all about HMO

[Fionski]

Medyo lito ako. How is an HMO card different from a health insurance?

Last year I contacted Blue Cross so after ng mahabang usapan, the agent told me, "ay Ma'am mukhang HMO ang kailangan nyo." Hindi naman nya ni-explain why, baka kasi walang HMO card ang Blue Cross?

Paki explain naman please. Di ko makita ang explanation dito sa GT. Thanks! 

[Princess_Chill]

sis mg

ask ko lang mga sis, ano yung pinaka mura at magandang HMO pag mag aapply ako as individual?

mga aunts ko caritas ang kinuha nila...ok naman daw kaso medyo costly kaso nga lang 5yrs to pay naman

[chelsea03]

ask ko lang mga sis pwede pa kaya kumuha ng Individual HMO Card kapag 1-3 months pregnant na? Kung possible pa na kumuha magagamit mo kaya yung healthcard mo on your first year of membership?

[chelsea03]

Yes, especially if your plan is for individual. That's why my husband doesn't offer HMO to individuals lalo na sa may edad o may pre-existing condition, lugi sila at nakakaawa kapag gagamit na, kasi konti lang ang makukuha.

Sis, paki ask naman hubby mo kung pwede pa kumuha ng Individual HMO Card ang 1-3 months pregnant. Kung possible pa na kumuha magagamit kaya yun agad? TIA

[chelsea03]

Hi mga sis, agent ang hubby ko ng iba't-ibang HMO, kaya familiar na ako sa mga issues ng mga HMO. Ang mga ok na HMO ay MEDICard, Maxicare at Intellicare. Actually ang majority na problema sa ganyan ay ang mga package na pinili ng company, minsan hindi covered yung sakit nyo o kaya mababa ang limit. Kung nahihirapan naman kayo makatawag sa mga call center ng HMO, pwede nyo ipadaan sa agent nyo, yun ay kung visible sila. Ang husband ko naman sobrang visible sa mga client kasi nilalagay nya ang contact number nya at kung nahihirapan ang mga client na makipag-usap sa call center or sa mga approving officers sya mismo ang pumupunta sa office para kausapin sila.
Kung interesado pala kayo, pwede nyo refer ang company nyo sa amin,  nagbibigay ng incentive/commission ang hubby ko sa mga nag-re-refer, kapag nag-renew pa every year na ang incentive nyo. PM nyo lang ako.

Sis very interested ako kaso individual lang ang kukunin ko kasi freelancer ako kaya wala akong HMO card na galing sa company. Sis, Pa pm naman ng contact number mo or email add. Paki pm na din sis kung pwede pa kumuha ng HMO ang 1-3 months pregnant and kung magagamit na ba agad yung card? And kung anong magandang company and package ang para sa mga pregnant women. TIA

[lischan]

Hi mga Sis,

Just hoping that someone can give light to my friend's predicament with Intellicare and laparoscopy.

Yung coverage namin sa office is 75k. She has a cyst sa ovary. If my friend will undergo lap, she will spend around 120-150k more or less. If she will undergo open surgery, mga 80-100k daw ata or something. That includes all fees na for both, meaning, surgery, prof fee, hospital room, etc.

Now, of course we kind of thought na sagad na yung 75k sa coverage. However, sa booklet pala ng Intellicare, ang coverage nila for PEC - Laparoscopy is 30k. I'm not really sure I understand why. If yung coverage ng person insured is 75k per year, per illness/disease/whatever it's called, why do they have a limit for this PEC?

Also, does it mean din if my friend needs to do a laparoscopy (God forbid) for a cyst 3 times in 1 year, 30k each time ang i cover? Or 30k for the entire year na yun?

Eto pa, when she called the customer service ng Intellicare, she was told na if she opt to do open surgery for the cyst, sagad yung 75k na magamit nya/na i cover sa kanya. But if she undergoes lap, 30k lang. I don't understand the logic especially since it's more expensive to undergo laparoscopy. Sana may makatulong sa pag intindi.

TIA 

[sonia62]

^ [textspeak!] 30k or 75k na limit per disease per yr afaik eh pag naubos mo na yung limit for the same disease within the year, yung mga next na operation eh hindi na covered yun unless iba naman yung naging sickness. kunwari yung sabi mo na kung 3x in a year sya maopera, kung naubos na sa first operation yung limit nya, yung mga susunod na operation hindi na covered yun.

[lischan]

^ Ah okay, thanks sis 

[audreygar86]

Hi!

Are there any Blue Cross plan holders here? I'm planning to enroll my parents whose current HMO coverage are ending this year, and at the same time they're turning 60 years old by the end of the year, so I really need to find them a new HMO provider. I've read this whole thread and mukhang okay ang feedback sa Blue Cross, the only downside na nakikita ko usually is that hindi kasama outpatient consultations and by reimbursement lang siya. With the reimbursement, that's fine with us, pero alanganin din ako sa walang outpatient.

