What is Health Insurance?
Costs of health care is increasingly becoming expensive by each passing day. As the economy grows and creates opportunities for citizens, the risk it poses is also on the rise. The best answer in providing indemnity to health care needs is best secured by means of a health insurance. A health insurance provides monetary assistance and covers up costs of treatment in case of an injury or an ailment. Most importantly, it gives you access to reputed and top notch medical care in the form of treatment at the best facilities, access to specialized doctors. It also extends cash assistance in case of fatality or permanent or total disability so that your loved once are shielded from financial extremities.
Most importantly, it gives you peace of mind by securing the health care needs of you and your immediate family members. Just like any other growing country, Philippines provides access to health care in the form of government aided public health schemes and options provided by private insurers.
Why Does One Need Health Insurance?
Just like any other form of insurance such as life, insuring health is the need of the hour. In this age plagued by ailments, risks & diseases that are constantly on the prowl, it's better to be safe by securing the financial face of treatment. Apart from the most basic feature of covering health related expenses, you will surprised to discover a the variety of benefits if offers. Let's list them out for you to understand the need for it.
- Offers cashless financial assistance in case of hospitalization or prolonged treatment.
- If cashless facility is not available, it offers reimbursement of hospital expenses incurred.
- Provides financial aid for expenditure incurred pre and post hospitalization.
- Costs relating to prolonged treatment such as chemotherapy and dialysis are also covered on the basis of coverage clause.
- Financial assistance during emergency hospitalization.
- All members of the family can be covered under a single policy, ensuring comprehensive protection.
- Offers tax benefits by way of deduction, depending on the product in question.
- Lump sum financial assistance in case of critical illness or long term disability.
- Cash assistance during hospitalization.
Types of Health Insurance in Philippines
Provision of Health Insurance in Philippines is mix of government administered health insurance programs and coverage offered by private companies. While the National Health Insurance Program(NHIP) or PhilHealth under the aegis of Department of Health(DOH) administers state mandated health insurance programs in the country, a league of homegrown and private players offer a range of comprehensive and customizable health insurance plans in Philippines.
The Health Insurance sector in the country can be categorised as below, based on the nature of providers and services offered.
- PhilHealth(Philippine Health Insurance Corporation) administered National Health Insurance Program(NHIP)
- Private Health Insurance offered by local and international general insurance companies.
- Health Maintenance Organizations(HMO)
- International Health Insurance
- Expatriate Health Insurance
PhilHealth - National Health Insurance Program(NHIP)
The Philippine Health Insurance Corporation is a government owned organization and functions under the aegis of Department of Health. PhilHealth was set up in 1995 to provide a universal health coverage at affordable rates to Filipinos with a goal to provide sustainable and accessible health insurance for all. Regularly employed Filipinos have a PhilHealth account since employers make monthly payment on behalf of them that contribute towards the fund maintained by the government.
Schemes of health insurance administered by PhilHealth offer comprehensive medical benefits such as inpatient and outpatient care, catastrophic coverage, surgery & maternity benefits and a host of other ancillary services. The treatment can be availed at any of the network hospitals and clinics consisting of public and private institutions. The provisions of PhilHealth are also applicable to Overseas Filipino Workers(OFW). The corporation extends a host of services for citizens online such as Member Registration, Group Enrollment, Payment & Location of Health facilities online.
Membership plans are available for payment of periodic premiums or a lifetime membership for a lump sum payment.
Private Health Insurance
Run by private insurers, Private Health Insurance in the country are generally bought by self employed and freelance individuals who are not benefited by PhilHealth schemes. Insurance programs by private players are also available to salaried individuals. The premium for the coverage is fully paid by the insured who can also include immediate family members in the cover.
Employers are free to tie up with private insurers to provide health insurance benefits to their employees. Cover for family members comes at an additional cost. The benefits and features offered by private insurers are on par with international standards owing to their association with leading hospitals in the country offering quality healthcare. These health insurance programs extend a slew of benefits such as inpatient & outpatient services, hospitalization and surgical assistance, cash assistance for loss of income due to accident/illness, lump sum payment for death, disablement or dismemberment etc.
Leading Health Insurance Companies in Philippines
- Philippine Prudential
- Sun Life Financial of Philippines
- Insurance Life Health Care Inc.
Health Maintenance Organizations(HMO)
HMO’s in Philippines have a major role to play in organizing the health sector. These are institutions that administer managed healthcare for individuals/Companies who are looking for self financed health care plans. This category consists of private liaison operators who bring together a cluster of medical services and assistance to members who wish to avail the best of health care for self or employees.
