|
Post by gadgets88 on Mar 13, 2008 9:07:44 GMT 8
HMOs ExplainedWhat are the different health care organizations in the Philippines? What are their PROs and CONs? Please list them here. Any HMO agents here in PinoyMTBiker? Please enlighten us! Thank you!
|
|
|
Post by gadgets88 on Mar 13, 2008 10:09:11 GMT 8
Split from: How+hard+should+you+push+yourself%3FBefore I did my 3 5k events last January, I had a complete work up in December - 2D-echo, stress test, all lab tests - blood, urine, cholesterol, sugar, blood pressure, liver, etc. It costs less than 10k at Borough Eastwood - way less than an XTR crankset. Considering how much we spend on our bikes, think about this - your body should be your best investment - look after it and get "XTR-level" health checks as well. I pay a little less than P20K a year for my Caritas Health Shield card. I got the E level (whatever that means, I have yet to ask the agent) and 10 units. There are many levels (A-B-C-D-E) of coverage. I think the units refer to the limit of peso value of coverage. What are the PROs? I get a free dental cleaning once a year, 10 free consultations to the doctors a year, dunno how many lab tests allowed. Haven't really understood much about how the card works, I just try to get as much tests as I can for free. Also, my kid gets 10 free visits to his pediatrician (who is caristas accredited) as well (side benefits of my card). My 1st visit to the cardiologist, after giving me an ECG, refused to give me the 2D-echo and treadmill test, telling me that my result in the EGC did not warrant further study. It took me 2 years to find another cardiologist who believed I required the 2D echo and treadmill test and got the tests approved by Caristas (pahirapan minsan yung approval = you don't get the test without the consent of the accredited doctors). What are the CONs? You have to shop for accredited doctors who care enough to suggest you take certain tests. Some doctors don't welcome Caritas holder patients because Caritas take 3 months or so to pay the doctors. (Pahirapan din ang pagbayad sa duktor = delayed reimbursements to the doctors from Caritas) These doctors treat Caritas holder patients badly. I had my share of dreadful meeting of this kind. Some doctors are so popular with Caritas holder patients, the queue takes all day to finish. Sorry if you're on the last in the queue (better to bring a nailcutter, shaver and lots of reading materials while wasting your time in the queue) I don't bother with these doctors either. Like all advertisements, what you hear from the agent while he is selling the product, and what actual benefits you can get from the card, is 2 different things. It takes a while to get the hang of using it to the most. Please share experiences in using your health cards. I'm sure there are lots of bikers interested of getting coverage for themselves and their family. Btw, the Caritas package, when I got it in 2003, has a money back benefit.Meaning, P20K that I pay every year, for 5 years, I will be able to get the whole cash layout back, someday. I think I have to read the contract again. Wonder if there's this kind of money back package still. Come to think of it, I was lucky to get this package when it was available then. My kids use up their 10 free visits to the pediatrician every year for the past 5 years. And that's sulit for me. Para lang akong nag-time desposit I get my money back anyway.
|
|
|
Post by Ben Dover on Mar 13, 2008 11:52:00 GMT 8
me and my wife are covered by HMO with certain limits as company benefit...we enrolled our children too...my youngest was recently hospitalized due to pneumonia..he had a flu..our bill at medical city was P 29K plus for 4 days...dang! at this time of year that enrollment is nearing, thats bad for "aliping namamahay" like us..after deducting everything including philhealth we only paid around P10K plus..thats a bit of a relief.
i guess you just have to choose the HMO with widest coverage..i.e. number of clinics and most number of accredited hospitals..you can also ask around for HMO's reputation with hospitals and clinics..then choose the best policy for you.
|
|
|
Post by arcireyes on Mar 13, 2008 12:07:40 GMT 8
just thinking out loud (perhaps some people in the HMO industry can give some comments on this) can a biker specific or tailor-fit HMO product be available? , i.e.: 1. something that covers an annual executive check-up, and, 2. something that covers (trail) ambulance service, in case of trail accidents as well as hospitalization and other collateral treatments as a result of biking accident. 3. accident insurance opkors hehehe i know this is a "long shot" but as i had said earlier........JUST THINKING OUT LOUD ;D ;D
|
|
|
Post by BrusKO on Mar 13, 2008 14:28:01 GMT 8
Listen to gadgets. IMHO, Caritas is the best. Along with my policy is a free check up every month or 12 times a year and prophylaxis every year. Then, 5 years after paying ecerything off, you have a choice to get your money back or stay insured.
