Best HMO & Prepaid Health Cards in the Philippines

Last Updated on – Nov 16, 2020 @ 4:41 am

Masakit sa bulsa ang magkasakit. Agree?

This painful reality is felt all the more by freelancers, self-employed, unemployed, and anyone with limited budget in the Philippines.

Without an employer who takes care of your health insurance, you’ll have to pay for medical bills out of your pocket. Ouch. But you can minimize your healthcare costs through an HMO.

Understand everything about HMO in the Philippines, so you can choose the right healthcare plan for you and get the most out of it.

Contents

What is HMO?

HMO stands for Health Maintenance Organization.

Republic Act 7875 (National Health Insurance Act of 1995) defines it as an “entity that provides, offers, or arranges for coverage of designated health services needed by plan members for a fixed prepaid premium.”

By themselves, HMOs are not healthcare providers. Rather, they’re the middlemen between healthcare providers and patients.

How Does HMO Work?

An HMO gives members access to its network of healthcare providers—including doctors, dentists, hospitals, and clinics—through prepaid health products for a monthly, quarterly, semi-annual, or annual fee.

Standard HMO Benefits in the Philippines

You can get these standard benefits through an HMO company:

  • Out-patient care (consultations, laboratory and diagnostic tests, etc.)
  • In-patient care (hospitalization, operating room and recovery room, professional fees, etc.)
  • Emergency care (professional fees, hospital bills, emergency room, medicines for treatments, etc.)
  • Preventive care (annual physical exam, immunizations, etc.)

2 Types of HMO Plans

HMO providers in the Philippines offer two kinds of healthcare plans:

1. Comprehensive HMO Plans

These are traditional HMO products covering a wide range of healthcare benefits, with annual premiums ranging from Php 4,000 to Php 60,000.

2. Prepaid Health Cards

Prepaid cards are a more affordable option for low-income to middle-income earners in the Philippines. They’re considered HMO plans in tingi or “sachet” amounts, much like buying a shampoo sachet if you can’t afford the more expensive bottle.

For a minimal one-time payment of around Php 100 to Php 5,000, you get an HMO coverage (usually for single-use) in a year.

Other Crucial Info About HMO

Other important things you need to know about how HMO providers work:

1. Membership

Although most HMO companies in the Philippines cater to employees, some of them are open to individuals (freelancers, self-employed, etc.) and families. Members can be newborns (as young as 15 days old), children, and adults up to 60 years old.

2. Coverage

HMO plans have a one-year coverage. They’re renewable yearly, depending on a member’s age, health status, and amount of claims filed within a year.

3. Accredited vs. Non-Accredited Healthcare Providers

Members don’t need to pay for healthcare services if they avail of them within the HMO’s network.

Medical services outside the HMO’s network aren’t covered, so members have to pay their bill in full. An exception is emergency care availment in non-accredited facilities, in which an HMO may reimburse 80% to 100% of hospitalization and professional fees.

4. Maximum Benefit Limit

The maximum benefit limit—the maximum amount an HMO can cover in a year—varies from one HMO plan to another. If you exceed this coverage limit in a year, you’ll have to pay for your succeeding medical bills on your own.

5. Integration with PhilHealth Benefits

Patients can use their HMO plan in addition to PhilHealth benefits during hospitalization. PhilHealth covers 15% to 30% of hospital expenses of its members. The HMO pays for the remaining costs up to the benefit limit.


How is HMO Different from PhilHealth and Health Insurance?

HMOs, PhilHealth, and health insurance plans provide healthcare benefits to Filipinos. However, they aren’t one and the same.

Here are the major differences between the three types of health insurance in the Philippines:

 HMOPhilHealthHealth Insurance
Service providerHMO companies (Maxicare, Intellicare, MediCard, etc.)National governmentLife insurance companies (Sunlife, Manulife, AXA Life, PruLife, etc.)
Regulating government agencyInsurance CommissionDepartment of HealthInsurance Commission
Cost per year (for self-employed members)Php 100 to Php 60,000+Php 2,400 to Php 3,600Starts at Php 40,000
Standard benefits
  • Out-patient
  • In-patient
  • Emergency
  • Preventive
  • Out-patient
  • In-patient
  • Maternity
  • Z benefits (for certain cancers and other diseases)
  • Life insurance
  • Savings
  • Out-patient
  • In-patient
  • Critical illness
Benefit availment
  • Immediate use in any accredited healthcare provider (no cash-out upon presentation of HMO card)
  • Reimbursement for emergency care costs in non-accredited facilities
  • Deducted from the hospital bill
  • Reimbursement in some cases
Reimbursement


Pros and Cons of Having an HMO?

It’s important to know the advantages and disadvantages of HMO plans before you avail of one.

4 Advantages of Getting an HMO

1. Affordable Cost

HMOs offer lower premiums than most health insurance plans. For as low as Php 100, you can receive basic healthcare within a year.

Also, having an HMO plan means you won’t have to pay upfront before you can avail of a medical service in an HMO-accredited facility.

2. Ability to Choose Your Coverage

If you’re paying for an HMO plan as an individual member, you can customize your plan based on your healthcare needs.

This is an advantage self-employed people have over employed members. Employees are tied to the HMO plan chosen by their employers, and changing HMO coverage for corporate accounts isn’t possible.

Employees can only add dependents (subject to certain restrictions) and pay for their coverage out of pocket.

3. Wide Range of High-Quality Healthcare Providers

HMO companies, especially the most established ones, have large networks of medical specialists and facilities in the Philippines.

This means members enjoy coverage for a wide range of healthcare services through HMOs than other types of health insurance.

Healthcare providers undergo an HMO’s accreditation process and must meet certain qualifications.

So you can be sure that you’ll get not only affordable but also high-quality services.