HMO’s offer comprehensive and customizable health options to members on a reimbursement basis. They partner directly with health service providers such as hospitals, doctors & clinics and create a network of facilities easily accessible to its members at affordable rates. This type of health insurance option is generally subscribed to by corporates and small enterprises due to its accessibility and popularity in this sector. HMO administered programs offer major medical facilities such as outpatient and inpatient services, hospitalization and surgical benefits, cover for medication, laboratory tests and much more.
Some of them even offer cash assistance benefits in case of loss of income as a result of an injury due to an accident or illness. It also provides monetary compensation to the insured and family members in case of death or disability due to an accident. Customised HMO plans also allow immediate family members to be a part of the coverage ambit.
Leading HMO’s in Philippines
- Maxicare: Established in 1987, Maxicare is the pioneer of the HMO industry in the Philippines and continues to hold a dominant position in the market. Founded by a group of like minded healthcare professionals with a vision to deliver a sound healthcare system, it continues to do so with a strong network of over 43,000 accredited doctors and specialists backed by 1,000 plus hospitals and clinics. The tabulation below provides further details about the products offered by Maxicare in the Philippines.
Product Name Type Description Plan Types 1) MyMaxicare Individual & Family An exclusive program designed to answer the health insurance needs of individuals and their family members. This plan not only provides hospitalization benefits but also covers other treatments such as cover for out/inpatient, emergency & preventive care, dental care to help you make the most of it.
- Platinum Plus
2) Maxicare Plus SMEs (Small to Medium-Scale Enterprises) A one of its kind health insurance plan for SMEs in Philippines, this scheme offers unparalleled benefits which includes coverage for preexisting conditions. The MBL (Maximum Benefits Limits) value ranges from P60,000, up to P220,000. N.A 3) Maxicare Corporate & Employees Corporations Custom made health insurance scheme for employees working in corporates and offers the best healthcare in the country. This scheme offers benefits of Emergency Care, In & Out patient care on a reimbursement basis. Available on demand by contacting the provider.
- Caritas Health Shield: Established in 1995, Caritas maintains an extensive network of over 107 branches spread across the length and breadth of Philippines backed by 703 plus hospitals and clinics. This HMO has over 574,000 members on its database and continues to grow by each passing day. This HMO is an active member of the Association of Health Maintenance Organizations of the Philippines (AHMOPI).
A variety of highly customized health insurance plans for various working groups dominates the portfolio of Caritas. They have been listed below for reference.
Product Name Type Description 1) Expanded GOLD Health Care Program All The standard health care program where the premium payments are restricted to just 5 years. This plan provides yearly increment in benefits and maximum coverage amount. 2) Expanded PREMIER Healthcare Program All Akin to the plan above, this plan offers quality healthcare at affordable pricing. This 5 year premium payment plan offers comprehensive cover such as hospitalization benefits, In & Out patient care with an yearly increment in the maximum coverage amount. 3) Expanded PRIME Plus Healthcare Program All A health protection plan which provides over for the insured and family members with a guaranteed 5 percent increment from 7th or 11th year. This plan also covers limited pre existing illnesses. 4) Expanded CORE - 10 Healthcare Program Employees A tailor made scheme for corporates for their employees, where the premium can be paid by the enrolled member by way of salary deduction. This plan provides affordable protection and shields the insured from premium hikes through a 5-year plan. COMBI Plan Employees Similar to the plan above, this scheme offers the best of healthcare benefits such as Hospitalization, In & Outpatient care, Lump Sum Pension Benefits and so on.
- Blue Cross Healthcare: A market leader in segments such as Health, Travel & Accident Insurance in the Philippines, Blue Cross Insurance, Inc. has a considerable presence across this region with footprint in countries such as Hong Kong, Thailand, Vietnam and other countries. The group partners with thousands of medical establishments & doctors across the country to offer the best access to quality healthcare through its highly customized medical insurance plans.
The tabulation below illustrates the healthcare plans it offers in Philippines.
Product Name Type Description 1) Blue Royale Individual This “All Inclusive” plan covers almost every possible health risks one can think of. From hospitalization to maternity assistance, it has it all. Plus, one can also choose additional covers to stay protected. 2) Blue Royale Premier Individual A tailor made scheme for senior citizens, it offers flexibility to the insured to choose their own doctor or hospital from a network of top notch medical facilities from around the world. The Maximum Medical Coverage one can avail under this scheme is US$ 100,000. 3) Blue Royale Dual Protect Overseas Workers (OFWs) - Group Plan This plan is designed to meet the medical and travel emergencies of workers employed offshore with a maximum coverage of up to US$50,000. The member can avail treatment on both cashless or reimbursement basis. 4) Select Standard & Select Plus Individual A plans that offers a high MBL, this scheme offers medical care in Philippines and abroad. It gives you the freedom to choose the doctor or medical facility. These are two different plans but more or less come with the same set of benefits and features. 5) Lifestyle Young Individuals A tailor made health insurance plan for the health conscious youth of the country that offers maximum benefits of up to P500,000. This scheme is open to aspirants between the age group of 21 - 40 years. 6) Blue Cross Flexi Employees in groups of at least 50 members A highlight flexible scheme that offers companies medical insurance for their employees. it helps the company easily modify the benefits in accordance to their needs and offers a wide range of medical benefits to the employees. 7) Blue Cross Flexi Baby Group Employees in groups of 20 - 29 members At affordable premium, this medical insurance cover for employees in groups offers medical aid such as Hospitalization benefits, In & Out patient Care on reimbursement and cashless basis. 8) Healthline TPA Employees Administered by a third party, this plan requires you to make a deposit into a fund and get access to a wide network of hospitals, doctors & medical facilities to manage the medical needs of the group.
