all about HMO

[lencute]

ah talga. until now, di ko pa din alam what to get.

pero nakakuha na ako ng application form sa icare..iniisip ko na lang kung itutuloy ko dun or sa bluecross...

 

[dalmatian]

May naka-enroll ba sa HMI dito? Feedback pls. TIA

[prettynvain]

which is better for individual? i am actually based abroad, pero i needed to apply para magkaroon din 4y.o son ko. kasi hindi naman siya pwedeng maging primary member unless 18 na siya. is there such HMO na included yung mga ultrasounds?

and upon application, do you need to pay ba yung annual fee muna before mo magamit? thanks.

[nikmatik]

A 4 yr old cannot enroll with an HMO.  He cannot enter into a contract or agreement.  Both parents must also enroll.  Pwedeng one of the parents lang ang mag-enroll if there is a valid reason why the other is not enrolling.
This brings us to another HMO issue the "heirarchy rule".  Heirarchy rule simply means you cannot choose who are you going to enroll as your dependent.  For married members, you should enroll your spouse first, then your eldest child down to the youngest.
If you are single, you should enroll your parents first (depende sa age limit ng program), then eldest sibling (21  & below), down to the youngest.  You cannot skip unless there is a valid reason which you must prove.  Valid reasons would be if the one you are skipping is not qualified, is abroad or already has an HMO.  All these you have to prove by submitting supporting papers.
Heirarchy rule is in accordance with HMOs "anti selection" policy which says you cannot just enroll as dependent anybody of your choice.  Without the "anti selection" and "heirarchy rule", ang mangyayari is eenroll lang ang mga sakitin which HMOs do not like.

Ultrasound is covered by almost all HMOs provided that the condition for which it is being done is covered.  For example, if your pre-existing is not yet covered and you need ultrasound for it, then it is not covered.  If the ultrasound is going to be made on something that is not pre-existing then it is covered.  Kung cover na ang pre-existing at dun kelangan ang ultrasoung then walang problema.  pero kung covered nga ang pre-existing mo pero the ultrasound naman ay related sa permanent exlcusion like maternity or pregnancy, then hindi covered

Upon application, of course you have to pay na.  It would depend on the HMO you are getting if they will allow semi-annual or quarterly payment.  W/out payment di gagalaw yung application mo.

[prettynvain]

^yeah,i know that of course! bale dependant ko siya. my son is using my maiden surname. actually, i've inquired na before with regards to that. and my concern lang is which HMO is better for individual and family plan.  no questions, with regards to my son's application. i've inquired na before.

and which HMO, covered yung ultrasounds, since im based abroad nga, i think ultrasounds and other lab tests lang pwede kong magamit.

hope, anybody can answer my questions ONLY.

again, which HMO is better for individual/family plan. na cover din ang ultrasounds. since, madamin nang HMO company, i dont know which is the best.

[nikmatik]

w/c is better for family individual?  Already answered in previous posts.  Icare is recommended.  http://www.icare.net.ph

covered ang ultrasound?  Answered sa previous post.  Depende kung para saan ang ultrasound

[ms.rain]

^^nikmatik explained already very clearly in his/her previous post re: inclusion of ultrasounds in HMOs. more or less, standard sa lahat yan.

[ms.rain]

In case you don't know, most HMO standard benefits include warts removal worth P1,000 a year, neck up only.

sure ka neck up? i have intellicare. covered lang ang warts removal neck down. i have to shell out 2.5k for my warts removal sa face since covered lang ng intellicare is neck down. 

[prettynvain]

w/c is better for family individual?  Already answered in previous posts.  Icare is recommended.  http://www.icare.net.ph

covered ang ultrasound?  Answered sa previous post.  Depende kung para saan ang ultrasound

sorry, namislook ko. kasi may ibang nagsasabi na mas maganda daw maxicare kesa icare. kaya im torn talaga kung alin sa 2.

a friend naman kasi sabi niya, di daw covered ultrasound, pero you explained naman na. thanks for that. actually, the ultrasound is for monitoring pcos. and for kidney.

i'll check the site you gave. thanks.

[nikmatik]

sure ka neck up? i have intellicare. covered lang ang warts removal neck down. i have to shell out 2.5k for my warts removal sa face since covered lang ng intellicare is neck down. 

Yes I'm sure.  Na-avail ko under Icare, na-avail ng wife ko under medicard. Sa medicard daw sabi wife ko, any part of the body basta hanggang P1,000 lang. Kung neck down covered ng intellicare at least you will see na talagang standard yan sa mga HMO.  Maraming di nakakaalam na kasama sa benefits nila warts removal.         