4. Peace of Mind

Having an HMO plan gives you a sense of security that any time an illness or accident strikes, you won’t need to worry about how to fund your medical expenses.

3 Disadvantages of Getting an HMO

1. Non-Coverage for Out-of-Network Healthcare

With an HMO plan, you can enjoy benefits only within the HMO’s network of specialists and facilities.

This means if you avail of a service in a non-accredited facility, your HMO provider won’t cover it, and you’ll have to pay for your medical bills on your own.

The only exception is emergency care.

For example, if you get an emergency treatment in a non-accredited hospital, some HMOs allow you to reimburse 80% to 100% of the total cost.

2. Restrictions on Healthcare Providers

Despite having a large network of providers, HMO companies usually set many limits on the physicians patients can visit and healthcare facilities they can use.

Do you prefer a specific doctor or hospital?

Your choice may not be included in your HMO’s network.

For instance, if you want to be confined in one of the major hospitals in the Philippines, your options will be limited to plans that offer this feature, typically at higher costs.

3. Benefit Exclusions

HMOs generally cater to those who need basic healthcare services such as consultations and annual physical exams—and nothing more.

Most HMO plans exclude pre-existing conditions (cancer, stroke, diabetes, etc.), maternity benefits, and dental care.

Others offer them as optional benefits for an additional premium.


Why Should You Get an HMO?

Considering the pros and cons of HMO, is it worth signing up with one?

The short answer: Of course!

Here are the biggest reasons why HMO is important for self-earning people in the Philippines:

1. Get affordable healthcare when you need it

Being a freelancer or self-employed means nobody will take care of your hospital bills—except yourself.

Getting an HMO gives your much-needed safety net for any medical need.

Can you instantly fork out Php 50,000 for hospital bills?

Losing income due to hospitalization drains your income already, and it hurts more to be burdened with expensive medical bills.

With an HMO plan, you can rest assured that after a trip to the hospital, your income and savings won’t be wiped out, and you won’t have to borrow money from anyone.

2. You can’t rely solely on your PhilHealth benefits

While PhilHealth benefits are helpful in reducing your hospital bills, they aren’t enough to cover all your medical expenses.

Also, PhilHealth doesn’t cover many healthcare services such as check-ups and annual physical exam.

This is where HMO providers bridge the gap. By getting an HMO, you’ll get a wider coverage for different medical services in the Philippines.

3. Healthcare costs in the Philippines keep rising

Did you know that the Philippines has the highest medical inflation rate in Asia?

Based on the survey of global HR consultancy Mercer Marsh Benefits, the projected Philippine medical inflation rate is 13.1% in 2018—way higher than the 6.7% consumer price inflation rate in September 2018.

The rising healthcare costs in the Philippines make having an HMO plan all the more a necessity rather than an option for freelancers and self-employed individuals.


8 Best HMO Plans for Filipinos with a Limited Budget

Good news for freelancers and self-employed Filipinos: you won’t run out of affordable, value-for-money HMO options in the Philippines.

Based on the key considerations discussed above, here are the best HMO plan for anyone with a tight budget.

1. MediCard Health Check

Ideal For: Low income-earning and tight-budgeted Filipinos who need a health card just for regular checkups or want to buy multiple health cards for their family

HMO Type: Prepaid health card for preventive healthcare

Price: Php 500

Benefits:

  • Unlimited consultations with primary care doctors
  • Annual physical exam
  • 20% discount on laboratory tests

Pros:

  • Affordable and accessible preventive healthcare
  • No age limit and required medical exam for card purchase
  • Discounts and freebies in optical shops, restaurants, wellness centers, hotels, and beach resorts
  • Online and text services for membership application and renewal

Cons:

  • Limited to preventive healthcare only; need to buy an additional health card if you want your other healthcare needs covered
  • Can be used on weekdays and by appointment only in MediCard free-standing clinics where you purchased your card
  • Consultations with specialists such as ophthalmologists and EENT doctors cost an additional Php 350 fee

2. Healthy Ka Pinoy Health Emergency Card

Ideal For: People looking for an affordable emergency health card with additional disability, death, and burial benefits

HMO Type: Prepaid health card for emergency care (a joint product between PNB Life and EastWest Healthcare)

Prices:

  • Php 720 for a maximum coverage of Php 140,000
  • Php 1,200 for a maximum coverage of Php 280,000

Benefits:

  • Two emergency medical expense availments worth up to Php 20,000 or Php 40,000 per year
  • Php 20,000 or Php 40,000 accidental burial benefit
  • Php 100,000 or Php 200,000 accidental death and disability
  • Reimbursement of emergency care costs in non-accredited hospitals

Pros:

  • Can be availed at any of 1,000 EastWest Healthcare-accredited hospitals nationwide
  • Automatic renewal through PNB’s auto-debit arrangement

Cons: Limited to emergency care only; need to buy an additional health card if you want your other healthcare needs covered


3. Maxicare EReady

Ideal For: People who want to prepare for any medical emergency without draining their money

HMO Type: Prepaid health card for emergency care

Membership Eligibility: 15 days to 65 years old

Prices: Php 549 (without major hospitals) and Php 749 (with major hospitals) for a maximum one-time coverage of Php 15,000

Benefits:

  • Emergency care services (professional fees, emergency room fee, medicines for treatment and immediate relief, diagnostic and laboratory tests, oxygen, IV fluids, dressings, casts, and sutures)
  • Up to Php 50,000 group life with accidental death and dismemberment coverage
  • 15% to 20% discount on selected Metro Dental and MyHealth services

Pros:

  • Budget-friendly safety net for any medical emergency
  • No preliminary check-up and paperwork
  • Access to 1,000 accredited hospitals nationwide

Cons: Limited to emergency care only; need to buy an additional health card if you want your other healthcare needs covered


4. PhilCare ER Vantage Plus

Ideal For: People who need a low-cost health card with higher emergency care coverage