International Health Insurance
Non - Life insurance companies in Philippines offer health insurance options to individuals and family member to offer protection while travelling abroad. Insurers partner with multiple international organizations and associations to offer seamless access to medical services at a foreign location. It also offers emergency access to medical care for critical cases along with evacuation and repatriation to home country. If you’re a globetrotter, signing up for a health insurance with international validity helps in securing your immediate and intrinsic health needs.
Expatriate Health Insurance
Access to international standard health insurance and medical facilities to expatriates working in Philippines. Private insurance companies host medical insurance plans tailor made for foreigners that gives them access to the best of health care. You can find further information on the web portals of major health insurance providers.
How Can BankBazaar.ph help you in Choosing the Best Health Insurance Plan in the Philippines
If you haven't covered self or family for medical and health risks, you must have understood its importance and need for it by now. Choosing an insurance cover that best matches your requirements can be quite challenging owing to multiple factors. One of the most visible challenge we face is decoding the jargons involved in the fine print. All of us may not be easily able to comprehend the literature and therefore find it difficult to choose the right insurance plan.
BankBazaar.ph understands the need for availability of information in a comprehendible and conversational manner that helps you to get first hand information on various health insurance products available in the market. Our aim is to decode information of health insurance products available from various sources and present them to you in a format that is appealing and provides all the information you want in the little time you have.
Therefore, if you’re doing homework on preparing for investing in a health insurance, do browse the “Health Insurance” section of this website for the required information.
Frequently Asked Questions
- What is pre-existing condition in Health Insurance? Please elaborate.
It is a commonly used term to denote an existing health condition/issue prior to availing the health insurance. Based on the plan and the offer, some insurers do provide limited or unlimited cover for pre-existing conditions. Based on situations where you either self declare it or is determined during the medical tests, you can be charged additional premium for a pre-existing condition.
- What is Accident Insurance? How is it different from Health Insurance?
This type of insurance deals with the covering the costs arising out medical treatment for an injury caused accidentally. It covers most of the related expenses such as costs of surgeries, In-Outpatient treatment, Emergency care, Hospital Stays, Medical Tests & others.
It may either be offered as a benefit tagged in a comprehensive health insurance plan or as a standalone policy that only covers medical costs arising out of treatment of an injury due to accident.
- What is Critical Illness in Health insurance? How does the coverage work?
Illnesses that have a lasting impact on the health or the ones which need treatment for a longer period for recovery is tagged as critical illness. Strokes, Cancer & Heart Attacks are some of the common examples.
Most of the health insurance products cover critical illnesses by offering either a lump sum payment for treatment or offer periodic cash based on the illness in question.
- I came across a term called “Deductible” in my health insurance policy. What does this mean?
This term is used to denote a specific amount (fixed or percentage), payable by you in a health insurance claim. A deductible is nothing but your share the expenses incurred in the medical treatment. It is a small value charged either due to non-coverage of certain types of medical charges or due to the terms and conditions you had agreed to in the contract.
Not all health insurance companies charge a deductible
- What are the benefits of group health insurance? I am looking to cover all my employees under a single policy.
Group health insurance is one of the most preferred and affordable way to provide comprehensive health cover to employees. Here, you buy an insurance for a certain number of group of employees under a single window who will share a common set of benefits such as cashless hospitalization, emergency and critical care and so on. It's a plan where you as an employer can select the basket of benefits and administer them to the employees.
Based on the insurer or the TPA (Third Party Administrator), your employees get access to quality healthcare through network hospitals and specialized doctors.
- How are hospitalization expenses settled by the insurer with the hospital? Can you explain in detail?
Expenses relating to hospitalization of the insured member is generally settled in two different ways as explained below, depending on the predefined terms and conditions.
- Can you please provide some details about PhilHealth?
The Philippine Health Insurance Corporation or PhilHealth as popularly known is a government owned health insurance company whose goal is to provide and administer health insurance in the public space. It provides various packages depending on the requirements of the member(s).
