Many Filipino professionals feel covered for health because they have an HMO card from work. It helps, but it isn’t the whole picture.
What an HMO is
A health maintenance organization gives you access to a network of doctors and hospitals, usually up to an annual limit, often through your employer. You use the card instead of paying upfront, within the plan’s rules.
Strengths: convenient, covers routine consultations and common needs, often free to you.
Limits: tied to a network, has annual caps, often ends when you leave your job, and may restrict pre-existing conditions or certain illnesses.
What health insurance does
Health insurance (including hospitalization and critical illness benefits) pays according to your policy when specific events happen, often outside a network. A hospital plan pays toward bills. A critical illness benefit pays a lump sum on diagnosis of a listed condition, which you can use for income gaps, care or travel.
Strengths: you own it. It generally stays with you if you change jobs, as long as premiums are paid.
Limits: premiums, waiting periods, exclusions and benefit limits.
Why you may need both
The HMO covers the everyday. Insurance covers the unusual and the large. And if your HMO ends with your job, the policy you own is the one still standing when you’re between employers or starting a business.
Questions to ask about your HMO
- What is the annual limit, and what happens beyond it?
- What’s excluded or restricted?
- What happens to my coverage if I leave?
- Which hospitals are in the network near me?
Questions to ask about a policy
- What triggers a payout?
- What are the waiting periods and exclusions?
- Is the benefit a reimbursement or a lump sum?
- What’s the premium, and does it change with age?
Do this week
Find your HMO booklet. Write down the annual limit, and write the date your coverage would end if you left your job. If that date is “immediately,” you have your answer about owning your own.