Common HMO Questions in the web Explained
What is an HMO in the Philippines?
An HMO (Health Maintenance Organization) is a company that provides yearly renewable healthcare services through a network of accredited hospitals, clinics, and doctors. HMO plans typically include outpatient care, inpatient hospitalization, emergency services, and preventive healthcare, allowing members to access medical services with minimal or no upfront cash payment. HMO can quote for individual and family plans & Corporate/SME/association/cooperative/Government/union plan.
What does HMO cover in the Philippines?
Most HMOs typically cover:
Outpatient consultations
Laboratory and diagnostic tests
Emergency care
Inpatient hospitalization
Annual physical examinations
Preventive care
Dental care (coverage depends on the plan)
Coverage varies by provider and plan. Some HMOs also offer prepaid or situational plans, which are lower-cost options designed to cover emergency hospitalization (e.g., dengue or sudden illness).
What is the purpose of an HMO?
The main purpose of an HMO is to make healthcare accessible, affordable, and predictable in cost.
It allows members to receive medical services without paying large amounts upfront.
HMOs are not meant to be purchased when already sick; they are designed to protect against future or unexpected medical needs.
What are the types of health insurance in the Philippines?
The Philippine healthcare system generally includes:
PhilHealth – Government-mandated social health insurance
HMO Plans – Yearly renewable healthcare plans (individual, family, or corporate)
Private Health Insurance – Offered by traditional insurance companies, usually with higher coverage limits, optional riders (life or critical illness), and longer-term commitments
Is PhilHealth considered an HMO?
No. PhilHealth is a government social insurance program, not an HMO.
PhilHealth provides fixed case-rate benefits, while HMOs provide managed healthcare through accredited provider networks with coverage limits chosen by the member.
How much does HMO cost per month?
For individual plans, HMO costs usually range from:
₱1,200 to ₱4,000 per month
Pricing depends on age, coverage limit, benefits, and provider.
Can I use HMO in public hospitals?
Generally, no. HMOs are typically limited to accredited private hospitals and clinics.
However, there are some public hospitals that may be accredited by certain HMOs, such as:
Philippine Heart Center
National Kidney and Transplant Institute
Philippine General Hospital
Accreditation varies by provider.
What is HMO and its benefits?
An HMO is prepaid healthcare that offers:
Faster hospital access
Lower medical costs
Cashless transactions
Coordinated healthcare support
Protection against unforeseen medical needs
What are examples of HMOs in the Philippines?
Common HMO providers include:
Maxicare
Intellicare
Medicard
PhilCare
iCare
Cocolife
Health Maintenance Inc. (HMI)
Etiqa Philippines
Pacific Cross
Medocare
Can I use HMO without PhilHealth?
Yes, but it usually results in higher premiums or out-of-pocket payment for the PhilHealth portion of the hospital bill.
Most HMOs require PhilHealth to be used first to reduce costs.
Which is better, HMO or PhilHealth?
They are designed to work together, not replace each other.
PhilHealth reduces the hospital bill, while the HMO covers the remaining balance up to your plan limit.
What is the disadvantage of PhilHealth?
PhilHealth pays fixed amounts per illness and does not fully cover hospital bills, especially in private hospitals.
Can I use HMO and PhilHealth at the same time?
Yes. PhilHealth is applied first, and the remaining balance is covered by the HMO, subject to your coverage limit.
How much is PhilHealth per month?
PhilHealth contributions are 4% of monthly salary, shared equally by employer and employee.
For voluntary members, contribution amounts depend on declared income. It is best to confirm current rates directly with PhilHealth.
Is laboratory covered by PhilHealth?
Laboratory coverage is limited and illness-based. Coverage rules change, so members should verify directly with PhilHealth for updated benefits.
What is the No. 1 HMO in the Philippines?
There is no official ranking. Leading providers commonly include Maxicare, Intellicare, Medicard, iCare, and PhilCare.
Being the “No. 1” does not automatically mean better coverage or service. Plan suitability depends on individual or company needs.
What are the top health insurance companies in the Philippines?
This varies by year, but major providers often include, take note: health insurance is different to HMO/plan
AXA Philippines
Sun Life Philippines
Manulife Philippines
What is the oldest HMO in the Philippines?
Health Maintenance, Inc. (HMI) – founded in 1986
What is the ranking of Intellicare in the Philippines?
Intellicare is consistently considered among the top HMOs, particularly in the corporate market, based on employer adoption and coverage reach.
Which is the best private health insurance?
There is no single “best” plan. The best option depends on your age, health needs, budget, and coverage goals. Professional plan analysis is recommended.
