HMO vs PhilHealth vs Health Insurance: What do you need?

We all know the cost of health care in the Philippines and to aid us with the crippling cost of medical expenses, HMO, PhilHealth, and Health Insurance, are our options. But how are they different from each other? Let’s find out.

HMO (Health Maintenance Organizations)

HMOs are private providers of healthcare insurance that allow you access to doctors in their network. HMOs are prepaid and normally cover you for a year, so you must renew them annually. There are several payment options, including monthly, quarterly, and yearly.

HMO plans are typically provided as a part of the benefits package for private businesses so upon separation. Because HMOs are associated with employment, coverage age is up to 65 years old only.

PhilHealth

PhilHealth is a government-owned and controlled corporation attached to the Department of Health to serve as a national health insurance program. It provides assistance in the health care of Filipinos, whether employed or not. Membership is compulsory for employees and contributions are automatically deducted from their salaries. Deductions per month is based on the brackets set by the government and may increase depending on mandated policy changes.

PhilHealth covers all ages and demographics and provides in-patient services, maternity benefits, and pays for a certain percentage of hospitalization fees (including COVID-related confinements).

Health Insurance

Health insurance is a contract between an insurer and a policyholder that guarantees financial support from the former in the event of hospitalization, expensive surgeries, life-threatening health concerns, or even death.

Aside from the healthcare benefits, health or life insurance policies come with investments that can be useful when you retire. Additionally, it has an accruing value that enables automatic saving. In the event of the policyholder’s demise, beneficiary/ies will get a lump amount that, depending on the value of the company’s stock, may or may not be greater than the total contribution.

All of these health insurance companies in the Philippines have the same objective – to pay for the medical costs of its policyholders or members. This table will help us better understand their differences:

	PHILHEALTH	HMO	HEALTH INSURANCE
Provider	Government	HMO companies	Insurance companies
Governing agency	Government/ DOH	Insurance Commission	Insurance Commission
Coverage age	No age limit. Senior citizens are automatically covered for free.	Up to 65 only	16-75
Policy term	Senior citizens – indefinite Non-senior members – for as long as they’re actively paying.	Yearly renewal and subject to health status assessment.	Fixed term
Premium	Constant, unless government impose changes.	Premium increases according to age.	Premium increases according to age.
Benefits	Cash assistance (fixed amount) depending on the illness.	1. Hospitalization 2. Emergency hospitalization 3. Outpatient consultation 4. Dental services (depending on the plan)	1. Some providers include Life insurance saving (dividends/fund values) 2. Hospitalization 3.Critical illness benefit 4. Some outpatient benefits
Critical illness benefits	Z benefits package – subsidize specific amount for treatment and hospitalization depending on the illness.	Covered by the policy but is limited to the consumable amount set by the HMO.	Lump sum cash if policyholder is diagnosed with a critical or terminal disease.
Daily hospitalization	Case dependent. Will vary depending on the availability of rooms and case of patient.	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.	Daily hospital income benefit is provided. The amount varies according to the plan chosen by the policyholder.
Transmittal of financial subsidy or assistance	Automatically deducted from the hospital bill.	The accredited hospital or clinic will charge your bill against the consumable limit or amount provided by the HMO. Just provide HMO card.	Reimbursement
When policy is not used after a year or in the contract period	Contribution will be added to PhilHealth’s fund to extend financial assistance to their members who are in need.	Policy defaults back after 1 calendar year and your contribution whether or not you’ve consumed your annual limit.	Earn dividends which can be withdrawn.

Now that we have a better understanding on how they differ, which among should you have? Bear in mind that each 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 major illnesses as they grant more reimbursement, which is useful for long term hospitalizations and more expensive treatment and medical treatments.  PhilHealth is by default, mandatory, and while it may not offer as much as HMOs and private health insurance policies, its benefits can be helpful in subsidizing your expenses for critical illnesses.

If your budget allows, it’s best if you have all three for optimum protection and peace of mind. The combination of the three allows you to cover for the benefit that the others doesn’t have as each has unique offering that can be compensated by the other if you have all three.

References:

Leon-Intal, P. de, MD. (2016, September 13). What are the Differences Between Health Insurance, HMO and PhilHealth? My Finance MD. http://myfinancemd.com/differences-health-insurance-hmo-philhealth/

Difference Of HMO & Health Insurance In Philippines. (2022, September 19). iMoney.ph. Retrieved December 12, 2022, from https://www.imoney.ph/articles/difference-hmo-vs-health-insurance/

What Is The Difference Between PhilHealth, HMOs, And Health Insurance In The Philippines? (2020, March 4). eCompareMo. Retrieved December 12, 2022, from https://www.ecomparemo.com/info/philhealth-vs-hmo-vs-health-insurance