The network consists of both public and private institutions operating in the field of healthcare and ancillary services. To know more, you can visit the official website of PhilHealth or visit the nearest center for information on products and services.
Cashless: Here, the member walks into any of the hospitals or facilities in the network and avails the required hospitalization or treatment without paying the medical bills since the insurer or TPA settles the bill directly with the hospital in question. You may be required to pay nominal charges towards those components not covered.
Reimbursement: In this option, The insured member is required to pay the expenses relating to the treatment upfront to the hospital and claim it with the insurer by presenting bills and other paperwork. The reimbursement will be made either through a cheque or by means of a direct credit by the insurer. Slowly fading, the reimbursement mode of settling bills is exercised when the hospital/medical facility does not fall within the published network or on the basis the type of payment mode provided in the insurance policy.
News About Health Insurance
Supreme Court Agrees to Increase in PhilHealth Premium
The Supreme Court of Philippines has agreed to the increase of premium contributions by members of Philippine Health Insurance Corporation (PhilHealth). Kilusang Mayo Uno (KMU), the militant group, had filed a petition in 2014 questioning the increase in the minimum monthly contributions of the members. In the petition, the group questioned the increase of contributions to P1,000 from P750 of members who earn up to P8, 9999. They challenged other circulars as well including No. 0025 – 2013, which doubled contributions of land-based OFWs (Overseas Filipino Workers) to P2,400 per annum. The Court dismissed their petition saying it did not have merit and it was unable to prove that the company was wrong in issuing the circulars. The Court instead said that the company was being sensitive to the needs of the people and have postponed in the increase in rates many times. PhilHealth was able to give a valid reason for the increase in the rates and said that it was important so that the members could avail benefits from the packages.
01st August 2016
Employers to make payments for their workers’ health insurance
The employers of the different organisations in Philippines must enrol the employees with Philhealth (Philippine Health Insurance Corporation). It is a government agency in Philippines that deals with health insurance policies. The information officer of Philippine Health Insurance Corporation, Bryan Jabay stated that there are employees who have still not been enrolled by their employees to Philippine Health Insurance Corporation.
He added that now it is compulsory for all the employees to ensure that they have enrolled their workers with Philippine Health Insurance Corporation as per the National Health Insurance Act of 1995.
The agency’s legal department has been dissolved. Complaints will now be taken care of by the regional offices. If there is any refusal or failure in registering a complaint, then there will be a penalty. The penalty will not be less than P 5,000. However, it will also not exceed an amount of P 10,000. This amount will be multiplied by the number of employees who have lodged complaints. Criminal case can be filed against the employer by Philippine Health Insurance Corporation, if the employer does not register the workers with Philhealth.
24th July 2016
PhilHealth Reiterate Funds to be in Robust Condition
PhilHealth or the Philippine Health Insurance Corp. on Monday insisted that their funds remain in robust condition and that there is no indication that the corporation will go bankrupt for the next 128 years.
Atty Alexander Padilla, the President and Chief Executive Officer of PhilHealth has reiterated that their funds are continuing to grow strong. They are also confident that PhilHealth reserve funds are not expected to go down and become prone to collapsing or bankruptcy due to the good investments the corporation has made apart from their collection efficiency. He also validated the same by saying that their reserve funds have been growing steadily from Php 112 billion in 2012 to Php 128 billion in 2015.
14th June 2016
New rules issued for health insurance and pre-need
New rules have been issued by the Insurance Commission (IC) that will guide the sale of cost effective health insurance policies and pre-need products. This is done in order to offer better protection to the customers.
The features and specifics of Micro Pre-need products have been listed by the Insurance Commission. For pension plans, memorial plans and education plans that are under Micro Pre-need, maximum gross contact prices should never go above 7.5% of the wage rate (daily) for all the Manila based non-agricultural workers.
According to the IC, all the products that are introduced under Micro Health must broaden the coverage for accidental injuries and eligible illnesses. .
25th April 2016
Department of Health to spend on Dengue vaccine
The Department of Health, Philippines announced that more than a million students from public schools will be given 3 doses of vaccinations against dengue that are worth P3000. According to Health Secretary Janette Garin, the Department of Health is spending P3.5 billion in total for vaccination targeted towards students from public schools in areas where the incidence of the disease is high.
The government is receiving the vaccines at a discounted price. The first dose of the vaccine will be given to the students in March followed by the second dose in September and the third in March 2017.
It has been previously reported that the initial beneficiaries of the free vaccine are 9 year old children from government schools in Calabarzon, National Capital Region and Central Luzon.
Garin also reported that Philippine Health Insurance Corp. is also looking to cover vaccines against dengue for its members but this could take time of up to three years to materialize.
15th January 2016