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Need Suggestions on Health Insurance, HMO.

talisman · 9 · 3016


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on: Sep 10, 2012, 09:27 AM

Hi to all PMT'ers

Reading most of the topics here at PMT, i can say that it has been a truly educational experience. From zero knowledge, now I understand a little about UITF, Mutual Fund, stocks and the like. Thanks.  Pero one topic na wala talaga akong maintindihan is Medical Insurance and HMO’s or even the difference between the two.  I read somewhere here na importante magkaroon ng insurance which imho is true.  Tried  to read on the topic but am not really familiar with the terms (VUL, term, whole term) and the different providers (Maxicare, Medicard, Blue Cross, Caritas and many others). 
I’m a 42 yr old male, smoker. I maintain a small business which earns a modest amount for our daily needs and the little extras.  Hindi ako naging formally employed by a company so I never had the chance to be part of a group insurance, which I think this is one of biggest the perks in working for a company.  So now, talagang Philhealth lang as voluntary contributor.  My partner (we’re not married, yet) is a decade younger (non smoker) and we have a 6 yr old daughter.  She used to be employed pero I asked her to help me out in our business.  Her insurance is also Philhealth alone. 
While both of us are not sickly, medyo we are thinking of the “what if’s” na rin.  With the current hospitalization rates, not sure if Philhealth can really be helpful kasi.   Ang gusto lang sana namin is payment/reimbursement of hospital bills and PF’s of doctors.
Sir’s/ Madam’s, I’d really want to get your advice on the following if it’s not too much to ask-
A.Ano po ba ang ma sasuggest nyo na medical/health insurance/HMO?
   -Is there such an insurance which is in effect until old age?  I’ve read na meron ten years tapos may return na 70% after the 10th year pero paano na after the insurance period is over.
  -An insurance  na investment din?  Kahit tuloy tuloy for a certain number of years ang hulog. I’ve heard of Sunlife but not too familiar with their many products
  -Ang insurance po ba yearly lang na pag natapos ang year paid for eh expired na rin?  Eto ho ba ang tem insurance?  Is this a good deal?
B.Sa mga HMO’s po ba by year lang ang effectivity?  Alin kayang insurer ang ma rerecommend nyo based on experience?   Meron bang pang long term?

Thanks so much.  I asked too many questions on my first post.  I hope its ok. 


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Reply #1 on: Sep 13, 2012, 01:31 AM
Life insurance until old age, of course halos lahat ng insurance companies may ganung product.

HMO-Like Life insurance on the other hand, I only know of 3
Insular's I-Heal
Manulife's HealthPlus
Philam's Health100(ata)

They are like HMO's wherein you are covered for age 100(ata, philam for sure
until 100) but there's a lifetime limit of 1M(normally) meron rin 2M,etc

Normally, 20 years to pay to.

Yung insurance with investment is called a VUL.

Tama po, term po yung yearly lang ang effectivity.

Other insurances are for life with payment period of for life,
10 years,20 years, etc.

HMOs are like term rin na yearly rin ang effectivity.


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Reply #2 on: Jul 07, 2013, 01:17 AM
Plano ko rin po kumuha ng HMO pero hindi ko alam kung anung magandang company ng HMO ang may good services or benefits.....
Any ideas or nakasubok na? Im chossing between (Maxicare, Medicard, Intellicare)


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Reply #3 on: Jul 08, 2013, 01:06 PM
Any suggestion?


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Reply #4 on: Jul 08, 2013, 01:20 PM
Asked recently a doctor about this question.

The reply I got was: it's best to pay in cash if you have it.

I wasn't able to get the reasons why paying in cash is much better than any HMO.


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Reply #5 on: Jul 08, 2013, 02:06 PM
Hindi po ba mas ok na my HMO card holder before entering a hospital becasue they prioritize you? Or should i separate a emergency hospital fund as part of my savings?


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Reply #6 on: Apr 04, 2014, 03:28 PM
Hindi po ba mas ok na my HMO card holder before entering a hospital becasue they prioritize you? Or should i separate a emergency hospital fund as part of my savings?

Hindi, mas prioritize pag cash :),  pag hmo para kang nakapila sa out-patient.


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Reply #7 on: Apr 04, 2014, 11:38 PM
Asked recently a doctor about this question.

The reply I got was: it's best to pay in cash if you have it.

I wasn't able to get the reasons why paying in cash is much better than any HMO.

Ang mga doctors talaga they prefer cash dahil ang lahat ng HMOs ay may table na sinusunod, meaning kahit anong HMO pa yan ang rates na makukuha nila ay uniform. Of course there's nothing wrong with it kasi they get paid anyhow. Ayaw lang nila yung process kasi nalilimit ang presyo ng services nila. Kung cash kasi they could charge a patient according to how much they want to, it goes both ways, if their client is not that well off, they can always charge lower or with a discount, if the client can afford their services naman they can charge a little higher. Pero kapag naka HMO kasi centralized yun rates so whatever ang nasa Table ng HMO, yun ang makukuha nilang Prof. Fee. These HMO networks are like wholesalers of services, thats why they can demand a price especially if the HMO has a lot of members in the community, once a hospital and the doctors are accredited kasi, the HMO provider suggests to their members where to go, so ayun they are directly sending patients to the doctor's door, naturally, mas marami, mas mura.

With regards to Magandang HMO provider, mas convenient ang Hospital Based instead of Clinic Based. Hospital Based means that you can go directly to any accredited hospitals even for Out Patient consultations. Lab and Diagnostics. Ang Clinic Based naman eh may certain clinic na pupuntahan ang card holder to get referrals or consultations.  I am not sure if Medicard and Intellicare offer Individual membership, I know Maxicare has IFG (Individual, Family, Group) and Corporate.  All in all, almost all of the HMO's around have the same network, same packages, they just differ in other services, rates and discounts.

Hope this helps!


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Reply #8 on: Jun 29, 2014, 01:59 PM
Hindi, mas prioritize pag cash :),  pag hmo para kang nakapila sa out-patient.

this is absolutely true...pag HMO, pinapipila pa yung pasyente maski dapat naka-confine na


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