As I said previously, lahat ng HMO ay magaganda pagdating sa corporate accounts na malalaki.  Halos anything goes kapag big accounts at milliones in premium na pinaguusapan. 

Sa Family/Individual preferred ko ICare kasi your are given the choice kung icocover pre-existing mo, unlike sa iba na automatically excluded forever yung mga adverse condition upon enrollment.
Sa pagkakaalam ko halos pareho ang Family/Individual ng Maxicare and Icare

[sleepingrant]

A 4 yr old cannot enroll with an HMO.  He cannot enter into a contract or agreement.  Both parents must also enroll.  Pwedeng one of the parents lang ang mag-enroll if there is a valid reason why the other is not enrolling.
This brings us to another HMO issue the "heirarchy rule".  Heirarchy rule simply means you cannot choose who are you going to enroll as your dependent.  For married members, you should enroll your spouse first, then your eldest child down to the youngest.
If you are single, you should enroll your parents first (depende sa age limit ng program), then eldest sibling (21  & below), down to the youngest.  You cannot skip unless there is a valid reason which you must prove.  Valid reasons would be if the one you are skipping is not qualified, is abroad or already has an HMO.  All these you have to prove by submitting supporting papers.
Heirarchy rule is in accordance with HMOs "anti selection" policy which says you cannot just enroll as dependent anybody of your choice.  Without the "anti selection" and "heirarchy rule", ang mangyayari is eenroll lang ang mga sakitin which HMOs do not like.

Ultrasound is covered by almost all HMOs provided that the condition for which it is being done is covered.  For example, if your pre-existing is not yet covered and you need ultrasound for it, then it is not covered.  If the ultrasound is going to be made on something that is not pre-existing then it is covered.  Kung cover na ang pre-existing at dun kelangan ang ultrasoung then walang problema.  pero kung covered nga ang pre-existing mo pero the ultrasound naman ay related sa permanent exlcusion like maternity or pregnancy, then hindi covered

Upon application, of course you have to pay na.  It would depend on the HMO you are getting if they will allow semi-annual or quarterly payment.  W/out payment di gagalaw yung application mo.

hi nikmatik...ask ko lang kung saan ako pwede mag enroll na maidedeclare ko ang baby ko as my dependent...i am a single parent di kami kasal ng father nya and since nakalagay sa rule na "If you are single, you should enroll your parents first (depende sa age limit ng program), then eldest sibling (21  & below), down to the youngest.  You cannot skip unless there is a valid reason which you must prove." gusto ko lang kasi na magkaron din ng health card ang baby ko...please help...thanks   

[nikmatik]

If you are separated you can enroll your kid as your dependent w/out your husband having to enroll but you have to prove that you are.  Best proof of course is divorce/separation papers or annulment papers.  W/out those, which is usually the case, a simple written declaration stating that you are a single parent will do for some HMOs.  Some HMOs will require a notarized affidavit.  If you are single, as in never been married but with a child a simple written statement usually will suffice.  In both cases you have to submit a copy of the birth certificate of your kid to prove that he/she is really your child.

FYI, this is something that is very common.  I have quite a number of corporate clients and all of them have situations like these.  And mind you, hindi lang single mom ang common, marami din single father na never been married also.

Question : Kung single ka na may anak as dependent, pwede ba ieenroll ang parents or sibling as dependents?
Answer : No, you cannot.  You have to choose whom to enroll as dependent, yung anak mo, or yung parents and siblings mo.  Di pwede pareho.

[sleepingrant]

If you are separated you can enroll your kid as your dependent w/out your husband having to enroll but you have to prove that you are.  Best proof of course is divorce/separation papers or annulment papers.  W/out those, which is usually the case, a simple written declaration stating that you are a single parent will do for some HMOs.  Some HMOs will require a notarized affidavit.  If you are single, as in never been married but with a child a simple written statement usually will suffice.  In both cases you have to submit a copy of the birth certificate of your kid to prove that he/she is really your child.

FYI, this is something that is very common.  I have quite a number of corporate clients and all of them have situations like these.  And mind you, hindi lang single mom ang common, marami din single father na never been married also.