My mother-in-law who happens to be an agent got us the HMO years ago when the policy was still a goldmine.
|
|
|
Post by gadgets88 on Mar 15, 2008 8:17:10 GMT 8
Any Caritas agent here? Please do the honors (business) of presenting the product here.
If none, I might as well go to Caritas in Quezon Ave (opposite PCSO) and start attending seminars on how to be an agent and start selling Health cards to PinoyMTBiker! ;D
|
|
|
Post by redhotblood on Mar 19, 2008 8:56:29 GMT 8
we have a maxicare premium card courtesy of my wife's manufacturing company. All of us are automatically enrolled (me, wife and 2 kids) what we get is: unlimited free consultations (pedia or cardio) on any accredited hospital we choose including laboratory, blood exams. We only pay for the vaccines (Hib, measles, flushots, etc). Annual free check-up for the whole family. I was so scared the first time we used it when my panganay was hospitalized and we stayed at asian hospital for 5 days, the bill was 30k and we didn't pay a single cent for a private suite and extra blankets / pillows. Most known hospitals carry this hmo and many doctors are already members. Their maxicare personnel was very accomodating and ensures that you got the right room and service, just give them the card and they'll do the rest. What is not included was the dental and maternity benefit cause their company provides the dental care for the whole family and they recieve maternity pay on their coop. I was surprised to found out that my wife only pays 86 pesos every month for her contribution. Yun nga lang no money back but sulit na din everytime we use it it's always free.
|
|
DarKman
Urban Assaulter
Ride Hard... or Go Home.
Posts: 91
|
Post by DarKman on Mar 19, 2008 9:48:12 GMT 8
My sistyer is covered by Maxicare thru the office that she works for. She was given a Platinum card with pre-existing conditions covered.
When she had an operation at Makati Med for a pre-existing condition her bill ran about 300,000 but she didn't have to pay a single centavo.
HMO cards have different levels just like gadgets said, however individual companies have different arrangements with HMO's. A amxicare Gold card in one company can have a maximum benefit of 50k annually, but another company also with a Gold card can have 70k for example -- depends on the agreement.
|
|
|
Post by arcireyes on Mar 19, 2008 9:54:54 GMT 8
can i join? Any Caritas agent here? Please do the honors (business) of presenting the product here. If none, I might as well go to Caritas in Quezon Ave (opposite PCSO) and start attending seminars on how to be an agent and start selling Health cards to PinoyMTBiker! ;D
|
|
|
Post by plankton_dash on Mar 19, 2008 10:31:01 GMT 8
I'm a Maxicare (Gold Plan only) card holder, also my wife & son. Contributions are automatically deducted from salary. Pro's: Free consultation, some free dental procedures, reimbursable cost of medicine (there's a maximum limit, though: Php5K/year for me, a bit lower for the wife/son). Some free laboratory procedures (my wife got free 2-D echo & stress tests; countless free x-rays & blood tests; I even got free MRI scans!). Some free physical therapy sessions. Nationwide coverage. 24/7 call center support. Major hospitals accept the card (Makati Med, St. Luke's, Phil.Heart Center, Cardinal Santos, Medical City, to name a few). Con's: Limited number of doctors "accredited". I think medical treatment arising from accidents coming from "extreme sports" is also not covered (?!?!?!). BTW, my father-in-law is a Caritas card holder. No complaints from him.
|
|
|
Post by gadgets88 on Mar 19, 2008 11:52:23 GMT 8
Wouldn't it be nice if, say, Tito Arci, became an agent of several health orgs in the Phils? He'll not only do good business, we'll get the full blow-by-blow account (ala boxing) of the pros and cons. Ain't that something? It's a win-win situationer.
|
|
|
Post by Ben Dover on Mar 19, 2008 12:00:31 GMT 8
you know what peeps i think PHILHEALTH was conceived to perform this function...now, compute this...your total contribution to philhealth ( i.e. employee and employer share) in a year...then, compare the amount of the premium you are paying to a private HMO annually...now, compare the benefits you are getting from the two.
anong masasabi mo?
anybody here who works for philhealth?
