What is an HMO?
A Health Maintenance Organization or HMO started in the early 1900s in The United States of America in Washington wherein a small clinic offered lumber mill owners and their employees prepaid medical services and procedures for a premium. With the influence of President Nixon in the 1970s and with the HMO Act of 1973 the HMO industry blossomed because of the need for medical attention.
An HMO is basically an organization wherein they close the gap between individuals or companies and health care providers such as doctors, specialists, clinics and hospitals. It enables itself through a fund wherein individuals or corporations who seek medical help pay a premium monthly, quarterly, semiannually or annually. Normally services provided by these medical practitioners are less costly than standard since the HMOs provide a steady stream of customers.
Advantages of Getting an HMO
- An HMO has a large network. In the Philippines, an HMO is alike the fancy ones offered by Life Insurance companies. Hospitals and Clinics affiliated with HMOs are very competitive since it usually involves accreditation that is filtered by HMOs set qualifications. So you are in good hands with doctors and you always have the choice to prefer which provider you would like to have tests or procedures done.
- An HMO is less costly than most medical plans. Basically it is the more practical way of getting yourself a health plan since at a minimum it will only cost you less than 1,000 pesos a month, in short “hindi masakit sa bulsa.” Most of the treatments that you typically do within the HMO network are dependent on the Maximum Benefit Limit (MBL) which is usually per illness per year, some providers even go as far as use all hospital services that you desire to avail just as long you are within the MBL.
Disadvantages of Getting an HMO
- The flexibility of a visiting specialist. An HMO does have a network of medical practitioners but you can only see specialist (e.g. neurologist, physical therapist, etc.) if your doctor referred you to see the specialist. Although this is not exactly the case for the Philippines at the moment since most specialist are also with many HMO networks because of it being relatively new.
- You will pay for treatments done outside the HMO network. This one is a bit tricky because most of the time, procedures done outside are reimbursable but only up to 80% of the total cost or a certain value determined by the HMO, apply of which is more applicable.
So what happens if I will not be using my HMO? Well, be happy of course! It means that you were healthy when the plan took effect until it expired. We have to stress out that getting an HMO will only be used as a protection for when your health suffers either by an accident, poor nutrition or something acquired. Again and again, “Prevention is better than cure.”