Question : Kung single ka na may anak as dependent, pwede ba ieenroll ang parents or sibling as dependents?
Answer : No, you cannot.  You have to choose whom to enroll as dependent, yung anak mo, or yung parents and siblings mo.  Di pwede pareho.

thanks nikmatik for your reply...if that so, saan kaya ako pwede mag enroll na pwede ang ganitong case and sana affordable sya...dito sa company namin enroll kami sa medicard pero declared ko as single tinanong ko na sa hr namin kung pwede ko ba ienroll ang baby ko sabi nila hindi daw unless declared ko as married pwede daw, sa tingin ko company policy lang yung ganito kasi kahit parents ng mga single di pwede as dependent...kung hindi pwede hanap na lang ako ng iba na pwede as dependent ang baby ko he is only 1 year old and sana makahanap ako ng kaya sa bulsang health card para sa baby ko...please help...thanks 

[$ale... seeker!]

^ confirm mo w/ HR sis, normally pwede and just need to provide supporting documents like birth certificate to prove kinship!

[nikmatik]

thanks nikmatik for your reply...if that so, saan kaya ako pwede mag enroll na pwede ang ganitong case and sana affordable sya...dito sa company namin enroll kami sa medicard pero declared ko as single tinanong ko na sa hr namin kung pwede ko ba ienroll ang baby ko sabi nila hindi daw unless declared ko as married pwede daw, sa tingin ko company policy lang yung ganito kasi kahit parents ng mga single di pwede as dependent...kung hindi pwede hanap na lang ako ng iba na pwede as dependent ang baby ko he is only 1 year old and sana makahanap ako ng kaya sa bulsang health card para sa baby ko...please help...thanks 

Marami ako alam na single mom & dad who enrolled their kids sa Medicard.  Medicard allows this subject to those conditions earlier stated.  You could be right that it is company policy so as to control utiization.  But then again, baka hindi alam ng HR nyo na pwede, especially kung ikaw naman magbabayad and not the company.  You have to check with your HR.  or maybe if it is ok with you can tell me you company name and number of employees.  baka pwede ko ma-check,  baka lang ha hindi sure kasi minsan nakakakuha kami info minsan naman hindi

[sleepingrant]

Marami ako alam na single mom & dad who enrolled their kids sa Medicard.  Medicard allows this subject to those conditions earlier stated.  You could be right that it is company policy so as to control utiization.  But then again, baka hindi alam ng HR nyo na pwede, especially kung ikaw naman magbabayad and not the company.  You have to check with your HR.  or maybe if it is ok with you can tell me you company name and number of employees.  baka pwede ko ma-check,  baka lang ha hindi sure kasi minsan nakakakuha kami info minsan naman hindi

thanks again nikmatik...i'm choosing now between icare and cocolife ano kaya ang mas maganda sa kanila kasi kung hindi talaga pwede dito sa company kuha na lang ako ng iba i've already check na yung mga accredited hospitals nila and meron malapit sa house namin nakita ko ang rates ng icare ok naman sya kaya lang sabi nila sa sobrang dami daw ng may icare baka di na daw maasikaso and sa cocolife di ko pa alam rates nila please help naman to choose...thanks so much nikmatik for helping me 

[nikmatik]

as I've said earlier in the thread Icare is recommended.  The fact that marami client is proof of good service and good benefits. Icare has the best package for family & individual

As fas as I know cocolife doesn't accept individual accounts.  You have to enroll under their life or pension policies to be entitled to health benefits.  I could be wrong about this

[Bosbly]

Hi!

i am currently researching what's the best HMO for us.

i got emails from:
 maxicare-ok daw to but medyo mas mahal ang premium
 medicard- ok na sana but yung PEC ay 5k lang kahit 2nd year na
 medserv- yung youngest ko na 1yo di maisasama sa family package and mas mahal premium nya kesa sa medicard kung buong family ko ang enroll ko   Bluecross-reimbursement and no OPD benefits


I want a HMo that will cater our whole family and on the 2nd year i can use the PEC 50%-100%,no cash out IN/OUT patients,covers at least prenatal check ups coz most hmo doesn't cater it.

yung ICare na nakita ko website nila, napansin ko limited ang accredited hospitals and ano yung ibig sabihin ng name sa baba ng hospitals name?yun lang yung accredited doctor dun sa hospital na yun or sya pupuntahan kung gagamitin ang card?

[rumplehuey]

Does anyone know kung i-cover din ba ng medicard yung confinement kapag nanganak na? I know na hindi i-cover ng medicard ang panganganak pero yung confinement kaya?

[ms.rain]

^alam ko hindi sya covered ng medicard.