HMO Type: Prepaid healthcare voucher for emergency care

Membership Eligibility:

  • Adults: 18 to 64 years old
  • Children: 6 months to 17 years old

Price Range:

  • Adults: Php 1,050 to Php 1,750
  • Kids: Php 2,950 to Php 4,950
PhilCare Health CardCostMaximum Coverage
ER Vantage Plus 40 for AdultsPhp 1,050Php 40,000
ER Vantage Plus 60 for AdultsPhp 1,350Php 60,000
ER Vantage Plus 80 for AdultsPhp 1,750Php 80,000
ER Vantage Plus 40 for KidsPhp 2,950Php 40,000
ER Vantage Plus 60 for KidsPhp 3,950Php 60,000
ER Vantage Plus 80 for KidsPhp 4,950Php 80,000

Benefits:

  • Up to Php 40,000, Php 60,000, or Php 80,000 (depending on card type) one-time coverage for emergency care and hospitalization for viral and bacterial diseases, and treatment of injuries from accidents
  • Up to Php 5,000 benefit for hospital confinement, professional fees, laboratory and diagnostic tests, necessary medicines, and special modalities of treatment
  • Php 50,000 accidental death and dismemberment benefits

Pros:

  • No medical exam required for card purchase
  • No hospital deposit required for availment
  • Easy SMS registration
  • Additional accident insurance

Cons:

  • Limited to emergency care only; need to buy an additional health card if you want your other healthcare needs covered
  • Expensive prices of health cards for kids; better to avail cheaper cards from another HMO provider with comparable services
  • Excludes major hospitals in Metro Manila

5. MediCard RxER

Ideal For: People willing to shell out extra bucks for a health card with a bit more comprehensive coverage

HMO Type: Prepaid health card for emergency, out-patient, and preventive care

Price: Php 1,998 for a maximum coverage of Php 20,000

Benefits:

  • Emergency care (professional fees, emergency room fees, and medicines) for burns, animal bites, and accidental chemical poisoning
  • Up to Php 5,000 worth of emergency diagnostic and laboratory tests
  • Anti-rabies immunization
  • Casting and splint
  • 100% reimbursement of professional fees and hospital bills for emergency care in non-accredited hospitals up to the coverage limit
  • Out-patient care in all MediCard free-standing clinics
  • Unlimited consultations with primary care doctors and dentists
  • 30% discount on laboratory and diagnostic tests, dental services, and surgeries at MediCard free-standing clinics
  • One-time oral prophylaxis
  • Up to Php 50,000 accidental death and disability financial assistance

Pros:

  • Affordable yet offers more comprehensive healthcare coverage than other health cards
  • No age limit and required medical exam for card purchase
  • Benefits can be used more than once (other health cards are only single-use) up to the coverage limit and within 6 hours from the accident
  • Discounts and freebies in optical shops, restaurants, wellness centers, hotels, and beach resorts
  • Online and text services for membership application and renewal

Cons: Consultations with specialists such as ophthalmologists and EENT doctors cost an additional Php 350 fee


6. Pacific Cross Select

Ideal For: People who frequently travel abroad and need a comprehensive HMO plan at a minimal cost

HMO Type: Comprehensive healthcare plan for individuals and families

Membership Eligibility: 15 days to 65 years old

Price Range: Php 4,482 to Php 58,995 annually (for a maximum coverage of Php 500,000 to Php 1.5 million), depending on age and hospital type

Benefits:

  • In-patient care (hospital confinement, professional fees, ICU, operating room and recovery room, etc.)
  • Emergency care (out-patient treatment, ambulance service, emergency dental services, overseas confinement, worldwide assistance, etc.)
  • Annual physical exam
  • In-patient benefits for a female insured’s newborn from 15th day old up to the policy renewal
  • Accidental death coverage

Pros:

  • Comprehensive in-patient and emergency care coverage at reasonable rates
  • Highest maximum coverage at Php 1.5 million among the best HMO plans on this list
  • Offers flexibility, with your own choice of doctor, specialist, or hospital
  • Coverage for confinement due to emergencies and accidents and 24/7 assistance anywhere in the world

Cons: Out-patient and dental care benefits are only optional and can be availed for additional costs


7. ValuCare Individual and Family Plans

Ideal For: Married couples (especially self-employed) who need cost-effective healthcare coverage for their family

HMO Type: Comprehensive healthcare plan for individuals and families

Membership Eligibility:

  • Principal: 18 to 60 years old
  • Dependents:
    • Legal spouse from 18 to 60 years old
    • Children/Siblings: from 90 days old to 20 years old
    • Parents below 60 years old

Price Range:

  • Quarterly: Php 2,186 to Php 7,203
  • Semi-annual: Php 4,137 to Php 13,634
  • Annual: Php 7,806 to Php 25,725

*Without access to major hospitals

*With access to major hospitals

Benefits:

  • Preventive care (immunizations, annual physical examination, etc.)
  • Out-patient care (unlimited consultations, treatments, laboratory tests, diagnostic procedures, 10 prenatal or postnatal consultations with accredited obstetricians, etc.)
  • In-patient care (hospital confinement, ICU/CCU confinement, operating room and recovery room, professional fees, blood transfusions, etc.)
  • Emergency care (doctor and hospital services, oxygen, IV fluids, laboratory and diagnostic tests, 100% professional fee reimbursement and 80% hospitalization reimbursement in non-accredited hospitals, etc.)
  • Coverage for pre-existing conditions only after the first year of membership (no coverage for dreaded diseases such as stroke, cancer, diabetes, bronchitis, etc.)
  • Medical procedures (dialysis, angioplasty, CT scan, chemotherapy, etc.)
  • Dental care (unlimited consultations, annual oral prophylaxis, temporary fillings, simple tooth extraction, annual dental examination, etc.)
  • Financial assistance ranging from Php 5,000 to Php 20,000 in case of principal’s death or dismemberment
  • Motor vehicular accident insurance
  • Ambulance service

