I was exhausted, cranky, in need of a long, warm bath and some chocolate bars to perk up my mood. Worrying about someone in the family who is sick, especially if that person is a baby, does that to you.
But the voice of the man near the admission counter of the hospital where my son was admitted pierced the cloud of selfishness around me. He was obviously in pain. And he could not get a room at the hospital.
“I’m sorry, sir. We don’t have a room for you. You can wait in the ER until we have a room that fits your card,” the clerk said.
“Why, what’s wrong with my card?” the man said.
“We need to double check if you can get a private room just as you requested. I know that the maximum for your card is P1,900 per night, but we will have to check again,” the attendant said.
In the end, he decided to go home while waiting for a room. He was seventh on the list and it was already 4 p.m.
Sickness is a financial planning wild card. Even if you stock up on vitamins, eat lots of fruits and vegetables, swear by the benefits of eating wheat bread, there’s no telling if or when you will get sick. There are just too many factors when it comes to health – including genes. It’s a probability that each family needs to prepare for.
Are you prepared for the cost of getting sick? Is there room in your finances right now for sickness in the family?
I have long wanted to do a comparative study on HMOs in the Philippines, but my son’s condition prompted me not to put the topic in the backburner any longer. However, instead of presenting you with data, I will have to throw questions at you, hoping that you will share your experiences so that we can have an initial data scan of what options Filipinos have out there when doing emergency planning.
What HMO do you have?
How much are you paying?
What are your benefits?
How would you rate the delivery of these benefits?
How would you rate the quality of their service?
Let me be the first to answer:
My family’s HMO is Intellicare. We pay P1,484.40 per month for five cards, one of which is for a 1.6-year old baby, which I understand is the most expensive one. We have dental benefits, annual executive check-ups, check-ups with doctors affiliated with their network. The HMO covers room rates up to big private room for my husband who is the main cardholder and small private room for his beneficiaries. Whenever someone is hospitalized, they give P1,000 per day in cash, I suppose to cover other expenses during hospitalization. Ours is a corporate plan. The service is excellent.
What about serious illnesses? Are you prepared for them? Last week, I attended a press conference organized by Stryker Corp., one of the biggest orthopedic implant maker in the world, which has entered into a tie-up with HSBC and BPI Credit Cards so that Filipinos can avail of an operate-now-pay-later plan.
Orthopedic implants cost around P80,000 to P150,000. The entire operation can reach up to half a million. Under this scheme, if you have been recommended to have an operation, you can use your card to pay for the implant at zero percent interest and in so doing defray the cost.
Using our litmus test for those zero-percent advertisements, I asked them what would happen if the patient wanted to pay in cash. Same price, they said. I was able to have a good talk with their Finance guy (they are my favorite people in every company) and he said that Stryker was charged one percent per month by the card companies, totaling 12 percent per annum, but the company decided to shoulder the cost for the first year of the program.
I guess, a good deal, all in all, as long as you don’t default on your payments. One-month default would lose that zero percent deal and trap you into paying a 42 percent per annum interest on a huge amount of debt. That would give you a headache to go with your new bone transplant. Not a nice combination.
The best strategy is still to have an emergency plan in place. Make sure you have three to six months worth of expenses as emergency buffer, and a good HMO to back you up. Medical insurance companies, are in general, cheaper than HMOs. But they operate by reimbursement, so you need that cash for this to work.
Let the HMO story sharing begin :).
November 7th, 2008 at 1:44 am
problem with hmo in phils. they don’t cover pre-existing conditions ie. hypertension even if you haven’t have a claim for years. sana covered din kahit with a condition to take effect after a certain contestibility period when stroke will occur if ever.
November 6th, 2008 at 9:37 am
Having read all your comments…maganda talaga pag may HMO ang pamilya kaya parang puro private companies lang nag-avail ng services ng HMO.
Sana may mga government offices nat’l or local gov’t man na mag-enroll for their employees kahit na salary deduction man lang basta wala ng excess sa hospital bills after philhealth.
Ofcourse, we understand philhealth kung bakit maliit lang coverage eh P100/month lang naman ang deduction tsaka for the whole family na.
September 30th, 2008 at 3:22 pm
friends…… some questions that may need answers……. in order to qualify for corporate account….. minimum of 15 employee needed to enroll for the program…..
corporate rate is much cheaper than individual rate, something like 40% cheaper…… something like 12k pesos for individual account , can be reduced to around 7k pesos for corporate account with same terms and conditions
now…. if you can muster above 90 employees to enroll with hmo….. usually the pre-existing condition is waived
congenital defects are not covered…..i.e. indirect hernia and some others
September 30th, 2008 at 10:04 am
What companies offer medical health insurance? I want to get one. Thanks.
