When searching for health benefits, understanding the different options in the market is the first stop on your journey to finding the right plan that fits your needs — especially if it’s for your company, where the wellness of numerous people depend on the decision.
HMO insurance, or Health Maintenance Organization insurance, is a healthcare plan designed to provide members with access to a network of healthcare providers (hospitals, clinics, and doctors). Members subscribe to the HMO and pay a fee or a premium, typically annually, granting them access to a range of medical services part of the package of HMO benefits. These services range from emergency treatments to preventive care; so knowing what would benefit your employees best is key to matching which HMO to choose.
HMO insurance and health insurance serve distinct roles in healthcare coverage, differing in focus and structure. Health insurance or medical insurance are types of insurance coverages that pay for medical and surgical expenses incurred. It can reimburse the member for out-of-pocket expenses or pay the healthcare provider directly, depending on the terms of policy. They are also often provided by life insurance companies, and its primary focus is mostly on critical illness coverage or as an add-on to life insurance.
On the other hand, HMO insurance is provided by HMO companies licensed by the Insurance Commission in the Philippines, offers more comprehensive benefits such as outpatient and in-patient care, emergency services, and could also include preventive care and even mental health support.
While both types of insurance have their merits, relying on HMO-licensed providers can be advantageous for individuals and businesses prioritizing broader and more immediate healthcare services. This distinction underscores the importance of choosing the right provider based on your healthcare needs.
For businesses, HMO insurance is a valuable tool for employee well-being and productivity. An HMO plan can simplify healthcare access, ensuring employees can focus on their work rather than navigating complex medical systems as most Filipinos have experienced, such as long lines, unpredictable doctor schedules, confusing paper-based systems, and more. Additionally, the broad coverage and network accessibility encourage employees to seek preventive care and ultimately reduce the risk of any health complications.
What can you expect when your HMO coverage starts? It would depend on the benefits covered by your HMO, which is why it is important to identify the needs of your employees.
There is a wide range of healthcare services that can be tailored to meet your needs. Its comprehensive scope should ensure that individuals receive timely, effective care without the stress of unexpected expenses. Here are some examples of benefits offered by HMOs:
Some HMO insurances offer modern benefits such as:
Hive Health offers comprehensive, modern benefits as mentioned above, plus medicine reimbursement for prescribed medications and maternity cash assistance.
While pricing on health plans vary from each HMO, getting HMO insurance is an overall economical solution compared to traditional health plans or remaining non-insured and paying out of pocket. It reduces overall costs for both companies and employees: corporate HMO plans often have lower premiums and include packaged services, which help minimize costly medical emergencies. For businesses, investing in HMO insurance translates to cost efficiency without compromising on quality healthcare, in order to take care of your employees and their dependents.
An HMO’s network of providers is key to making these benefits accessible to your members. This network connects members to an extensive list of nationwide accredited hospitals, clinics or medical centers, dental clinics, doctors, and specialists. This streamlined access ensures convenience and reduces out-of-pocket costs.
See our Accredited Providers via Find Care in the Hive Portal here
Coordinated care is a hallmark of HMO insurance, as it simplifies the whole patient journey. Members are to receive seamless healthcare experiences, often via Letters of Authorization or Approval (LOA) which pre-approves treatments or hospital stays, which serves as clearance for payment or billing.
An HMO plan in the Philippines operates on a cashless system for most services, streamlining healthcare access for its members. Upon enrollment, members receive an HMO card, which serves as a gateway to their network of accredited healthcare providers.
When seeking medical attention, members simply present their HMO card at an accredited facility to access services. Depending on the treatment, some procedures might require a Letter of Authorization or Approval (LOA), which can be quickly processed through the HMO provider. The cashless system reduces the financial and administrative burdens for members, allowing them to focus on their health without falling in long lines or worrying about upfront payments.
Members benefit from the affordability and convenience, as they can avail of services within the provider’s network, but some HMOs also offer out-of-network reimbursements. The model promotes preventive care, with regular health checkups often covered to identify and address health issues early, minimizing the risk of costly treatments later on.
For HR teams, managing HMO plans goes beyond paperwork – it’s an ongoing process that assists members in accessing their healthcare benefits while also meeting organizational compliance. The tasks can be time-consuming, especially as employee headcount grows or employees need help in availing care.
Before getting started with an HMO, it’s important to know what to expect: workload and tasks included. Managing HMO plans typically fall under HR teams or personnel, but for smaller teams, business owners or founders may have to manage them as they grow.
According to PeopleGoal, HR teams spend up to 1 hour on benefits administration everyday on average (or 12.5% of their work week). For any organization, lessening this workload is beneficial not only for the business, but also for the different team members involved (both in managing HMO and for members easily accessing their benefits). Manual management also increases the risk of errors, such as missing renewal deadlines, adding and terminating members, or failing to onboard employees correctly.
There are many ways to streamline the process of managing HMO. After signing and starting coverage, the onboarding process is crucial to the entire experience. If employees fully understand their benefits, any exclusions, and the step-by-step of how to avail care. Digital solutions such as an online portal also helps in streamlining the process – especially helping members to easily access their information and availment processes.
Another digital solution is a dashboard which can assist in major tasks that come with HMO management. The Hive Health HR Dashboard automates tasks such as enrolling members, managing APE results and Pre-Employment Medical Exams, and invoice overviews.
When looking for an HMO, be ready with business registration documents including but not limited to:
With Hive Health, you can activate your team’s HMO plan in just 4 days!
To learn more about how Hive Health can help your team take care of your employees with hassle-free care, book a call today.
