5 Steps to Finding the Best HMO and Healthcare Plan For You

Updated: July 21, 2023

I am often asked what’s the best health maintenance organization or health insurance company in the Philippines. And each time, I reply that there is no straightforward answer to that question.

Some would then ask me which HMO do I have, and I’d share that (at present) I have Intellicare and Kaiser as my short-term healthcare providers.

However, I immediately say that I don’t recommend getting from them simply because I have those. I remind them that there are other important considerations when choosing your HMO and healthcare plan.

For example, my budget and medical needs may not be the same as theirs. And thus, another health insurance company could be a better fit for their requirements.

So how do you find the best HMO for you? How do you choose the right medical insurance company to get your short-term healthcare plan? Below are the steps.

Step 1: Create your initial list of HMOs based on your area.

Go to your preferred hospital and ask for their list of accredited HMO providers. If you don’t have a preferred hospital, then choose the one that’s most accessible from your home.

Moreover, get a similar list from your preferred medical clinics and diagnostic testing centers. You’ll visit these places more often than the hospital, so it’s best to have an HMO that they recognize.

Step 2: Assess your healthcare and medical needs.

All HMOs offer comprehensive coverage. But instead of just accepting their most popular package, it’s better if you can customize it according to your exact needs.

Some considerations that can make one HMO more preferable to the other are:

• Coverage for maternity and dental benefits
• Coverage for pre-existing conditions
• Coverage for special procedures
• Coverage for diagnostic medical tests
• Reimbursement for prescription medicines
• Reimbursement for medical services availed from outside the HMO network
• PhilHealth benefits integration
• Life and accidental death and dismemberment benefits
• Extension of benefits to family members

Step 3: Study your cash flow and decide on your budget.

Know exactly how much you can afford to pay for your healthcare policy. While it’s tempting to avail of a plan with a lot of benefits, it may not be practical.

For example, if you already have a life insurance policy with AD&D benefits, then you can probably strike that one out as a requirement for your health insurance plan. This could help in lowering its cost.

You should also note the “must-have” benefits of your policy. If you have children, for example, then you’d want a medical plan that covers doctors’ consultations for them and not just you.

Step 4. Ask for a quotation and compare costs.

Remember your HMO list from Step 1? It’s now time to contact them. Once an agent gets in touch with you, give them your coverage and benefit requirements, as well as your budget.

Ask for a quotation from as many companies as you can to make sure that you’re getting the best possible plan out there.

If you like a particular package, but can’t afford it, then ask the agent if there’s anything they can do to lower its cost. You should also revisit your cash flow to check if there’s anything else you can do with your budget.

Step 5. Research the company and its quality of service.

At this point, you should have 2 or 3 choices left. The last criteria you should consider before you decide which HMO to get is the company’s reputation and quality of service.

It may be helpful to ask your social network for their thoughts on each HMO. Give more weight to those who share their personal experience in dealing with the company.

Hopefully, this step will help you finally decide which HMO and healthcare plan is the best one for you.

But I already have health coverage from my company.

Employees with existing medical coverage should take the time to know the exact benefits that they’re getting from the company’s HMO partner.

If you believe that it’s inadequate, then you can ask the HR Department if it’s possible for your policy to be customized. But be ready to pay additional costs for it.

Alternatively, you can contact another HMO, using the steps above, to get a healthcare policy that can provide what’s missing from your company’s HMO plan.

Remember that having health insurance is important. One serious medical emergency in your family can bring your whole finances to the ground and bury you in debt, and you don’t want that to happen.

Lastly, always do your best to live a healthy lifestyle. And encourage your family to do the same. Because, after all, health is wealth.

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