Pros:

  • Comprehensive healthcare coverage at relatively cheaper rates than most HMOs
  • Coverage limit is on per-illness basis instead of total availment per year
  • May conduct simple laboratory tests such as urinalysis, fecalysis, and blood test at the member’s home (Metro Manila only)

Cons:

  • Coverage priority for dependents based on hierarchy (parents first for single principals; legal spouse first for married principals)
  • No access to Asian Hospital and Medical Center (one of the major hospitals in the Philippines)
  • Requires PhilHealth membership

8. PhilCare Health360

Ideal For: Young, starting families of freelancers and self-employed Filipinos

HMO Type: Comprehensive healthcare plan for individuals and families

Membership Eligibility: 6 months to 60 years old

Price Range:

  • Quarterly: Php 2,201 to Php 16,606
  • Semi-annual: Php 4,281 to Php 32,306
  • Annual: Php 8,002 to Php 60,385

Benefits:

  • Out-patient care at PhilCare-owned clinics and over 400 accredited clinics
  • In-patient care at over 500 hospitals nationwide, including major hospitals
  • Emergency care (with 100% hospitalization and professional fee reimbursement at non-accredited hospitals)
  • Annual physical exam
  • Ambulance service
  • Special modalities of treatment and diagnostic procedures (MRI, sleep study, etc.)
  • Php 100,000 term life insurance
  • Php 100,000 accidental death and dismemberment benefits

Pros:

  • High annual benefit limit ranging from Php 100,000 to Php 500,000
  • 100% emergency care reimbursement for hospital bills and doctor’s services at non-accredited facilities

Cons:

  • Dental care services are optional benefits only at an additional fee
  • Charges PhilHealth fees (Php 2,688 annually, Php 1,439 semi-annually, or Php 740 quarterly)

Complete List of HMO Providers in the Philippines

Presently, 30 HMOs in the Philippines are licensed by the Insurance Commission.

Some of them cater to individuals such as freelancers and self-employed professionals, while others serve only corporate accounts.

Here is the full list of authorized HMO companies for the license year 2017-2019 (in alphabetical order).

1. Asalus Corporation (Intellicare)

Hotlines: (02) 789-4000 | (02) 902-3400

Intellicare (formerly Asalus Corporation) serve only corporate accounts and small and medium enterprises (SMEs). It doesn’t offer individual HMO plans yet.

2. Asiancare Health Systems, Inc.

Contact Information:

  • Hotlines: (02) 519-8751 | (02) 925-5298
  • Mobile: (0917) 531-5008 | (0918) 951-9576
  • Email: info@asiancare.ph

Catering to individuals, families, SMEs, and corporations, Asiancare has only two accredited healthcare providers: Abella Midway Hospital in Bukidnon and Accumed Diagnostic Center in Pampanga.

However, the HMO reimburses costs of emergency care in non-accredited medical facilities.

3. Avega Managed Care, Inc.

Contact Information:

  • Hotlines: (02) 902-3430 | (02) 789-4030
  • Email: info@AVEGA.com.ph

Avega’s HMO plans are for corporate accounts only. It doesn’t offer HMO plans for individuals and families.

4. CareHealth Plus Systems International, Inc.

Contact Information:

  • 24/7 hotline: (02) 208-4611
  • Telephone:  (02) 247-1878 | (02) 521-8752
  • Mobile: (0977) 804-2137 | (0925) 652-1927
  • Email: carehealthplus@gmail.com

HMO Rate: Starts at Php 1,807 monthly

For individuals and families, CareHealth Plus offers two plans: the ValuePlus and OptimumCare healthcare programs. ValuePlus is the affordable package with a two-year payment period. OptimumCare has a more comprehensive coverage with a five-year payment period.

5. Carewell Health Systems, Inc.

Contact Information:

  • Hotlines: (02) 355-5771 | (02) 434-4868 | (02) 935-1237 | (02) 871-5586
  • Mobile: (0917) 538-7499 | (0998) 988-4692 | (0925) 720-4819

HMO Rate: Starts at Php 555 monthly

The Carewell health card can be used for unlimited consultations, preventive healthcare, and emergency care, among other HMO benefits in accredited hospitals and clinics.

6. Caritas Health Shield, Inc.

Contact Information:

  • 24/7 hotline: (02) 868-7000
  • Trunkline: (02) 635-7100
  • Mobile: (0917) 873-3882 | (0917) 310-3327 | (0917) 508-1023 | (0998) 579-5518 | (0922) 897-8635 | (0922) 897-8680
  • Email: memb_rels@caritasshield.com.ph

HMO Rate: Starts at Php 5,390 quarterly

Caritas Health Shield has one of the most extensive medical networks in the Philippines, with over 15,300 accredited doctors and dentists, and around 700 healthcare facilities nationwide.

7. Cooperative Health Management Federation (CHMF)

Contact Information:

  • Hotlines: (02) 899-7663 | (02) 899-7667 | (02) 931-0387 | (02) 283-2321
  • Toll-free: 180010-9310387
  • Mobile: (0917) 506-7809 | (0998) 966-8501 | (0943) 132-7628

CHMF or One Coop Health is the first cooperative HMO in the Philippines. CHMF offers low-cost medical services to cooperatives, federations, and NGOs with cooperative-related programs. It serves individual members of its member-cooperatives.

8. Dynamic Care Corporation (DCC)

Contact Information:

  • Hotlines: (049) 576-0915 | (049) 576-0913
  • Mobile: (0927) 391-4023 | (0939) 891-0315 | (0932) 879-8747 to 49
  • Email: info@dynamiccare.com.ph

Based in Sta. Rosa City, Laguna, Dynamic Care serves the Calabarzon region (Cavite, Laguna, Batangas, Rizal, and Quezon). Its accredited healthcare facilities are located in Cavite. DCC provides HMO plans to individuals, families, and corporate accounts.

