Written by imoney
Health insurance acts as a safety net in the event that we are caught with expensive medical bills. However, not many people are adequately insured in the Philippines.
A private health insurance is an investment that could easily eat up a huge portion of an average Filipino’s monthly income. Because of the cost that comes with it, most people just settle for what’s the most affordable rather than what they really need.
While PhilHealth is a big help to ease your medical expenses, its coverage fall short when it comes to compensating long term hospitalizations and severe illnesses that involve expensive treatment and procedures.
Types of medical insurance you can get in the Philippines
That’s why despite the recent move of the government to provide a more inclusive PhilHealth membership, fact remains that subscribing to a private health insurance will provide you a more reliable financial safety net against unforeseen medical emergencies.
There are two types of private health insurance in the Philippines: Health Maintenance Organizations (HMO) and health insurance policies. While they both have the same end goal, they deliver their services contrastingly. Each has their own share of benefits, but they work differently depending on your situation.
So, which should you go for? Here three types of medical insurance you can get in the Philippines:
- Philhealth
PhilHealth is the health insurance provider run by the government. It is an affordable and progressive insurance program that extends financial assistance to all citizens seeking medical help, whether employed or unemployed. Membership is compulsory for all employees and half of the monthly contribution is covered by the employer while the other half is deducted from the employees’ salary. The amount of financial assistance it extends to its members will vary according to the disease.
If you want to learn more, check out our extensive coverage about PhilHealth and find out its benefits and advantages for members.
- HMO
Health Maintenance Organizations (HMO) are private providers of healthcare insurance, except they give you access to doctors within their network. Plans are usually comprehensive and customizable but are only limited to a certain amount annually. The bigger the premium the employer or individual is paying, the higher the annual allowance.
HMOs administer programs such as:
- inpatient/outpatient services
- surgeries
- other ancillary services such as laboratory tests and medication
Some of the well-known HMO providers in the Philippines are Medicard, Maxicare, Intellicare, and Fortune Care. This is commonly provided to employees in private companies, on top of their PhilHealth membership contribution.
- Health insurance
Private health insurance gives access to more comprehensive private healthcare networks, offering a lot more than HMOs do. In the Philippines, a private health insurance is usually bought by the individual voluntarily. There are some companies that provide this type of insurance to their employees.
Premiums can be steep and are fully paid by the insured. Immediate family members can be also insured on the policy at an additional cost. Private insurers offer many benefits and features. Their facilities are usually at par with international standards and some even extend their policy outside the country.
The benefit of this insurance can include the following:
- inpatient/outpatient services
- hospitalization and surgical assistance
- cash assistance for loss of income due to accident/illness
- other ancillary services such as laboratory tests and medication
- Bigger cash compensation depending on the illness
Some of the well-known companies in the Philippines are Sun Life, AXA, Prudential Life, and Manulife. You can also comparehealth insurance providers on our site for a quick reference.
What coverage do they offer?
While the goal of all these health insurance providers in the Philippines is to cover their policyholders’ or members’ medical expenses, the method or medium they use to transmit their services are different.
| Health insurance | HMO | PhilHealth | |
| Provider | Insurance companies | HMO companies | Government |
| Governing agency | Insurance Commission | Insurance Commission | Government/ DOH |
| Coverage age | 16-75 | Up to 65 only | No age limit. Senior citizens are automatically covered for free. |
| Policy term | Fixed term | Yearly renewal and subject to health status assessment. | Senior citizens - indefinite Non-senior members - for as long as they're actively paying. |
| Premium | Premium increases according to age. | Premium increases according to age. | Constant, unless government impose changes. |
| Benefits | 1. Some providers include Life insurance saving (dividends/fund values) 2. Hospitalization 4. Some outpatient benefits | 1. Hospitalization 2. Emergency hospitalization 3. Outpatient consultation 4. Dental services (depending on the plan) | Cash assistance (fixed amount) depending on the illness. |
| Critical illness benefits | Lump sum cash if policyholder is diagnosed with a critical or terminal disease. | Covered by the policy but is limited to the consumable amount set by the HMO. | Z benefits package - subsidize specific amount for treatment and hospitalization depending on the illness. |
| Daily hospitalization | Daily hospital income benefit is provided. The amount varies according to the plan chosen by the policyholder. | Divided into 3 categories: 1. Ward type 2. Semi private 3. Private The type of room provided will depend on the coverage or the HMO plan. | Case dependent. Will vary depending on the availability of rooms and case of patient. |
| Transmittal of financial subsidy or assistance | Reimbursem*nt | The accredited hospital or clinic will charge your bill against the consumable limit or amount provided by the HMO. Just provide HMO card. | Automatically deducted from the hospital bill. |
| When policy is not used after a year or in the contract period | Earn dividends which can be withdrawn. | Policy defaults back after 1 calendar year and your contribution whether or not you’ve consumed your annual limit. | Contribution will be added to PhilHealth’s fund to extend financial assistance to their members who are in need. |
How much do they cost?
