.png)
When a company cares for their people, they show it through actions and not just words. This is why extending healthcare benefits to our employees is the key to fostering a healthy and productive work environment. Providing comprehensive health management organization or HMO plans not only demonstrates our commitment to employee well-being but also enhances job satisfaction, reduces absenteeism, and boosts overall morale.
Navigating the different HMOs in the industry and the complexities of the proposals and how they fit the needs of your company can be a daunting task for HR professionals and business owners. Whether you’re looking to switch providers or new to the game, understanding HMO terms and considerations is crucial to making an informed decision.
HMO - Health Management Organization; a type of health insurance plan that provides health services through a network of providers. As of 2024, there are 24 authorized HMO providers regulated and approved by the Insurance Commission in the Philippines.
ABL - Annual Benefit Limit; the maximum cost of utilization that can be incurred by a member per contract year. [See: MBL]
Accredited provider - an entity (hospital, clinic, dental clinic, or doctor) that has received accreditation or affiliation from a recognized HMO.
View the Hive Health directory of accredited providers HERE
APE - Annual Physical Examination; a series of routine examinations performed every year that typically includes tests such as Complete Blood Count and Chest X-Ray
Claims - A request for payment that you or a provider submits to your health insurance or HMO when you get items or services that are covered
Coverage - the amount of payment that is covered for an individual or entity by way of health insurance or HMO
Dependent - a principal member’s spouse, child, parent, or family member that can be enrolled to be covered as well. [See: Principal]
Dependent policy - the policy which states who is eligible to become a dependent of each principal. Typically, a hierarchy is in place to determine the order of which dependent is eligible first.
[Hive Health offers an inclusive dependent policy that does not follow a strict hierarchy, and even allows domestic and LGBTQ+ partners]
Exclusion - a provision within an insurance policy that is not covered or not included in coverage
LOA - Letter of Approval; a request form requested by a member or a provider and approved by the HMO, designed to make availment of outpatient consults or procedures more convenient for the member
MBL - Maximum Benefit Limit; the maximum amount of coverage per illness/injury or hospitalization per member per contract year [See ABL definition]
PCP - Primary Care Physician; a healthcare professional who practices general medicine
PEC - Pre-Existing Condition/s; a medical condition that started before a person’s health insurance are in effect.
PhilHealth integration - the complementary use of PhilHealth alongside HMO for medical assistance
PME / PEME - Pre-Employment Medical Examinations; a series of diagnostic and laboratory tests that can help determine if a job applicant is medically fit to work. Some HMO Providers, such as Hive Health, can arrange this at accredited clinics.
Premium - an annual payment corresponding to a coverage plan that allows members to avail of medical services within the HMO’s accredited network of providers
Preventive care - practice and application of measures to prevent disease or healthcare issues; examples of preventive care benefits include Annual Physical Exams, vaccinations, wellness programs, and more
Principal - or principal member; the person who enters into the insurance contract as the primary member eligible for participation and services provided [See: Dependent]
Riders - insurance policy provision or additional benefit/s that can be included to an HMO contract to better match the client’s needs. Executive check-ups and group life insurance are some of the more common rider provided by HMOs..
Utilization - the total amount of medical availments utilized by an eligible principal or dependent member/s
Navigating the world of HMO can feel overwhelming, but having a solid grasp of the terminology makes all the difference when in search for an HMO for your company. From the different benefits, exclusions, and contract terminologies, this glossary is designed to empower you with the knowledge needed to make informed decisions to get the care you need!
Empower your team with hassle-free HMO plans! Learn more about Hive Health here.