9. EastWest Healthcare, Inc.

Contact Information:

  • Hotlines: (02) 556-7885 | (02) 751-3004 | (02) 751-3005
  • Mobile: (0917) 839-4979 | (0998) 964-9678 | (0932) 883-8454

HMO Rate: Starts at Php 720 annually

Established in 2006, EastWest has 13,000 doctors and over 1,000 medical facilities in its network nationwide.

Its Infinity Health Advantage program provides extensive healthcare services for individuals and families. The HMO package covers pre-existing conditions, emergency care, out-patient and in-patient care, hospital income benefit, and life insurance.

10. Fortune Medicare, Inc.

Contact Information:

  • 24/7 hotlines: (02) 857-5499 | 1-800-10-633-8888
  • Telephone: (02) 857-5400

HMO Rate: Starts at Php 250 annually

This HMO is better known as FortuneCare, one of the pioneers in the HMO industry established in 1985. Its network of 9,000 medical specialists and 400 healthcare facilities in the Philippines serve the needs of individuals, families, and corporate entities.

11. Getwell Health Systems, Inc.

Contact Information:

  • 24/7 hotline: (02) 644-2580
  • Trunkline: (02) 913-8893 | (02) 912-4196 | (02) 912-4132
  • Mobile: (0916) 260-6241 | (0917) 526-0465 | (0929) 161-9274 | (0946) 133-9790 | (0932) 988-3252 | (0922) 388-4953
  • Email: getwell_adm@yahoo.com | getwell_availments@yahoo.com

Getwell membership is exclusive to private companies, as it doesn’t offer HMO plans to individuals like freelancers and self-employed Filipinos.

12. Health Care & Development Corporation of the Philippines (HC&D)

Trunklines: (02) 801-30141 | (02) 874-8515 local 134/163/559/560

A licensed HMO based in Pamplona, Las Piñas City, HC&D was founded in 1980 to provide HMO plans to individuals, families, students, and employees at budget-friendly costs.

13. Health Maintenance, Inc. (HMI)

Contact Information:

  • 24/7 mobile: (0917) 811-1313 | (0917) 812-8806 | (0917) 811-1653 | (0917) 821-3266  | (0920) 286-1102 | (0922) 343-0575 | (0933) 352-0346
  • Trunklines: (02) 865-3728 | (02) 811-1313 local 451/453/455/456
  • Mobile: (0917) 853-3705 | (0998) 964-9792 | (0943) 136-5772 | (0943) 136-5773

HMO Rate: Starts at Php 1,810 monthly

HMI is the first HMO in the Philippines, founded in 1981. Membership is open to individuals at least three months up to 59 years old.

14. Health Plan Philippines, Inc. (HPPI)

Contact Information:

  • 24/7 hotlines: (02) 984-5065 | (0917) 826-9693 | (0922) 808-9897 | (0922) 809-0010
  • Trunklines: (02) 477-4758 to 60
  • Mobile: (0917) 879-6031

HPPI is one of the more technologically advanced in the country, with its own mobile app for finding accredited healthcare providers. However, this HMO is available only to employees.

15. IMS Wellth Care, Inc. (IWC)

Contact Information:

  • 24/7 hotline: (02) 528-0480 | (02) 525-3129
  • Mobile: (0917) 851-8645 | (0922) 822-1033 to 35

HMO Rates:

  • Prepaid health card: Php 100 annually
  • Comprehensive healthcare program: Starts at US$ 30 (approximately Php 1,617) monthly

IWC caters mostly to overseas Filipino workers (OFWs) and their families. Its network includes 8,000 medical specialists from over 400 facilities nationwide.

16. Insular Health Care, Inc.

Contact Information:

  • 24/7 toll-free hotline: 1-800-10-8177857
  • Helpdesk: (02) 813-0131 local 0 | (02) 813-0132 to 36

HMO Rate: Starts at Php 12,137 quarterly

Founded in 1991, this HMO is a subsidiary of The Insular Life Assurance Company, a leading life insurance provider in the Philippines. Membership is open to individuals 18 to 59 years old.

17. Kaiser International Healthgroup, Inc.

Contact Information:

  • Telephone: (02) 845-0888 | (02) 845-2888 | (02) 845-3888 | (02) 504-8811 | (02) 504 8812 | (02) 504 8814 | (032) 318-9828 | (032) 318-8671 | (032) 318-0880
  • Mobile: (0917) 564-2398 | (0917) 564-1498 | (0917) 564-1598 | (0998) 959-1088 | (0998) 973-0188 | (0925) 301-9888 | (0925) 305-3888 | (0925) 302-9888 | (0925) 303-7888 | (0925) 303-9888

HMO Rate: Starts at Php 10,098 annually + Php 300 one-time membership fee

Kaiser differentiates itself from other HMO companies in the Philippines through long-term healthcare services beyond its members’ employment and retirement years. It caters to individual, family, group, and corporate accounts.

18. Life & Health HMP, Inc.

Contact Information:

  • Telephone: (032) 384-1174 | (032) 255-0035 | (032) 254-6729
  • Email: info@lifeandhealthhmp.com

This Cebu-based HMO offers healthcare services only to employees and their dependents in the Philippines.

19. Marzan Health Care, Inc. (MHC)

Telephone: (02) 434-2583

Based in Quezon City, MHC is an HMO provider with diagnostic and ambulatory services.

