PhilHealth vs HMO vs Health Insurance: What Do They Mean?
PhilHealth vs HMO vs Health Insurance: What's the Difference?
It’s no secret that getting sick is expensive and can easily wipe out your savings… if you’re not properly protected, that is. Filipinos have three main options -- the Philippine Health Insurance Corporation (PhilHealth), health maintenance organizations (HMO), and private health insurance. The question is: Is there a difference between PhilHealth vs. HMO vs. health insurance? Which one do you need?
Knowing how each one works is important so you can maximize each one’s full benefits and lower the total cost of your medical bills.
A Comparison of PhilHealth vs. HMO vs. Health Insurance
Below, we define PhilHealth, HMO, and health insurance to help you understand the benefits they offer and distinguish them from each other.
What is the Philippine Health Insurance Corporation (PhilHealth)?
The Philippine Health Insurance Corporation or PhilHealth is government-owned and controlled and is the country’s national health insurance provider. PhilHealth provides health coverage for all members.
Filipinos who are employed, self-employed, and/or have the capacity to pay may become members and enjoy its benefits. Members must contribute. For employed individuals, contributions are automatically deducted from their salaries, while voluntary members must pay monthly at their local PhilHealth office or payment center.
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), treatments, and procedures for the most common burdensome diseases in the country, which includes ischemic heart disease, kidney disease, and Pneumonia. PhilHealth also now covers outpatient emergency care and preventive oral care.
What is Health Maintenance Organization (HMO)?
HMO, short for Health Maintenance Organizations, are prepaid healthcare services that private corporations provide to their employees as part of their compensation package, usually upon regularization. Depending on the company, HMO coverage can completely be free or may be deducted monthly from your salary.
HMOs cover emergency room appointments, doctor’s consultations, dental procedures, laboratory tests that typically cost anywhere between P50,000 to P700,000 provided that they are done in clinics affiliated with your HMO provider.
The main difference between PhilHealth vs. HMO is that while both need to be paid for, the latter is provided by a private institution – an HMO provider – contracted by your employer. Moreover, PhilHealth is mandatory for all employees, whereas HMO is not. With that said, since HMOs are linked to your employer or being employed, they can only be used by those under 65 years old.
What is Health Insurance?
Health insurance is a form of investment you get from a private health insurance company through a contract you enter with them. Health insurance policies like Resilience provides the insured, or policyholder, financial support in case he or she gets hospitalized, undergoes surgery or any medical treatment, needs medication, needs to go through routine checkups, or loses their source of income due to an injury or illness.
One of the main distinctions of health insurance from HMO is that apart from receiving medical coverage, policyholders also receive financial protection in the form of cash benefits if they are ever diagnosed with any critical illnesses such as cancer, heart attack, or stroke. In case the policyholder dies during the coverage period, the cash benefit will be passed on to their beneficiaries, ensuring the loved ones will be provided for even after the policyholder’s death.
Some health insurance plans like Wealth Assure Plus have an investment component so policyholders receive additional cash payout upon maturity on top of the standard benefits.
How much you have to pay for health insurance will depend on the type of health insurance plan you get as well as certain factors like your age, your medical history, and your health habits (if you’re a smoker or not, for example).
Choosing Between PhilHealth, HMO, and Health Insurance
So, which one do you need? The answer is: all of them.
PhilHealth and HMO are already covered by your employers and are deducted monthly from your salary, but their coverage is limited, so they may not be enough to cover all your medical expenses if you ever get diagnosed with critical illness or get hospitalized for an extended period. Plus, HMO won’t cover you once you retire.
Health insurance serves to fill the gap that PhilHealth and HMO may not cover. For total protection and peace of mind, you’ll need a combination of the three, especially since health insurance provides a unique benefit that the first two do not have.
We hope this has helped you learn the difference between PhilHealth vs HMO vs health insurance!
If you want to learn more about insurance in the Philippines, don’t hesitate to reach out to InLife.