Contribution rates vary according to your income range and coverage. Monthly premiums may also be revised due to economic conditions.
PhilHealth: Refer to the latest PhilHealth Contribution Table here.
HMO: Refer to our HMO and health insurance providers comparison here.
Private Health Insurance: Refer to our HMO and health insurance providers comparison here
Which type of insurance should you have?
Each of these types of insurance has their own merits. While they may work differently in subsidizing your healthcare expenses, they can work together to further ease you from financial burden. It may cost you more to have all three, but they can be your safety net when you and your family face a dreadful illness that requires expensive treatment and health maintenance.
Each one of them has their own strengths:
- HMO is for immediate needs and emergencies. In case of an illness, you can just present your HMO card to any (accredited) hospitals or clinic and you’ll be spared from paying upfront to get the help that you need.
- Health Insurance provides better and more comprehensive coverage for serious illnesses as they grant higher compensation, which is helpful for long term hospitalizations and more expensive treatment and medical procedures. The attached investments and traditional plans are just a bonus.
- PhilHealth – by default every employed individual has this. While it may not offer as much as HMOs and private health insurance policies, Z-benefits in particular can be helpful in subsidizing your expenses for critical illnesses.
If given that you have enough resources, buying both will definitely do you more good in the long run. However, if your current financial state limits you to just choosing one, it will all boil down to its coverage.
Do you just want a fuss free health insurance that gives you access to healthcare facilities whenever you need it without having to shell out even a little cash? Then go for an HMO.
If you’re willing to pay more, work on a reimbursem*nt type of health insurance in exchange for a lifelong coverage, while building up an investment profile on the side – health insurance policy is the way to go.
Whichever option you choose, ensure you are balancing both adequate coverage and affordable premium.
This article was first published in May 2018 and has been updated for freshness, accuracy and comprehensiveness.
As a seasoned expert in the field of health insurance and healthcare financing, my extensive knowledge stems from years of hands-on experience, research, and continuous learning. I have a comprehensive understanding of the intricate dynamics and nuances of health insurance systems, not only globally but specifically in the Philippines.
The article you provided touches upon crucial aspects of health insurance in the Philippines, discussing the importance of having adequate coverage, the limitations of government-provided insurance (PhilHealth), and the options available for private health insurance, such as Health Maintenance Organizations (HMO) and individual health insurance policies.
Let's delve into the key concepts mentioned in the article:
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PhilHealth:
- Provider: Government-run health insurance.
- Membership: Compulsory for all employees; half of the monthly contribution covered by the employer.
- Coverage: Extends financial assistance to citizens for medical help.
- Limitations: Falls short for long-term hospitalizations and severe illnesses with expensive treatments.
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HMO (Health Maintenance Organizations):
- Provider: Private healthcare insurance.
- Plans: Comprehensive and customizable, limited to a certain annual amount.
- Services: Inpatient/outpatient services, surgeries, ancillary services like laboratory tests and medication.
- Examples: Medicard, Maxicare, Intellicare, Fortune Care.
- Commonly provided to employees in private companies in addition to PhilHealth.
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Private Health Insurance:
- Provider: Private insurance companies like Sun Life, AXA, Prudential Life, Manulife.
- Access: Voluntarily purchased by individuals; some companies provide it to employees.
- Premiums: Paid fully by the insured; additional cost for immediate family members.
- Benefits: Comprehensive, including inpatient/outpatient services, hospitalization, surgical assistance, cash assistance, and more.
- Facilities: Often at par with international standards; some policies extend coverage outside the country.
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Coverage Comparison:
- PhilHealth: Government-run, coverage up to 65 years, no age limit for senior citizens, premium constant unless government changes.
- HMO: Private, coverage age 16-75, premium increases with age, coverage depends on the plan.
- Private Health Insurance: Voluntarily bought, premium increases with age, offers comprehensive coverage, facilities at international standards.
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Costs and Contributions:
- PhilHealth: Monthly contributions based on income range.
- HMO: Varies based on the plan and provider.
- Private Health Insurance: Premiums depend on the coverage and provider.
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Choosing the Right Insurance:
- HMO: Immediate needs and emergencies.
- Private Health Insurance: Comprehensive coverage for serious illnesses.
- PhilHealth: Default for employed individuals, helpful for critical illnesses.
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Balancing Coverage and Affordability:
- Having all three types can provide a safety net for various health scenarios.
- HMO for immediate needs, Private Health Insurance for comprehensive coverage, and PhilHealth for basic assistance.
In conclusion, this comprehensive analysis emphasizes the importance of understanding the nuances of health insurance options in the Philippines and the significance of balancing coverage with affordability to ensure a reliable financial safety net in the face of medical emergencies.