20. Maxicare Healthcare Corporation

Contact Information:

  • 24/7 customer care hotline: (02) 582-1900 | (02) 798-7777
  • Product inquiry hotline: (02) 798-7770
  • Email: customercare@maxicare.com.ph

HMO Rates:

  • Prepaid health card: Starts at Php 549 annually
  • Individual and family health plan: Starts at Php 14,390 annually

Built in 1987, Maxicare is a leading HMO in the Philippines with a network of 56,000+ doctors and specialists, 1,000+ medical facilities, and over one million members consisting of individuals, families, SMEs, and corporate entities.

21. MediCard Philippines, Inc.

Contact Information:

  • Hotline: (02) 884-9999
  • Toll-free hotline: 1-800-1-888-9001
  • Email: inquiry@medicardphils.com

HMO Rates:

  • Prepaid health card: Starts at Php 500 annually
  • Individual/Family health plan: Starts at Php 10,739 annually

MediCard is an industry pioneer and one of the top HMO companies in the Philippines. It has almost half a million members, over 8,000 accredited medical specialists, and over 300 healthcare facilities nationwide.

Membership is open to employed and self-employed individuals. You can choose from its wide variety of plans to suit your healthcare needs, be it unlimited checkups or a more comprehensive HMO package.

22. Medicare Plus, Inc.

Contact Information:

  • 24/7 hotlines: (0917) 883-4111 | (0917) 805-0764
  • Trunklines: (02) 815-3049 | (032) 254-2567 | (082) 305-1057
  • Mobile: (0917) 867-4349 (Customer Service) | (0927) 293-6742 / (0905) 488-4290 (Sales)
  • Email: customerservice@medicareplus.com.ph

HMO Rates:

  • Prepaid health card: Starts at Php 750 annually
  • Individual/Family health plan: Starts at Php 11,541 annually

Medicare offers HMO plans to individuals, families, and companies in the Philippines, with over 15,000 accredited doctors and dentists plus 1,000 medical facilities nationwide.

23. MEDOCare Health Systems, Inc.

Contact Information:

  • Telephone: (02) 628-9044 | (02) 628-9000 | 1-800-10-MDOCARE
  • Mobile: (0915) 488-2518

MEDOCare’s network consists of over 10,000 doctors and over 1,000 hospitals and clinics in the Philippines. It offers healthcare programs for individuals and families.

24. Metrocare Health Systems, Inc.

Telephone: (02) 519-4427 | (049) 508-6064

Based in Cabuyao, Laguna, Metrocare has no website and social media accounts, but it’s an Insurance Commission-accredited HMO.

25. Optimum Medical and Healthcare Services, Inc.

Telephone: (02) 215-5430 | (02) 729-7968

This HMO is accredited at hospitals like Cardinal Santos Medical Center, De La Salle University Medical Center, and Mary Johnston Hospital.

26. Pacific Cross Health Care, Inc. (Blue Cross Health Care, Inc.)

Contact Information:

  • 24/7 hotline: (02) 230-8511
  • Email: info@pacificcross.com.ph | medical_sales@pacificcross.com.ph

HMO Rate: Starts at Php 4,482 annually

Formerly Blue Cross, Pacific Cross is a medical, travel, and accident insurance provider in the Philippines and ASEAN. Its medical benefits can be availed not only locally but also overseas. The HMO also has special healthcare plans for OFWs and senior citizens.

27. Philhealth Care, Inc. (PhilCare)

Contact Information:

Telephone: (02) 802-7333 local loc 19216 or 19224 | (02) 462-1800

Email: order@philcare.com.ph

HMO Rates:

  • Prepaid health card: Starts at Php 499 annually
  • Comprehensive health plan: Starts at Php 8,002 annually

Despite the almost identical names, Philhealth Care or PhilCare is different from PhilHealth. The former is an HMO, while the latter is the government-run health insurance provider.

Founded in 1982, PhilCare has a network of over 30,000 doctors, 1,400 healthcare facilities, and 300,000 members nationwide. Its main HMO products include individual comprehensive health programs, corporate health plans, and prepaid health cards.

28. Stotsenberg Healthcare System, Inc.

Telephone: (045) 499-4339

Stotsenberg Healthcare System is a licensed HMO company in Angeles City, Pampanga.

29. Transnational Medical & Diagnostic Center, Inc. (TDMC)

Contact Information:

  • Telephone: (02) 908-4998 | (033) 320-8936
  • Email: admin@tmdc.ph

Since 1989, TDMC has been providing comprehensive HMO programs, disease prevention, and diagnostics services to OFWs.

30. Value Care Health Systems, Inc. (ValuCare)

Contact Information:

  • 24/7 hotlines: (0917) 7-WECARE | (02) 687-3219 | (02) 317-4310 / (02) 702-3310
  • Mobile: (0917) 886-2892 | (0925) 610-0301
  • Trunkline: (02) 702-3388 / (02) 317-4388 
  • Toll-free hotlines: 1-800-1-888-1568 | 1-800-1-888-7345 
  • Email: wecare@valuecarehealth.com 

HMO Rate: Starts at Php 7,806 annually + Php 250 one-time processing fee

ValuCare has been providing HMO programs to individuals, families, and employees since 1997. Its network consists of over 20,000 physicians and dentists as well as 1,300 hospitals and clinics.


How to Find the Best HMO in the Philippines?

Overwhelmed with the vast range of HMO options in the Philippines?

Choosing the right HMO can get very complicated. As a TIME article notes, a study found that eight in every 10 workers picked healthcare plans that were more expensive than their alternatives over time.

Nobody likes to be in a similar situation. You don’t want to end up regretting your decision and asking your HMO provider for a cancellation and refund, which could cost you more.

So while you haven’t picked one yet, take your time researching and comparing your options.

5 Key Considerations When Choosing an HMO

Before you review different healthcare packages, it helps to have a clear idea of the things that matter to you.

HMO companies vary in their costs, coverage, and accredited medical facilities. These will be among the factors you’ll look for when assessing HMOs to trim down your choices. This way, choosing an HMO is easier and less overwhelming.

