who are more than 150km from the place of residence
  • With Group Life with Accidental Death, Dismemberment and Disablement (ADD&D) coverage up to Php 50,000.00

Maxicare PRIMA

Maxicare PRIMA is a prepaid healthcare plan for individuals that offers unlimited Outpatient Consultations, and access to 255 types of laboratory and diagnostic procedures within Maxicare’s network of Primary Care Centers (PCC) and MyHealth Clinics.

PRIMA Silver Php 4,999

  • For 0-59 years old 
  • Access to all Maxicare Primary Care Centers (PCC) only 

PRIMA Gold Php 12,999

  • For 60 years old and up 
  • With Emergency Care Coverage for up to Php 20,000
  • Access to all Maxicare Primary Care Centers (PCC) and MyHealth Clinics for Outpatient Consultation and Lab Availments 

Benefits/Features

Unlimited outpatient consultations with any of the following:

  • Internal Medicine (IM)
  •  Obstetrician-gynecologist (OB-GYN)
  • Ears-Nose-Throat (ENT) 
  • Dermatologist
  • Pediatrician 
  • Ophthalmologist 
  • Internal Medicine (PCC physicians)
  • FREE Dental Care Coverage from MetroDental
  • Pre-existing conditions are covered
  • With a consumable Php 20,000 annual emergency room coverage for Gold members in all Maxicare-affiliated hospitals nationwide
  • Access to the 24/7 TeleConsult Service: 02 8582 1980

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.

ENHANCED Core 6

Maximum health care coverage is up to 6 years. The payment period is 5 years.

Benefits/Features:

  • Medical Expense Benefits
    • Special Diagnostic Procedures
    • Hospitalization Benefits
    • Medical Expense Benefit Outpatient Services
    • Emergency Care
  • Membership Privileges
    • Annual Physical Examination
    • Preventive Health Care
    • Dental Care
    • Membership Privileges Outpatient Services
    • Other Services
  • 4-Way Insurance Benefits
    • Credit Life
    • Term Life
    • Accidental Death
    • Waiver of Installment due to Disability

ENHANCED Core 10

Maximum health care coverage is up to 10 years. The payment period is 5 years.

Benefits/Features:

  • Medical Expense Benefits
    • Special Diagnostic Procedures
    • Hospitalization Benefits
    • Medical Expense Benefit Outpatient Services
    • Emergency Care
  • Membership Privileges
    • Annual Physical Examination
    • Preventive Health Care
    • Dental Care
    • Membership Privileges Outpatient Services
    • Other Services
  • 4-Way Insurance Benefits
    • Credit Life
    • Term Life
    • Accidental Death
    • Waiver of Installment due to Disability

Kiddie Health Plan

The KIDDIE offers a comprehensive program for a child’s needs as well as insurance coverage for the payor. Maximum health coverage is up to 10 years. The payment period is 5 years.

Benefits/Features:

  • Medical Expense Benefits
    • Special Diagnostic and Laboratory Procedures
    • Hospitalization Benefits
    • Medical Expense Benefit Outpatient Services
    • Emergency Care
  • Membership Privileges
    • Annual Well Kiddie Check-Up
    • Preventive Health Care
    • Dental Care
    • Membership Privileges Outpatient Services
  • 2-Way Insurance Benefits for the Payor
    • Credit Life
    • Waiver of Installment due to Disability

6. KanMend by FWD

KanMend offers financial support for medical treatments for customers diagnosed with any of the covered illnesses.

If you’re between 18-50 years old, you can get coverage for Php100,000 for only Php1,799 per year. 

Benefits & Features:

  • Critical Illness Starter Plan
  • Covers 42 Critical Illnesses
  • Apply and pay online (Gcash, credit card, debit card are supported)
  • 6 months free KonsultaMD telemedicine access

Premium: 

  • Php1,799 per year

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.

About Venus Zoleta

Venus Zoleta is an experienced writer and editor, specializing in personal finance and digital marketing. Hoping to retire early, she started investing and bought a home in her early 20s. This crazy cat mom eats ramen like there's no tomorrow. Stalk her on LinkedIn.

Reader Interactions

Comments

  1. CJ says

    Great read! Thank you for providing your insights about health insurance. This is very helpful for an individual with limited background, like me. Hopefully, more Filipinos will begin to prioritize healthcare moving forward.

  2. Eva Marie says

    Thank you for this well explained article about HMO.But until now I am still in doubt which Health Insurance I will avail.I have 3 option:ist is Kaiser 2nd is axa and lastly is Insular.I am 44 yrs old,owf single.I hope you help me to decide which HMO suites wt my health needs.Thank you in advance

  3. Tito Gonzaga says

    Thanks for the nice article. However, it might be much of help if you can tabulate the features and benefits of each provider for easier comparison. Also, I have to google search each provider instead of just finding a hyperlink in our article.

    I checked some of the providers, their website is likewise not user friendly and the customer support is mediocre.

    • says

      Thanks for the feedback, Tito.

      We’ve added the links to each healthcare company’s website. Local insurance companies are still heavily relying on local agents/brokers to promote and sell these services. But a lot has changed this year – and I’m assuming that they’re already working on transitioning most of these activities online – so hoping that customer support will eventually improve as well.

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