How to Secure an HMO as a Freelancer

An HMO (Health Maintenance Organization) coverage is one of the things I miss as a freelancer. As a corporate employee for nearly a decade, health insurance was a staple benefit. Fast forward to 2012 when I shifted to freelancing, I lost my coverage. I was fortunate that my husband was still employed; naturally, his coverage extended to me. All that changed when the hubby decided to work from home early this year. Now with two kids, I can’t stress enough how this little card can be of extreme importance. To put it bluntly, it saves us a lot of money with all the monthly check ups coming our way.  While there are some companies and agencies like MyOutDesk and Balsam Brands offering health insurance to their freelancers, majority of clients (like mine) stick to monetary compensation. This post is a documentation of my hunt to secure health insurance for my family. Hope this guide will help decide if you need one too.

Do I really need an HMO?

The answer lies on you. If you’re young, single, and hardly gets sick, then you may opt to skip this option. You can always pay for your check ups and hospitalization costs. My reason for scouting an HMO provider is simple – with two kids and being 30-something, it’s inevitable to visit the Pedia, Internal Med, OB-Gyne, and med tech every once in awhile. For me, trips to doctor’s clinics can go as often as monthly to sometimes fortnightly. I am still blessed that my boys have been spared from hospitalization since they were born. I intend to keep it that way but I have to be prepared.

What are the benefits of having an HMO?

My friend Gail Perez, a mom of three and a former employee turned consultant/freelancer, perfectly outlines the pros of using the services of HMOs.

 

A lot of employees look for this benefit when they apply for a company. It’s because they realize the value it brings when sickness strikes them – free consultations from different kinds of doctors, free laboratory examinations, free minor surgeries and more. While many see its importance, there are some that neglect it. Common reasons are:

 

  • “I’m young and healthy.”
  • “I can’t afford the premium because of my current financial expenses (i.e. utilities, bank loans, amortizations, personal lifestyle).”
  • “I’m single, I don’t have family to support.”
  • “I work from home; I don’t face too many risks like corporate employees.”

 

“BUT in reality, no one is spared from sickness or accidents.”

 

3 good reasons why you should consider getting an HMO:

 

  1. Peace of mind – Anyone who has been hospitalized knows that hospital bills pile up quickly. Without HMO, you may not be able to afford expensive medical services when you need them. This often leads to debt/loans. For example, a three-day hospital stay can cost as much as Php20,000. While total annual HMO premium may be expensive, so are the “out-of-pocket” costs for unforseen medical treatments.
  2. Affordability – There is a variety of HMO packages being offered. For young people in their 20’s, who are at the pink of health, plans can be as low as P20,000 annually. There are also affordable HMO plans available for people that are in their “pre-golden” years, have families, or have medical conditions. Finally, there  are “pre-paid” health cards to make it even more affordable. This can go as low as P1,000 per year. More on this below.
  3. It encourages good health and healthier lifestyle – People who are covered are more likely to visit their doctor on a regular basis, whereas those without often neglect their symptoms to avoid the financial implication. Consultation fees range from Php400 – Php1200 depending on your doctor’s specialization.  However, taking charge of your symptoms leads to earlier diagnosis and proper treatment. You can also take advantage of the HMOs preventive services such as annual physical exams, dental check ups and laboratory tests. Remember, “an ounce of prevention is worth a pound of cure”.

 

HMO Family

7 Steps I Took to Get my HMO

 

  1. Asses your needs – There were several non-negotiables for me.
    • First, I was looking for a coverage of about P100,000 per illness per individual. This is the closest I was getting from our previous provider.
    • I also need coverage for my son who was 1+ y.o. at the time of my research. Note that some providers only cover children 2 y.o. up.
    • We need access to the closest tertiary hospital (with complete facilities and services). This is of importance to make sure special tests and procedures are easily accessible.
    • Our doctors (most if not all) must be accredited.
    • It should accommodate pre-existing illnesses such as Hypertension or Diabetes. My husband is pre-disposed.
    • Access to a regular private room.
    • Reasonable premium for the family.
  2. Do your research – As an employee, I remember using several providers namely Medicard, Maxicare and Intellicare. I know for a fact that Intellicare only accepts corporate accounts so I crossed it out of my list. I also talked to a freelancer friend and she told me to check out ValuCare. And so the research began. I simply went to their websites and checked out their product offer. But since I was in a haste, I went straight to the contact form and requested more information about my needs. I gave them my non-negotiables and waited for their response.
  3. Check their response time – The fastest response I got was from MaxiCare. Their agent was highly responsive to my questions via email. Next, came ValuCare’s package. Medicard did not respond to my email so I did an extra step and pestered them on their Facebook page. After 2-3 follow ups, I got an email from their agent. This agent was very polite and patient in answering my questions. He even called me up a couple of times to clarify some concerns. This is important because you’ll most likely have to contact them again when you start using your card.
  4. Do a comparison chart –  Use your list in #1 to help you choose the best provider for your needs. Here is a sample:
    • Table A.  Regular Health Insurance Package
      ValuCare Maxicare Medicard
      Plan Name Gold
      Annual Premium P 21,174 **