Consider these five factors when shopping around for HMO packages:

1. Financial Stability

It’s risky to deal with an HMO company that you aren’t sure would still exist by the time you need to claim your benefits.

Consider only HMOs that are financially stable, which guarantees payment for your healthcare expenses. Check the Insurance Commission’s website to find licensed HMOs that have fully complied with its standards.

You may also check an HMO’s financial performance on its website, usually on the About Us or FAQ page. Some HMOs provide their figures, such as paid-up capital and net worth, which indicate a company’s financial health.

An HMO’s years of operation also signifies its financial health. Among the HMO providers that have been operating in the Philippines for the longest time are HMI, PhilCare, Maxicare, MediCard, and Insular Health Care.

2. Cost of Premium

While it’s important to pick an HMO product you can afford, the cheapest one isn’t necessarily the best for you. The priciest plan your budget allows may not be a practical choice, either.

Usually, the lowest-priced products come with a limited coverage. On the other hand, the expensive ones may have too many benefits that you don’t need.

So, how do you strike a balance between HMO cost and benefits?

When choosing an HMO plan, set your budget range first, request quotes from different providers, and shortlist products within your budget. Then look at the benefits of your shortlisted HMO plans.

Find one that offers all the benefits you need at the lowest cost.

To lower your HMO cost, ask the provider if you can customize your package to remove any riders or add-ons that you don’t need or are already included in your existing life insurance policy.

3. Your Healthcare Needs

A value-for-money HMO plan meets all your healthcare needs without eating up a bulk of your budget.

Here’s a list of HMO coverage considerations to help you decide which benefits you need or don’t:

  • Access to the five major hospitals in the Philippines (Asian Hospital and Medical Center, Cardinal Santos Medical Center, Makati Medical Center, St. Luke’s Medical Center, and The Medical City)
  • Access to Healthway, FortMED, and other clinics
  • Coverage for pre-existing conditions (PEC) such as diabetes, cancer, and hypertension
  • Diagnostic and laboratory tests
  • Dental care
  • Maternity care
  • Coverage for dependents and the maximum number of dependents you can enroll
  • Integration with PhilHealth benefits
  • Reimbursement for services availed from a non-accredited doctor or clinic
  • Accidental death and dismemberment insurance

Your chosen HMO benefits affect the price of your plan.

For example, PEC coverage and access to major hospitals can push the rate up. So select carefully the ones you actually need.

4. Network Size and Location of Accredited Facilities

Especially if you have preferred doctors, clinics, and hospitals, they must be part of your HMO provider’s network.

If your favorite doctor, for instance, isn’t among your HMO’s accredited specialists, you’ll have to pay out of your pocket and have the amount reimbursed later (if the HMO allows this).

You don’t get an HMO just to be hassled like this.

That’s why your HMO has to have a wide network of medical professionals and facilities in the Philippines.

Here are the HMO providers with the widest network of medical specialists and facilities:

  • PhilCare
  • ValuCare
  • Maxicare
  • EastWest Healthcare
  • Medicare
  • MEDOCare

The location of an HMO’s accredited specialists and facilities matters, too. During a medical emergency, you can quickly and conveniently avail of HMO benefits at the nearest accredited clinic or hospital.

Check the website of the medical facility with a branch near your home to see its list of accredited HMO providers.

5. Quality of Customer Service

Do several HMO companies tick all the boxes already? The clincher would be the quality of their service.

An HMO’s attractive rates, useful coverage, and wide network will amount to nothing if its customer service sucks.

Ask your family and friends for feedback on their HMO provider.

Check online reviews, too. The best places to get customer feedback are the HMO’s Facebook page, as well as online forums and Facebook groups of Filipino freelancers.

Consider also your interactions with each HMO during your research. How long did it take for an HMO to respond to you? Did it adequately answer your questions?  

Take note of all the pros and cons of each HMO in your shortlist based on the feedback you’ve gathered.

At this point, you should be able to choose the perfect HMO provider.


How to Maximize Your HMO Benefits

Getting the most out of your healthcare plan doesn’t just start and end with choosing the best HMO. You can stretch out your HMO benefits further without increasing your premium.

Here are six ways to do that:

1. Be a PhilHealth member

Being an active PhilHealth member lowers your hospital bills because your Philhealth benefits are deducted first before the HMO pays for the remaining costs.

If you’re already a member, update your membership into a self-earning individual member. Continue paying your PhilHealth contributions, too.

Also Read: Complete Guide to Philhealth: Online Registration, Contribution & Benefits

2. Avail of benefits at HMO-owned clinics

Having your check-ups and treatments at expensive clinics or hospitals can quickly deplete your HMO plan’s benefit limit. There may be nothing left for you should a real emergency happen.

For your simple and minor medical needs, it’s cheaper to go to a primary care clinic owned by your HMO provider than other out-patient facilities in the Philippines.

Aside from lower out-patient care rates, HMO-owned clinics like those of MediCard and PhilCare offer free consultations for members.

Typically, primary care clinics provide these services:

  • Consultations with primary care doctors (OB-gyne, pediatricians, family medicine, internal medicine, etc.)
  • Simple laboratory tests (X-ray, urinalysis, fecalysis, blood test, ultrasound, etc.)
  • Annual physical exam

3. Avoid emergency room consultations

A consultation in an ER is convenient, as it’s available beyond regular clinic hours and usually has shorter lines.

However, it can cost you up to five times higher than a regular clinic.

Except for medical emergencies, you’re better off having consultations in a regular clinic to avoid reaching your HMO’s benefit limit so soon.

4. Maximize your consultations and annual physical exams

In HMO, prevention is better—and less costly—than cure.

If your HMO plan includes unlimited consultations and an annual physical exam, take advantage of these benefits for early illness detection and prevention.

Doing so helps you save money on expensive medical procedures.