So I checked their website and I saw that aside from their core plans, you can actually have an add-on premium so that they'll also cover out patient consultations. And if you avail of this add-on, may included na ding reimbursement for prescribed meds. They also accept new members up to 65. Meron din sila for 66 and up. Has anyone tried this? Ok ba? And based from your feedback, kasama ang pre-existing right?

http://www.bluecross.com.ph/pdf/brochure_sstandard.pdf

Appreciate any feedback! 

[mjflkitty]

Hi,

Good Evening, I just want to ask if anyone happens to know a health card or health care or hmo that caters to 65years old and above. I've been searching for it for the past few months.

Thank you

[m_lim]

mga sis, please enlighten me. 21,876 pesos per quarter ang singil ng caritas. that's 5years to pay then 10years covered. tama ba ang pricing na ganyan?

lalabas around 400thou+ ang total na babayaran mo in 5years

[tina14]

Hi,

Good Evening, I just want to ask if anyone happens to know a health card or health care or hmo that caters to 65years old and above. I've been searching for it for the past few months.

Thank you

hi sis. sa paghahanap ko blue cross at caritas pa lang ang alam ko na nagcate sa mg senior citizens. as early as know naghahanap na ko kase my mom is turning 65 next year. i need to have an idea how much it would kase malapit na nga magend ang kanyang coverage. ang limit kase ng mga coverage sa companies ay usually 65. after that di na nila kinocover kase it's quite pricey

[e.viv]

hi sisters, okay ba ang medicard for individual paying member? i have philhealth kasi, pero for individual member parang very minimal coverage lang, if ever i get confined puwde ba gamitin medicard and philhealth ng sabay, i mean parang dalawa yung discounts, or pipili ka lang ng isa? tia!

sis based sa HMO namin sa office, kelangan talaga kasama yung philhealth.

Hospital Expenses - Philhealth = Amount to be paid by HMO

ang ilalabas na lang ng HMO is the amount left after ma-less yung Philhealth and if wala ka philhealth then babayaran ng patient yung amount na supposedly paid by philhealth.

[mjflkitty]

hi sis. sa paghahanap ko blue cross at caritas pa lang ang alam ko na nagcate sa mg senior citizens. as early as know naghahanap na ko kase my mom is turning 65 next year. i need to have an idea how much it would kase malapit na nga magend ang kanyang coverage. ang limit kase ng mga coverage sa companies ay usually 65. after that di na nila kinocover kase it's quite pricey

Sis wala na ata sa caritas eh hindi n sila tumatanggap

[koleen]

Sobrang na-sad ako sa Maxicare. I got a letter today and they are asking me to submit a clearance from my doctor and explain the diagnosis, medication, lab tests,  etc etc that i made since december of last year. Subject to renewal na kasi ako. sabi pa sa letter that submitting all those things is not a guarantee na ma-renew ako.

Ang sakin, hinde ba yun ang reason bat tayo kumukuha ng healthcards? Bakit nung nakakaraang taon (i've been with them since 08) na wala ako halos pinapagawa sa kanila eh wala ako naririnig?

Kung gusto nila i-exclude at hinde i-cover yung specific illness siguro pwede pa yun pero to not renew my contract totally, parang unfair naman ata.

sino na sa inyo ang nakaranas ng ganito, mga sis?

[blushydamsel]

hello mga sis question naman, san ba affordable mag apply ng individual accounts sa hmo? saka magkano ang bayaran? thanks!!

[-charm-]

may question lang po ako sa may mga alam about medicard, or agents ng medicard. i'm planning to get kasi for my parents dahil di ko na sila dependents.

i looked at their website, meron Individual and Family program, then may VIP program. dun sa individual and family, nakalagay lang is yung limit for dreaded disease (i think ito yung MBL sa ibang hmo). then sa vip, may breakdown for consltation, laboratories, etc. Does this mean na hindi covered yung consultations and laboratories sa individual and family program?

i hope someone can provide a feedback. important kasi yung regular consultations sa parents ko. Thanks!

[blushydamsel]

^sis tumawag ako sa Medicard just now, yung INdividual Plans meron din pala shang unlimited consultations pero yung plan 550 and plan 800, hindi pwede sa mga hospitals na ito magpaconsult:
AHMC - Asian Hospital and Medical Center, SLMC - St. Luke's Medical Center, CSMC - Cardinal Santos Medical Center, MMC - Makati Medical Center, MCGH - Medical City General Hospital

[swtgrl_bee]

I've been with 3 different health cards, Medicard, Intellicare then yung current ko Maxicare. Pinakagusto ko talaga Medicard, walang tanong tanong kasi mapa ER or clinic pa yun. Ayaw ko Intellicare kasi todo tanong naman sila kesyo anong company ko. Yung Maxicare ko naman, sakto lang. Depende lang din kasi talaga sa kinuha ng company na coverage. Masaya lang kapag nakahanap ka ng doctor na kahit accredited ng health card mo eh maayos ang gawa.

[vanitysim]

Morning mga sis. ano gamit nyong HMO? im looking for one saa
yun pwede sa mga premier hospitals like Asian St Lukes etc.

sa Caritas hassle. you need to go to their office para makakuha ng consultation letter.