      P 18,337 **

       

      P 18,419 **

      P 22,212 **

      P 15,708**
      Age for the above rate 18-40  y.o.

      41-50  y.o.

      26-30  y.o.

      31-35  y.o.

       

      18-60  y.o
      Benefit Usage One year One year One year
      Maximum Coverage P 100,000 P 100,000  P 100,000
      ** VAT inc. / Suite Room

      With dental  benefit

      ** VAT inc. / Private Room  exclusive of dental benefit ** VAT inc. / Private Room

      With dental  benefit

       

  5. Choose the best HMO service that fits your budget – I chose Medicard. It was able to meet 7/7 of my requirements. Maxicare was at par but only covers 2 y.o. kids while Medicard covers as early as 2 months old. ValuCare has the most affordable premium but is not affiliated with the closest tertiary hospital in our area.
  6. Complete the requirements – Once I decided to get Medicard, I submitted and deposited my premium payment. Requirements were simple:
    • Accomplish three (# of family members) separate application forms via email
    • Schedule a phone orientation
    • Deposit via BDO (I settled the annual premium already)
    • Send them back a signed waiver, deposit slip and orientation checklist
  7. Wait for your HMO Cards – The whole process was pretty quick. I was in a hurry because I needed to have some diagnostic tests done for my son. I submitted the application form Jan 18th, I got the cards by Jan 31st. Coverage started February 1, 2016 and will end after a year.

 

Medicard HMO

Conclusion

So far, I’m satisfied with my card of choice. I’ve used it a couple of times and transactions have been smooth. I had one encounter where my request was disapproved due to incomplete details on the doctor’s order. I paid for the service and submitted a reimbursement form. I simply attached the official receipt and mailed it to Medicard’s head office. I sent it on April 4th and got my Php2900 check in about two weeks. This work-at-home-mom is happy with her choice.

 

Over to you. Do you think freelancers need an HMO? What are your non-negotiables? Comment them below.

 

Appendix of HMO Packages

For your guidance, I’m attaching the screenshots of the individual packages and pre-paid options as well. If you need more details, I’ll be happy to connect you to my Medicard agent (at no commission of course!). Just leave a comment below.

Table B. Maxicare

Maxicare 100k HMO

Table C. ValuCare

ValueCare 100k HMO

 

Table D. Medicard

Medicard 100k HMO

Table E.  Pre-paid Health Insurance Package for ER coverage

 

PhilCare Maxicare
Card Name ER Shield EReady
Description Prepaid health card provides coverage* for outpatient emergency care for treatment of medical emergency cases due to accident or illness Prepaid health card that covers up to P15,000 hospital emergency fees for illnesses* or injuries* that require immediate medical assistance.
Cost / One-time Fee P800 P749
Benefit Usage Single Single
Maximum Coverage P50,000 P15,000

Table F.  Pre-paid Health Insurance Package for other medical needs

 

PhilCare Maxicare
Card Name Consultation Cards MyMaxicare LITE
Description This card allows you to avail of medical and dental consultation services Prepaid card that provides INPATIENT availment coverage exclusively for these eight (8) common diseases:   Dengue, Malaria, Cholera, Typhoid and Paratyphoid, Gastroenteritis, Pneumonia, Chikungunya and Leptospirosis.
Cost / One-time Fee P3,600 P2,199
Benefit Usage Unlimited use for one year Single
Maximum Coverage Not applicable P25,000

 

 

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