5. Pay your premium on time

Failure to pay your premium may lead to cancellation of your HMO plan.

Not only does it waste the premium you’ve previously paid; it may also put your finances at risk when you or a family member needs to be hospitalized.

So be sure to make timely premium payments and check your payment records with your HMO provider from time to time.

6. Review your HMO coverage before renewal

Before your HMO plan expires, review your provider’s coverage thoroughly.

HMO providers usually change their coverage, offerings, terms, and premium every year.

Also, your own healthcare needs might change. Take them into account when deciding whether to renew your HMO plan, upgrade it, or switch to another HMO.

No matter how diligent you are in earning and saving money, all your hard work will go down the drain if you don’t prepare financially for any medical emergency.

An HMO plan is an affordable way to do that.

Got any experience with an HMO provider? Anything missing on the list of the best HMO plans? Share your comments below!

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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. Rachel says

    Thank you for this very comprehensive and informative article. It’s just what I needed to learn about HMOs without having to do the tedious research myself.

    • MIKELE says

      Hi Rachel, I worked at Pacific Cross Philippines as a Account Executive that offer medical insurance for individual and groups. We are offering medical coverage with no age limits, from infant up to senior citizen age. The rising cost of medical treatments and hospitalization is extremely alarming which will definitely be a burden to your finances, to your future and to your family. On behalf of the company, it is a opportunity and is a pleasure to assists you for you and your family medical insurance needs.

      For inquiries, please do not hesitate to contact me at 09173548638 or email at mikele_betervo@pacificcross.com.ph

      MIKELE

      Thank you and God Bless.

    • Ethyl gerladez says

      Pwede ko po bang makuha yong pera ko na deniduct nila sa atm ko?kahapon pa po ako na member..akala ko kasi for approval pa sa bank…di ko po alam na automatic deduct na sa optimum care..

    • mikele_pacificcrossph says

      Hi Dan,

      I worked at Pacific Cross Philippines as Account Executive that offer medical insurance for individual and groups. We are offering medical coverage with NO AGE LIMITS, from infant up to senior citizen age. We are also offering medical coverage of PESO and DOLLAR denominated policy that you can covered worldwide. The rising cost of medical treatments and hospitalisation is extremely alarming which will definitely be a burden to your finances, to your future and to your family. On behalf our company Pacific Cross, it is a opportunity and it’s a pleasure to assists you for you and your family medical insurance needs.

      For inquiries, please do not hesitate to contact me at 09173548638 or email at mikele_betervo@pacificcross.com.ph

      Thank you and God Bless.

      Mikele Betervo
      Pacific Cross Philippines

    • Analyn says

      Thank you for this article, it is so helpful. I,ve read it numerous times to absorb all the details. thanks a lot. God bless.

  2. francis says

    hello sir/ maam,
    thank you for your info. May tanong lang po ako. Sabi nila c kaiser ay my 3 in 1 product, health care+life insurance+investment. Mairerecommend mo ba tong Kaiser sir?or anung HMO company pa po ba ang meron kagaya ni kaiser ang offer?para may mapagpilian po. Mas maganda po kasi yung tatlo 3 in 1 sir, parang sulit ang pera mo. kasi my plano ako before na mag VUL na lang sa BPI kaso, maraming cons sa VUL kasi sobrang mahal daw. at ito nakita ko c kaiser na my ganito. sa tingin nyo po mas ok cya?sulit ho ba talaga to?i need your advice sir/maam gusto kong magkaroon nito kasi.thank you po.

  3. Kari says

    Hi,

    If kukuha tayo ng hmo, let’s say nagbayad tayo for 5 years at wala naman nangyari at di natin nagamit yung insurance. Can we get our money back?
    Thanks.

    • Aubrey Mendoza says

      Hi Kari,
      Wala pong refund ang HMO. If you want some kind of coverage with investment, ung may babalik sayo after years of paying, you may check insurance like Pru Life UK. I can discuss to you the benefits just send me an email to plukaubreymendoza@gmail.com
      Stay well and keep safe! 🙂

    • Mikele says

      Dear Mr. Silvano,

      I worked at Pacific Cross Philippines as Account Executive that offer medical insurance for individual and groups. We are offering medical coverage with NO AGE LIMITS, from infant up to senior citizen age. We are also offering medical coverage of PESO and DOLLAR denominated policy that you can covered worldwide. We also cover foreigners or expats who needs medical coverage here in the Philippines. We can schedule appointment for a presentation to discuss to you personally the plans and benefits on your free schedule. For inquiries, please do not hesitate to contact me at 09173548638 or email at mikele_betervo@pacificcross.com.ph

      Thank you and God Bless.

      Mikele Betervo
      Pacific Cross Philippines

  4. AUENISK says

    OKAY LAHAT WAG LANG CAREHEALTH SYSTEMS. SCAM ITO! WARNING. WAG KAYO BIBILI. NASA OSPITAL AKO NGAUN STRESSED KAKASURGERY KO LANG. HINDI NILA ICOCOVER KASE ON THE 3RD YEAR PA DAW PWEDE. OCT 2019 KO KINUHA ANG CARD. SO DAPAT MAGKASAKIT ANG MAGAAVAIL SA 2021 PA PARA MAGAMIT ANG CARD. CAREHEALTH MAPUPUNTA KAYO LAHAT SA IMPYERNO SA PANLOLOKO NYO

  5. Mikele says

    I worked at Pacific Cross Philippines as Account Executive that offer medical insurance for individual and groups. We are offering medical coverage with NO AGE LIMITS, from infant up to senior citizen age. We are also offering medical coverage of PESO and DOLLAR denominated policy that you can covered worldwide.

    For inquiries, please do not hesitate to contact me at 09173548638 or email at mikele_betervo@pacificcross.com.ph

    Thank you and God Bless.

    Mikele Betervo
    Pacific Cross Philippines

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