June 11th, 2008 at 10:09 am
Hi again Salve! Here’s my two cents about this move by Stryker and HSBC/BPI Credit Corp.
While stryker is laudable in its move to offer solutions to the high cost of orthopedic surgeries and implants here in the philippines, it still does not address the root cause of the problem- the high cost of implants. It only allows the patients the “hulugan” method so he can avail of his/her surgery but not actually lower cost of implants.
More over, what if the implant needed (or is best) for the patient (as determined best by the surgeon) does not come from Stryker? Will the patient or the company “force” the surgeon to change the implant (even if he feels its not the best implant) just so the patient can avail of this scheme? Or worse, what if the implants by stryker actually is subpar (just like what happened in the US when FDA “warned stryker ” for substandard manufacturing in some of their hip implants) You know where this is going to- a bad surgery and a much poorer (if not disabled) patient!
I still would agree with you salve, that for now, we Filipinos should always prepare with an emergency fund, and be diligent in preventing orthopedic diseases (most are actually preventable). The government is mandated to make healthcare affordable to its citizens. This market driven orthopedic implant industry is patterned after the US, and so far, Philippines has just followed suit and left the surgeons and patients to save themselves!
November 6th, 2007 at 9:32 pm
[...] I know more or less how this author must’ve felt when I saw how the couple reacted when they were told of the amount they had to [...]
October 13th, 2007 at 6:23 am
Hi-I am working on a research paper about the Philippines for a class I am taking for my Masters in Nursing. Your article is very interesting and it sounds as if healthcare has negative aspects everywhere. Do you have any PPOs in your country? Again, great article!–Kathy
October 3rd, 2007 at 8:58 am
i am a doctor and this is my experience with HMOs. it can be exasperating at times because we accredited doctors may require tests or meds for the patient which we deem is best to help diagnose or treat the patient, yet the HMO has final say in these. say, we need a CT scan to better determine problem, but HMO would only approve an ultrasound; same case for meds - we would recommend a better antibiotic, HMO would change and use an inferior one. of course, all these is for HMO to scrimp on expenses. also, sometimes the HMO coordinators manage the patient even if the patient’s case is not their specialty, again so they don’t have to pay other doctors. there is a danger then of patient not getting the proper medical care, e.g. a surgeon treating the patient’s diabetes or hypertension problem.
the reason why many doctors don’t accept HMO patients is because accredited doctors are underpaid. a cardiologist friend related her experience. an HMO patient had a heart attack and was referred to her. patient was at ICU for 1 wk, then about 8 days in regular room before discharge. she would do visits 3-4x a day, sometimes at wee hours of the morning. when cardiologist’s professional fee was paid - about 8-9 months later - she got a measly P1500.00!
so, i hope patients would understand why many physicians are averse to HMO. watch michael moore’s SICKO!
October 2nd, 2007 at 12:57 pm
I believe that we really need an HMO, this is because PhilHealth Insurance will only cover 20% of the medical costs. Therefore, you have to pay the remaining 80%. Or if you have your HMO, most of the plans covered the remaining 80% of the bill.
I really dont know what could be the “best” HMO provider today - well at least for the individual plans/non-corporate.
September 22nd, 2007 at 12:07 am
any suggestion for old people age 60?
August 21st, 2007 at 8:30 pm
[...] dignified site now revise this synopsis http://www.inquirerbloggers.net/moneysmarts/2007/06/20/the-cost-of-getting-sick/ and give comments [...] retiree dental [...]
July 11th, 2007 at 3:42 pm
hello there. i hope you can discuss about the benefits and the downside (if any) of availing of an HMO as against a health insurance. thank you.
July 4th, 2007 at 12:42 pm
i’ve been hearing about an HMO provider “europe assist” or something like that. is anybody familiar with this HMO? I would like to inquire about their corporate rates. thanks
anyway, from experience, intellicare is very good, very accommodating, and great with employee-hmo relations.
as for medicard, well, they’re ok too, but very strict when it comes to reimbursements, enrollments, etc.
July 2nd, 2007 at 9:15 pm
can an office which only employs 2 people qualify for a corporate plan with HMO companies? our office is registered with the DTI as a partnership.
