Health is well, as the famous saying goes, and so it is just fitting to invest in your health and one way of doing so is having health insurance. It acts as a safety net that offers future-proof support during unpredictable times. With health insurance in place, you and your family will be prepared for medical emergencies and hefty medical bills. 

Health insurance in the Philippines has three types:

  1. PhilHealth (government-run insurance)
  2. HMO (Health Maintenance Organization)
  3. Private Health Insurance. 

#1 – PhilHealth (Philippine Health Insurance Corporation)

It is the official government-run health insurance provider in the country. It provides financial assistance to employed Filipino citizens needing medical services. The employee pays half of the monthly premium while the other half is shouldered by the employer.

Senior citizens (60 years old and above) and those with disabilities are automatically covered by PhilHealth. PhilHealth coverage includes inpatient and outpatient services, maternity benefits, ancillary services, surgeries, and catastrophic coverage. 

#2 – HMO (Health Maintenance Organization)

It is a private medical organization providing health insurance to members. It gives you access to a network of doctors and healthcare providers across the country. You can customize it according to your needs, but the medical services you will receive will depend on your premiums. In other words, the higher the premium, the bigger the yearly medical coverage.

Health Maintenance Organization is given by employers to their employees on top of PhilHealth contributions. Some of the popular HMOs in the Philippines are Medicare and Maxicare.

Medical coverage includes outpatient services, ancillary medical services like medicines and laboratory procedures, hospitalization, surgery, and dental services. 

#3 – Private Health Insurance

It is medical coverage that pays for the medical and surgical expenses of the insured individual. The expenses can be paid straight to the hospital or reimbursed to the insured. Unlike PhilHealth and HMO, private health insurance has a more extensive network of medical professionals.

It is great coverage, especially if you also want your family to be covered by your health insurance. Premium-wise, Private Health Insurance premium is higher but you and your family will get better coverage, which includes critical illness benefits, hospitalization, dental services, surgery, ancillary services like medicines and laboratory procedures, financial assistance during hospitalization and surgery, and financial assistance for loss of income secondary to illness or accident.

Which health insurance is best for you?

Choosing a health insurance plan can be a daunting task. To guide you with the best choice, here are the things to consider:

Premiums 

  • These pertain to the amount you are going to pay per month for health coverage regardless if you use medical and pharmacy services or not.
  • The premium is paid on a monthly basis. You will lose your coverage if you stop paying the premium. 
  • The rule of thumb is that the higher the premium the better the coverage will be.

Deductibles 

  • These pertain to the amount you need to pay out of pocket before the health coverage kicks in. 
  • Examples of pocket expenses include specialist visits, procedure fees, and prescriptions. 
  • Lower monthly premiums have a high deductible while higher monthly premiums have lower deductibles. 

Medicine coverage 

  • Is your regular prescription covered by your insurance plan? The list of medicines covered varies from one plan to another. 
  • It is usually divided into tiers, which will define the amount of coinsurance or co-pay you need to pay. 
  • To help you come up with the best choice, you need to create a list of your current medicine and compare it to your plan’s formulary. 
  • That way, you will be able to make sure medicines are covered. You will also have ideas of out-of-pocket costs associated with them. 

Policy Updates 

  • Check the policy update for it details the coverage you can avail of and the amount of premium you will pay. 
  • Less expensive policies only cover some cases of hospitalization. Higher premiums offer better coverage such as yearly comprehensive checkups and dental care. 
  • Some health insurance companies’ coverage increases even if your premium remains fixed. 

Check the list of affiliates and accreditation 

  • The insurer has a panel of accredited and affiliated hospitals, clinics, and doctors. 
  • Choose an insurer that offers a huge number of accredited doctors and hospitals/clinics for it will give you more and better options. 
  • The advantage is that even if you’re far away from home at the time of the medical emergency, you can still avail of medical services that will be paid for by your insurer. 
  • Another good thing about having more accredited hospitals and doctors is that you get to avail of services for rare diseases such as neurologic-related conditions. 

Inclusions 

  • What medical services are included in your coverage? Some insurance companies offer outpatient and inpatient coverage while others only offer inpatient services. 
  • For inpatient-only coverage, you will not be covered for an outpatient-related condition such as when you have a respiratory problem and went to the emergency room, but are not admitted. 
  • In other words, your ER stay, medicines, and procedures will not be covered because you are not admitted. 
  • Keep in mind that some minor procedures can be done in an outpatient setting. 
  • It is best to have medical insurance coverage that includes both outpatient and inpatient care. 
  • The premium is higher but you will receive comprehensive coverage. 

Health insurance is a lifeline in times of medical emergencies, but the premium can eat up a huge portion of income, especially for people with average income. 

The premium is dependent on the age when you sign up for a health insurance policy, type of coverage, and type of health insurance. PhilHealth and HMOs are more affordable than private health insurance but the latter offers better coverage. 

If you are still young, the premium is lower, and there’s a chance you can get a policy for as low as PHP 3, 000. The premium gets higher if you are older and nearing the age of retirement. 

If you reach past the age of retirement, there is a slim chance of getting approved. While it is important to consider your budget when choosing health insurance coverage, you should not disregard the importance of considering what you actually need. Choose an insurance policy that fits your healthcare needs.

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