hi nikmatik. glad you're around to answer our questions regarding hmo.
anyway, i am choosing between two companies kase. i think yung bluecrosss is health insurance na reimbursible ang confinement while icare naman is the usual hmo na one yr di pede gamitin for dreaded diseases and medyo mababa ang limit for confinement...
any inputs? para kaseng ang hirap ng bluecross kase irereimburse pa diba? paano kung wala kang pampalawal?
thanks
Bluecross is reimbursement type. You have to shell out money and reimburse later. as far as I know wala silang OPD benefits. I could be wrong on this.
Icare stands for Insular Life Health Care. It is traditional HMO, no cash out in and out patient benefit. Pre-existing condition is not covered on the first year but
may be covered on the 2nd year onwards, emphasis on "may". Merong yearly medical evaluation or underwriting wherein titingnan ang status ng dreaded disease mo and from there, it's either exclude yung adverse condition, sisingilin ka addtional rate para ma-cover in full or bigyan ka lang ng partial coverage for that condition. Upon enrollment you are asked to declare in application form all adverse medical condition. Merong mga add-on benefits like Group Term Insurance, Medicine Reimbursment benefit etc. check them out at
http://www.icare.net.phFortunecare lang ang may HMO benefits for senior citizens. Kaya lang you have to ask carefully and understand kung paano ang coverage nila for PEC ng matatanda. Ang alam ko 3 years na eexclude yung PEC and after 3 years, you can request for its coverage, subject to acceptance or denial depende sa resulta ng kanilang medical underwriting. I could be wrong about this kaya you have to ask. Check them out at
http://www.fortunecare.com.phKung Individual Plan, all HMOs don't cover pre-existing condition sa first year. Sa covergae on 2nd year onwards nagkakatalo. Yung iba coverd in full agad, yung iba graduated yearly, say 5K sa 2nd year, 10K sa 3rd year, and so forth. Or yung iba naman nag se set ng limit for PEC, say up to P15K lang forever. Kaya etong portion na to about PEC ang kelangan nyong itanong at malaman in detail. Ibaiba ang coverage ng bawat HMO sa PEC. Meron dyan pag nag-onset sa 1st year ang PEC or dreaded disease, permanently excluded forever. meron naman kung sa 2nd year nag-onset partial cover. and meron din na 3 years bago macover ang PEC.
Ingat din sa tinatawag na "concealment". Eto yung you are asked to declare in your application form all adverse medical condition. If say for example may hypertension ka upon enrollment but di mo dineclare. On the 2nd year when you are expecting that it will be covered sasabihin sa you permanently excluded because di mo dineclare. Kaya its better to be honest right from the start. Ask the HMO or HMO agent about this.
Medicard is the No. 1 HMO kaya lang they are very good only for big corporate and group accounts lang. Medyo di ako bilib sa Indidividual and Family Plan nila and also for small group. Dito yung graduated PEC coverage and pag nagonset sa 1st year patay kang bata ka!
And if you are 40 and above you have to undergo medical exams sa kanilang clinic. Kung may makitang negative findings- excluded forever.
INTELLICARE - la silang Individual except for a few na dati covered nila sa corporate then nag-resign kaya na enroll sa Individual.
Don't get me wrong ladies. We are talking here of Individual enrollment ha. Pag dating sa big corporate and big group, nag-iiba ihip ng hangin ng mga HMOs. Halos lahat magaganda.
Limit muna discussion to this topic. You can ask questions about the topic muna. Later we will talk about "anti selection", "heirarchy", "permanent exclusion".