June 27th, 2007 at 9:26 pm
Ishi–
I can understand ur predicament of not being able to use your HMO…my client was in a simiilar situation. However, i hope we will not always blame the HMO company if we fail to read first & understand the policies, procedures, & limitations of our plan. SOP naman talaga kasi na alamin ang nilalaman ng kontrata or user’s booklet.
I am guessing that the hospital was requiring you a police report. If so, I hope you have understood by this time that it was relevant to the Compulsory Third Party Liability (CTPL) provisions of motor vehicle insurance.
June 27th, 2007 at 8:50 pm
Don2x–
There is no such thing as contestability period with HMO plans. This is why I posted earlier that this is one of the trickiest matters in HMOs if not fully understood & explained well. If pre-existing conditions are not waived, if an illness is detected even after 5 years, but if it is proven that is was already pre-existing, then it will not be covered. This is for anti-selection. Pre-existing conditions are waived depending on the # of employees enrolled, w/c varies among HMOs. That is why corporate plans are better (& cost lower) than individual plans so encourage ur employers to get HMO plan even if w/ employees sharing on cost. & of course it is best to enrol in an HMO while still healthy so you are already fully covered when the inevitable happens.
June 26th, 2007 at 10:08 am
@jsalamat,
don’t rely on philhealth alone. the coverage is very minimal and it can only be used if you get confined. I might exagerate, but sometimes you can get, say, only 500 discount on a 5000 hospital room. most HMOs can be used in conjuction with philhealth, so you will pay only for the medication/maintenance that you will need. If your company offers this then I think you may consider this.
June 25th, 2007 at 9:55 pm
most HMOs do not cover pre-existing conditions. but is there a time limit for that condition, say after 2 years all pre-conditions are covered? like life insurance there is a 2-year contestibility period.
June 25th, 2007 at 3:55 pm
hello starter boy,
incidentally, we also live here in Cebu but unfortunately the H’s company plan does not allow for beneficiaries and i don’t mind carrying our son in my plan though coz i am already comfortable with how it works.
correcting my own post earlier: i computed my annual share and it amounts to Php 1900 for me and my son. Not too bad a deal and we can just directly go to any Philam affiliated specialist and get a checkup (with the correct form filled up of course) for free.
also re the question on HMO’s, i think it’s more important you get one for your old age. I actually am paying for an insurance geared for long term health plan. I am insured now under this but if i don’t use it until maturity then by age 60 or so i can get about Php 100,000 coverage annually. Yes that won’t be a big amount by that time but it’s better than nothing. I just hope i don’t outlive this HMO…
June 25th, 2007 at 3:02 pm
Would anybody here know if it’s really true that HMOs only cover those who are age 65 and below? Because if that’s true, retirees might end up spending all their savings and investments on medical bills.
June 25th, 2007 at 12:01 pm
I got this HMO(MedServ) for my parents thru my brother company. I pay P 5,000 each in four consecutive months. I would say mostly they’re covered and they’re pretty good in terms of benefits and service. It’s a little bit pricey because of the age bracket which is common in most HMO’s. The catch for most of the HMO’s if you get first time is the pre-existing, though some HMO’s waive this if they meet there quota as far as I know..
June 23rd, 2007 at 5:09 pm
i had a bad experience with medicard when i met an accident while working in a call center here in makati…although i know that they have to have a proper documentation with regards to the incident that i encounterd…they refused to entertain my concerns first without that documentation. since our company shelled out huge amount for this medicard annually i still ended up paying my hospital bills…maybe it would be better think twice before getting one….we are just making these HMO rich without us getting the right benefits….
June 23rd, 2007 at 1:31 am
Ur benefit package under corporate HMOs depends on the specifications ur employer & the HMO provider negotiate on. Actually, almost anything can be included or excluded in d HMO package if the company client wants so…but of course there’s a tagprice for each inclusion of benefit / special arrangement.
Hence, employees of Company X can be very happy about their coverage w/ HMO provider ABC; while employees of Co.Y can be very discontented about their HMO, also w/ provider ABC, coz they have different packages.
On the other hand, 2 companies may have exactly the same package from the same HMO provider but their annual costs differ. Why? Coz their utilization cost or ratios differ.
Based on my years of experience as an HMO agent (aside from being a life, & nonlife insurance agent, pre-need agent, & investment solicitor) the trickiest benefit features have to do w/:
1) the HMO package’s benefit limits coz there are diff ways of measuring & treating these limits w/c are not too obvious for the client & sometimes even confusing.
2) how the HMO covers/treats pre-existing conditions (very important!)
