Health Insurance & HMO
In the Philippines, getting financial protection to cover your health-related expenses can be through:
- Medical Insurance Policy
- Health Card, through a Health Maintenance Organization (HMO)
Is Health Insurance and Medical Insurance the same?​
Health insurance and medical insurance are closely-related concepts, but they are not entirely the same.
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Health Insurance – This is a broader form of coverage that may include hospitalization, outpatient care, diagnostic tests, preventive services, medicines, and in some cases, dental, vision, or maternity benefits, depending on the plan.
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Medical Insurance – This is more specific in scope and is generally focused on covering hospitalization and treatment costs resulting from illness or accidents. It may not always extend to preventive care or wellness services.
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​In the Philippines, the term “health insurance” is commonly used when referring to HMO (Health Maintenance Organization) plans, while “medical insurance” often pertains to indemnity-based products or hospital income benefits offered by life and non-life insurance companies.
Where do you get Health Insurance Coverage in the Philippines?
What is Philhealth?
PhilHealth is a government-run program designed to provide Filipinos with affordable access to healthcare. It helps cover part of the costs of hospitalization, surgeries, and other medical services.
PhilHealth membership is mandatory for all employed individuals and voluntary for self-employed and unemployed Filipinos.
Many Filipinos complement their PhilHealth benefits with private health insurance Philippines plans to enjoy wider coverag and added protection for unexpected medical expenses.
Choosing the right combination of PhilHealth and private health insurance ensures you and your family have stronger financial security and peace of mind when it comes to healthcare needs.
Individual Health Plan
Private health insurance companies offer a wide range of plans with varying coverage and benefits beyond what PhilHealth provides. These plans may include coverage for hospitalization, outpatient services, preventive care, and additional benefits such as dental and optical services. Premiums and coverage options vary depending on the insured’s age and the chosen plan.
Employer-Provided
Many companies in the Philippines offer health insurance benefits to their employees as part of their employment package. These plans are often comprehensive and may cover not only the employee but also their dependents. Coverage may include hospitalization, outpatient services, and other medical expenses.
Why get medical insurance or HMO?
Financial Protection
Health insurance provides a safety net against unexpected medical expenses, reducing the financial burden on individuals and families.
Access to Quality Healthcare
With health insurance, individuals can afford to seek medical care without worrying about the high costs.
Preventive Care
Some health insurance plans offer coverage for preventive services such as vaccinations, screenings, and wellness programs, promoting overall health and well-being.
Factors to Consider When Choosing Medical Insurance or Healthcare Plan
Coverage
Evaluate the extent of coverage offered by the insurance plan, including inpatient and outpatient services, maternity benefits, and coverage for pre-existing conditions.
Network of Providers
Check the network of hospitals, clinics, and healthcare providers affiliated with the insurance plan to ensure convenient access to medical services.
Premiums
Consider the cost of premiums and any additional fees associated with the insurance plan. Compare different plans to find the most affordable option that meets your needs.
Exclusions and Limitations
Understand the exclusions and limitations of the insurance plan, including waiting periods, pre-existing conditions, and coverage limits.