Which is the No. 1 insurance company in the Philippines?
There is no official “No. 1.” However, Sun Life, AXA, and Manulife are consistently among the largest insurers in the Philippines in terms of assets and policyholders.
It is important to note that insurance companies are different from HMO companies. While HMOs are considered a form of insurance, the term insurance company in the Philippines usually refers to life insurance providers.HMOs focus on medical or healthcare coverage, while health insurance plans offered by traditional insurers differ in pricing, benefits, coverage structure, and how claims are processed. These products serve different purposes and are designed for different healthcare and financial needs.
HMO Accredited Hospitals, Doctors, and Dental Clinics (Near You)
HMO-accredited hospitals, doctors, and dental clinics are facilities that accept the HMO plan you currently have or plan to enroll in. Only accredited facilities can honor your HMO benefits.
If your medical case is covered under your plan and is not part of the exclusions, you will not need to pay the hospital bill upfront. Coverage is always subject to your plan’s benefits, limits, and exclusions.
You may click the provided link to access the list of accredited facilities and doctors of our HMO partners.
https://servarehealth.com/hmo-availment-guide
HMO Approval (Letter of Approval – LOA)
HMO approval refers to the Letter of Approval (LOA) issued by the HMO to a member when visiting an accredited hospital or doctor. Since this is usually the first point of contact during availment, it is also where most issues occur.
LOAs can be secured through:
The hospital’s HMO section
The HMO mobile app
The HMO contact center
However, these channels are often insufficient during urgent situations. This is why many companies work with an HMO broker to provide support during employee availments. Individual and family plan holders can also benefit from this added assistance when their plan is secured through a broker.
Is Avega an HMO?
Yes, Avega is an HMO, but it offers Third-Party Administration (TPA) plans.
Under a TPA arrangement:
A company sets a fixed medical budget (e.g., ₱500,000 per year)
Standard coverage guidelines are agreed upon
All medical availments are deducted from the shared fund
Once the budget is exhausted, it must be replenished
Each availment is charged an administration fee plus VAT
All enrollees pay enrollment or access fees
Rates depend on negotiated terms or standard offers
Whether a TPA plan is better than a premium-based plan depends on your company’s risk appetite and utilization. An HMO expert can help determine whether a TPA or premium-based plan is more suitable for your needs.
HMO Age Limit
Individual and family plans: typically up to 60–65 years old
Corporate or group plans: usually up to 65 years old, but employees may still be covered beyond this age as long as they remain actively employed
Premiums for older members are typically rated higher (e.g., 2×, 3×, or 4×). This commonly applies to executives and business owners, but assistance may still be available for regular employees.
HMO License and Insurance Commission Accreditation
HMOs operating in the Philippines must be licensed or recognized by the Insurance Commission.
The official list of accredited HMOs is available on the Insurance Commission website.
HMO Application
Applying for an HMO typically starts with speaking to a sales consultant or broker. This is often better than buying online, as exclusions, limitations, and non-covered scenarios can be clearly explained.
A broker can also explain the advantages and disadvantages of each plan and provide a market-wide comparison, since they are not limited to offering only one product. This allows recommendations to be fair, objective, and based on your actual needs.
HMO Coverage: Anti-Rabies and Related Treatments
Most HMOs now cover:
Anti-rabies
Anti-venom
Anti-tetanus
Coverage is usually included under the Maximum Benefit Limit (MBL). However, some plans impose inner limits (e.g., ₱20,000–₱60,000 or first dose only).
Choosing the appropriate coverage should be based on typical treatment costs in your area. Excessively high limits may unnecessarily increase your premium.
HMO vs PPO
HMO (Health Maintenance Organization) uses a fixed network of accredited hospitals and doctors with mostly cashless services and is the most common form of medical coverage in the Philippines.
PPO (Preferred Provider Organization) allows greater flexibility in choosing healthcare providers and usually operates on a reimbursement or hybrid model. PPO-style plans are available in the Philippines but are typically offered by private or international health insurance providers rather than local HMOs.
An HMO may function similarly to a PPO when a Point-of-Service (POS) feature is included, allowing limited out-of-network access.
HMO Agency vs HMO Broker
In the Philippines, an HMO agency is a company that offers HMO plans in a consultative role but is not licensed by the Insurance Commission. Some agencies are directly accredited by HMO providers, while many operate through individual agents.
An HMO broker is a company that is licensed by the Insurance Commission, meets capitalization requirements, and complies with ethical and regulatory standards. Because of this, clients are better protected and assured that the broker operates under government oversight.
More coming soon!