June 23rd, 2007 at 12:50 am
Is it enough to have one HMO? Like if i have Philhealth already, will it be to my advantage to get another HMO like Philamcare? Or will this be just a waste of money? How many insurance coverage and HMO does one need?
June 22nd, 2007 at 9:56 pm
i think some cheaper HMOs have tie-up with philhealth.you have to be a philhealth member to avail extended health coverage.premiums for group or corporate is much lower than individual rate. i hope there should be a bill that unemployed/retired people can also avail of the lower group or corporate rate.or when you resign from a company giving you health insurance you can continue by paying the same corporate rate which is lower than individual rate.
June 22nd, 2007 at 1:52 pm
g: my company is medicard too but they allow me to buy a plan for my mom. Its around P1,000/month for a P300k max plan. I went to Chong Hua Hospital here in Cebu the other day and hassle free naman ang medicard.
Medicard, however, has some trouble with all doctors in Davao. The cos won’t recognze the card. So you have to pay them first then get a refund from Medicard.
June 22nd, 2007 at 12:18 pm
Need more about HMO.
June 21st, 2007 at 5:08 pm
i work for a company that shoulders cost of hospitalization and medicines of its employees (including all legal dependents) on a 75-25 sharing (75% paid by the company, 25% paid by the employee), on top of medicare. while i’ve been working for the company i don’t feel the need to get health insurance. does everybody need it?
June 21st, 2007 at 1:22 pm
i have a corporate HMO - Philamcare. My hubby has another HMO Medicard but their plan does not allow for dependents so i’m carrying our son under my plan.
Some companies pay 100% of their employee’s insurance. In our company we do 80-20 sharing of cost. I’ve looked at my files and the last one i have is dated 2005 and my employee share amounts to Php 1791.87 annually. I don’t know if there has been increases and i think that amount has not taken my dependent into consideration. I will compute the correct amount in another post.
Benefits: annual physical (including executive checkup for 35 yo above), annual dental cleaning + 2 free fillings, room and board max limit up to 130,000 (per illness per year is my understanding), free check-up with affiliated doctors as well as in their clinic, comprehensive maternity coverage (very very important as i had an emergency C-section and we even had to shell out money despite my insurance coverage), all charges deemed necessary by the affiliated doctor in the treatment (emergency or in-patient) of patient.
RATING: excellent really. they have a wide coverage of doctors. they periodically give out a list of affiliated docs under their respective specialties. when someone gets hospitalized, a coordinator comes to visit and guides you thru the steps needed. they even cover those maternity tests that may not be done at all (like the stress test) and all related tests (i had 2 more ultrasounds prior to giving birth as my doc was afraid my amniotic fluid had dried up). so all in all i am grateful for our insurance coverage.
June 21st, 2007 at 11:05 am
My former employer issued us with intellicare. I agree that their services are great - not hard to get a referral if you don’t want to be treated in their clinic, and i think they got a large network from the best hospitals (MMC, St. Lukes, etc). They can give you extra cards for 2 dependents, and they have the same benefits as you do. too bad they stopped offering services for individual accounts, now that I left the company I cannot enjoy the services of Intellicare even if I wanted to shell out extra cash. My employer now offered us SPCare as part of our employees medical benefit. we paid a one-time payment of 5,800 per employee, and sadly if I wanted to cover dependents I have to pay the same amount for them. Just yesterday we had our annual physical exam. We also have dental services that we can avail on affiliated doctors. Since this company is relatively small, their network is not that large although they have some affiliated hospitals in the provinces.
June 21st, 2007 at 10:17 am
salve:
My insurance is corporate so I don’t pay and don’t know the premiums. But I talked to insurance agents trying to sell their products. I think you can get free health insurance when combined with investment products. Of course it’s not really free because they take off the premium from your earnings.
I don’t know the details because insurance agents don’t like talking to me. If they say I’ll give you free insurance plus up to 15% return on your investment. I’ll say why don’t you invest in my portfolio and I’ll guarantee you 20% return. That usually ends the conversation.
June 20th, 2007 at 10:36 pm
my HMO is maxicare, which is tied up with my company. i’m single, so i don’t pay a thing, although if i choose to enroll my parents, it’s around P1,000 per dependent. there’s inpatient and outpatient services, dental benefits, private room, and benefits up to P250,000 annually.
salve, does your payment of P1,484.40 per month cover all five cards, or is that payment per card? if it covers all five, i’m inclined to think it’s a god deal.