|
|
|
Post by marcs on Mar 19, 2008 13:36:27 GMT 8
Philamcare Orange card holder here, part of company benefits also. What can I say? i've never had to spend for a single dental/optical/physical care. However, I think my company shares the overall health plan with Philamcare (e.g. Annual Physical Exam, OTC medicine, etc). It's helpful also that we have a company doctor here in the office, who recommend all the tests and also specialists that I have to consult, so it's very easy to get a Letter of Authorization. Whether simple cleaning or MRI scan, I'm covered Sakitin pa naman ako. Actually, last year I maxed out the OTC drug limit hehehe. Anyway, regarding Philhealth, I think your HMO will share the cost with PhilHealth as well. When I was in the hospital last year, the Philamcare rep handled all the paperwork, including getting claims from PhilHealth. Had to pay extra though for the room coz with the high rates of St Luke's my plan could only cover a twin sharing room (?). Wanted my own. Anyway, the rep handled all the paperwork such that I didn't have to shell out anything when I finally got discharged (the extra was automatically put into a salary loan). It's great to have an HMO so you don't have to worry about all the costs when you're sick, and don't have to think twice about taking all the tests (e.g. MRI scan is 20k!). Oh and i made sure to ask my doc that i'm covered if ever i fall and tumble from a mountain while riding my bike. (She dreads monday mornign when I come into the clinic . . . doooooc, sakit katawan ko . . . ) In such emergency situations, you can avail of emergency medical services from non-Philamcare accredited orgs, but they will shoulder only 80% of the cost I think. Any HMO plan is sulit with me hehehehehe Btw, just got a new pair of glasses thanks Philamcare
|
|
bm5er
All-Mountain Rider
Posts: 168
|
Post by bm5er on Mar 19, 2008 15:02:53 GMT 8
Blue Cross has sports accident coverage, including cycling. Thankfully we have not used this particular sports coverage as yet. We are looking for one that covers scuba diving, (beer-belly lipo?) and pre-existing conditions such as diabetes.
|
|
ruel
Bike Commuter
Bike Abuser
Posts: 58
|
Post by ruel on Mar 19, 2008 20:30:55 GMT 8
Im also a maxicare (gold) card user . (now our company replaced it to maxicare premium)..card covers 900php room cost per day, free check ups and laboratory test.
pros: check up, lab test, 2 times free dental cleaning and check up, cons: does not cover vehicular accidents and sports related accidents
|
|
|
Post by jr on Mar 19, 2008 21:50:49 GMT 8
Better watch those HMO's coverage. Is quite resonable price. Its good for singles and young people. Here in States some coverage are really bad (already experience it). Everything need referrals for every specialist.
|
|
|
Post by baboinsky on Mar 20, 2008 1:27:13 GMT 8
Since 99 i've been covered by the following HMO's:
Philam Care 1999-2000 Medicard 2000-05 Maxicare 2006-07 Intellicare - Present
My experience with Philam Care was not a pleasant one. Everytime you wanted to see a specialist, you had to go to their crappy clinic (not located in a hospital) to consult with their doctors. You'd be steaming mad from all the waiting and useless talk with their doctors before they actually give you a referral to a real doctor. I'm not sure if they changed the way they conducted their business though.
Out of the 4 insurance companies, I've used medicard the most because I had to undergo 2 operations (appendicitis and fistula removal) while I was with them. Everything was shouldered by Medicare except for the telephone bill at Makati Med. As far as I can recall, my annual limit was 200k in a Large Private room. I didn't bother with the dental plan since we had a family dentist.
I've only used maxicare and intellicare once (both at the ER) so can't really give a comprehensive description about their service.
|
|
Julia
XC Rider
S P A N K!
Posts: 131
|
Post by Julia on Apr 29, 2008 21:40:26 GMT 8
My immediate family is currently enrolled at intellicare thru the company i work with... Pros: Principal card holder (me)- 150,000 annual hospitalization coverage dependent (kids and husband)- 100,000 annual hpspitalization coverage unlimited cunsultation to accredited doctors, lab tests, xray, ecg at kung ano ano pa... dental: (principal ang dependent) 2 free prophilaxis 4 tooth extractions 4 sealant ER for konting sipon, sprain, dysmenorrhea,tummy ache... cons: for makati med cunsultation, you need to go to intellicare (PNB Bldg.) for LOA. doesnt have a sattelite office at MMC... other than that, i'm happy with it. than Medicard.
|
|
soctrumbiker
Free Rider
It's not the ride, it's the rider
Posts: 243
|
Post by soctrumbiker on May 18, 2008 9:16:26 GMT 8
My previous company has maxicare it's good but not good for dependents...
|
|