Availing of a health insurance is a highly individual exercise because each person has different needs. A freelancer’s requirements, for instance, will be very different from that of an employed parent. Someone who lives a sedentary lifestyle will have different needs from someone more active.
To help Filipinos decide, Maria Health, the country’s first online healthcare exchange platform, has listed the top 10 questions to ask when evaluating health plans from different health maintenance organizations (HMO).
1. WHY SHOULD I GET AN HMO COVERAGE? There are different types of health insurance plans such as a medical insurance plan that covers one’s medical and surgical needs or prepaid health cards that cover a specific treatment or medical procedure. Plans by an HMO have a more comprehensive coverage from its network of healthcare providers.
Tip: Ensure to do thorough research by reading up on the offerings of health plan providers.
2. WHAT DOES THE PLAN COVER? Know what services the plan will include and how much will it cover. Other items to consider: emergency services, ambulance transport, and medicine.
Tip: Before you start with your search, take the time to list down and prioritize the things that you want in a healthcare plan. Use this list to determine which plan covers your needs.
3. WHAT HOSPITALS ARE PART OF THE PLAN’S NETWORK? Given the traffic problem in the Philippines, the location of hospitals in a health plan’s network should be an important consideration.
Tip: Ask if the HMO could give access to major hospitals in your area, whether private or public. Also, inquire if they include access to clinic systems such as those found in malls.
4. IS MY CURRENT DOCTOR INCLUDED IN THE COVERAGE? Not all HMOs allow this, so you have to pay attention if this is offered.
Tip: To make things easier, you could ask your doctor which healthcare plans they are part of. If there is an HMO you really want but does not include your doctor, ask if they are willing to be accredited by the HMO.
5. HOW DOES THE PLAN HANDLE OUT-OF-NETWORK MEDICAL SERVICES? Check if the HMO reimburses medical services availed from doctors, hospitals, and clinics that are not part of their accredited network.
Tip: Ask if the HMO provides reimbursements at a special HMO or discounted rate if you avail of out-of-network medical services.
6. WHAT HAPPENS WHEN I GET SICK WHILE TRAVELING? If you travel a lot, you would want global health coverage, since hospital visits outside your home country can prove costly.
Tip: Ask the HMO how much, if any, of the costs the plan will cover if you need to go to the doctor while traveling.
7. DOES IT HAVE RESTRICTIONS ON MY PRE-EXISTING CONDITIONS? If you have a chronic or a pre-existing condition such as asthma, diabetes, or heart disease, make sure to get a health plan that includes such conditions.
Tip: Ask how long pre-existing conditions are excluded from the health plan.
8. ARE ANNUAL EXAMINATIONS INCLUDED? Some HMOs include routine examinations like mammograms, physical exams, basic laboratory tests, and even immunizations in their health plans.
Tip: Ask if the health plan includes an annual physical exam and what types of tests are included. Also ask if the additional tests recommended by doctors during the routine examinations will also be covered.
9. WHAT OTHER BENEFITS ARE INCLUDED? Some health plans also cover dental, vision care, and even medical prescriptions.
Tip: Ask for specific details about these additional services. For dental, are minor surgeries included or are just routine check-ups? For vision, are multiple examinations allowed or just a limited number a year?
10. HOW CAN I AVAIL OF THE SERVICES? Some HMOs have a complicated utilization process while others make it very easy to go in for medical services.
Tip: Ask what you need to do to avail of services covered by the health plan.
