My parents, despite their age, are doing well. And my own hospital stay? Just the one, back in 2019 when my son was born.
For a time, health insurance felt like something we could maybe put off. But life has a way of reminding you that things change.
Being a freelancer, with a little one and parents getting older, the “what ifs” of health scares started to weigh on me. The idea of facing a medical emergency without financial protection? It’s a knot in my stomach I can’t ignore.
That’s what set me on this quest to find some sort of safety net, even if it’s not full-blown insurance. Something’s got to be better than nothing, don’t you think?
Healthcare: The Canadian Dream vs. Philippine Reality
I can’t help but envy Canada’s publicly funded healthcare system. It’s a world away from our situation here, where we’re at the mercy of private insurance companies. PhilHealth exists, sure, but it’s a far cry from the comprehensive coverage Canadians enjoy. The thought of unexpected illness or accidents striking us or our loved ones is enough to keep anyone up at night. It’s a constant worry that chips away at our peace of mind.
The Price of Unpreparedness
Emergency medical expenses can be crippling, even in public hospitals here. It’s a stark reminder of why having an HMO plan is crucial. But for many Filipinos, the cost is a major hurdle. While some employees are fortunate enough to have coverage through their jobs, single parents, the unemployed, self-employed individuals, retirees, and freelancers often face hefty annual premiums ranging from P10,000 to P40,000.
The HMO Landscape: Big Players and Key Differences
Maxicare and Intellicare are the top dogs in the Philippine HMO scene, at least when it comes to the number of members. I’ve personally had experience with both insurance companies during my employment days. Thankfully, I never fell ill, but I did utilize it for dental care and maternity consultations. My colleagues found it invaluable during emergencies, showcasing the true benefit of HMOs – present your card, and the financial burden is significantly lessened.
However, it’s important to remember that not everything is covered. Childbirth, for example, can be a costly surprise – and most HMOs I know don’t include it (good thing is, SSS got pretty good maternity benefits.)
HMO vs. Health Insurance: Understanding the Distinction
Recently, I learned something surprising: HMOs and health insurance aren’t the same. While both offer assistance during hospitalization, health insurance is more like a long-term investment that grows over time. HMOs, on the other hand, typically become more expensive as you age and require annual renewal. Think of Etiqa and AXA as health insurance providers, while Maxicare, Intellicare, and Medicard fall under the HMO umbrella.
Ideally, you’d have both for maximum protection. But if your budget is tight, an HMO is a good place to start.
Budget-Friendly Alternatives: Health Cards to the Rescue
Gladly, some insurance companies are stepping up with more affordable options like health cards. These are great for emergencies but don’t offer the same comprehensive coverage as HMOs. Be sure to read the fine print thoroughly before you buy.
Here are some health cards that can be purchased and used during emergencies:
Insular Life ER Care All-In (Minimum: ₱1,350/year)
Who it’s for: Kids (1-17 years old) and Adults (18-64 years old)
What it offers:
- Emergency Care Coverage: Up to ₱100,000 coverage for emergency room treatment and inpatient care (confinement) for accidents, viral/bacterial diseases, and specific conditions.
- Benefits Include: Doctor’s fees, emergency room treatment, lab tests, medicines, room accommodation, surgery, and more.
- Additional Perks: Hospital cash allowance (adults only) and 1-year telemedicine access (kids only).
Where you can use it: Over 500 iCare-accredited hospitals in the Philippines (excluding top 6 hospitals in Metro Manila).
When it’s valid: For 1 year or until used, whichever comes first.
Why choose it:
- Provides financial protection against unexpected medical emergencies.
- Offers various coverage options to suit different needs and budgets.
- Simple and easy to use – just present your card at the hospital.
How to get it:
- Choose the appropriate plan based on your age and desired coverage level.
- Purchase online or through authorized sellers.
Important Reminders:
- It’s a one-time use health plan.
- Coverage starts 7 days after activation.
- Pre-existing conditions and certain exclusions apply.
- Review the Health Care Agreement for full details.
Exclusions:
- Certain medical conditions and treatments (refer to the Health Care Agreement).
- Top 6 hospitals in Metro Manila.
Medicard RxER (Minimum: ₱1,998.00/year)
While HMOs offer comprehensive coverage, their cost can be a barrier for many. If you’re looking for a more budget-friendly option, consider Medicard’s RxER health card.
Who it’s for: Anyone, regardless of age
What it offers:
- Free unlimited check-ups with a range of specialists, including GPs, pediatricians, and gynecologists (excluding maternity consultations).
- 30% off on labs, diagnostics, surgeries, and even aesthetic services.
- Free dental consultations and one teeth cleaning session, plus 30% off other dental procedures.
- An annual physical exam, including blood tests, urinalysis, and a chest X-ray
- Emergency coverage for accidents, poisoning, burns, and animal bites.
Where you can use it:
- Consultations and physical exams are at any Medicard clinic.
- Emergency coverage is valid at all Medicard-accredited hospitals nationwide.
When it’s valid:
- The card is good for one year.
- Emergency coverage kicks in within the first 6 hours of the incident.
Why choose it: RxER provides affordable access to preventive, outpatient, and emergency care.
How to get it: Apply online or at any Medicard clinic. The cost is ₱1,998.00 per year.
Maxicare PRIMA Gold (₱16,888/year)
Who it’s for: Newborns to Seniors
What it offers:
- Unlimited Consultations and Diagnostics: Access a wide range of lab tests and consultations with specialists at any Maxicare Primary Care Clinic (PCC), prescribed by a Maxicare doctor.
- Emergency Coverage: Up to ₱20,000 annual coverage for emergency room visits at Maxicare-affiliated hospitals.
- Dental Benefits: One free dental service per year at Metro Dental, including cleaning, X-rays, and consultations.
- Teleconsult: 24/7 access to medical advice via phone.
- Group Life Insurance: Coverage for accidental death, dismemberment, and disablement up to ₱50,000 (for members aged 15 days to 80 years).
Where you can use it:
- Consultations and diagnostics: Any Maxicare Primary Care Clinic (PCC)
- Emergency Coverage: Any Maxicare-affiliated hospital nationwide
When it’s valid:
- For one year from the activation date.
Why choose it:
- Covers pre-existing conditions.
- No preliminary checkup or paperwork is required.
- Offers comprehensive healthcare coverage for all ages.
How to get it:
- Purchase online or through authorized sellers.
- Activate your eVoucher or physical voucher online.
- Receive your eCard via email and physical card via mail.
Important Reminders:
- Always present your Maxicare PRIMA Gold card or eCard and a valid ID.
- Membership is non-transferable once registered.
- The 15-day free-look period allows for a refund only if the card hasn’t been used.
Exclusions:
- Specific lab tests and diagnostics (e.g., maternity-related, psychiatric tests).
- Hospital admissions or confinement.
- Consultation fees outside of Maxicare PCCs.
Maxicare PRIMA Gold provides a hassle-free and comprehensive healthcare solution, ensuring you and your family have access to quality medical services when you need them most.
My Choice: Maxicare PRIMA Gold
Personally, I’m leaning towards Maxicare PRIMA Gold. I like that it covers pre-existing conditions and doesn’t require a checkup. Plus, with unlimited consultations and a decent emergency room allowance, it seems like a solid choice for my family. The only catch is making sure we’re near a Maxicare clinic.
What’s Your Pick?
Choosing the right HMO is a personal decision. It all boils down to your individual needs and budget. Do your research, compare plans, and don’t hesitate to ask questions. And remember, some coverage is always better than none!
Note: This post was originally written in 2020 and has been updated as of September 25, 2024.