Things to consider when shopping for an HMO plan

Things to consider when shopping for an HMO plan

Finding the right healthcare plan can be frustrating, especially when you’re new to buying health insurance. Other than budget, here’s a 101 on things to consider when evaluating healthcare plans from different HMO providers.


Knowing if your preferred doctors are part of an HMO’s accredited network is important, but it’s also good to ask if your HMO offers access to the top hospitals, a.k.a. the “Big 5.”  If this is important to you, access to the “Big 5” will add around 40% to your cost per employee.

Other HMO providers also include access to Healthway clinics. Companies pay 3-5% extra for this but can save on healthcare costs if they use these clinics instead of the Big 5 for outpatient care.

Medical coverage

While all HMOs offer comprehensive care, there are unique differences between plans. Here are some:

Coverage for pre-existing or congenital conditions

If you’d like to extend coverage for any sickness, illness, or ailments which your employees have before your plan is activated, or any conditions they’ve had since birth, coverage can range from Php 5K/ year to 100% of the MBL (Maximum Benefit Limit).

Coverage for special procedures

Coverage for non-invasive and/or specialized forms of medical treatment prescribed by the doctor can also range from Php 5K/ year to 100% of the MBL (Maximum Benefit Limit) depending on the HMO provider.

Private patient reimbursements

When medical services are availed outside of the HMO’s accredited network, some HMO providers cover reimbursements at the special HMO rate.

PhilHealth benefits integration

All HMO products are currently integrated with PhilHealth, and all HMOs will always allow its members to use up the full MBL when applicable. The difference is in whether your HMO plan offers PhilHealth benefits on top of your MBL; that allows for bigger coverage inner limits of your plan.

Life & Accidental Death and Dismemberment (AD&D)

The industry rule of thumb for Life and AD&D is 1-year income replacement.  The good news is HMOs offer options. Some, for instance, offer a payout of 5 times the MBL while others can insure from Php 10,000 up to Php 100,000.


An HMO can offer riders, which are amendments to the terms or coverage of a policy, to closely match the needs of a client. Think of it as an additional benefit that can be included to your healthcare plan. Example of riders include coverage for maternity and dental benefits, reimbursement for prescription medicines, and executive checkups.

Know what specific type of coverage you need

It's important to know what specific type of coverage your team will need. Do you need access to the Big 5 hospitals, Healthway clinics, or both? Is coverage for pre-existing conditions a significant factor to consider? Will you cover their dependents? Will they care about maternity coverage? If the company availed of riders, will the benefits be worth the cost in the long run? It’s important to look at the total impact of all of these when choosing an HMO plan.

Making the right choice starts with understanding your options. At Maria Health, we simplify the process of getting health insurance. Get instant quotes, full enrollment support, and unbiased guidance in finding the most beneficial plan for your business.

Whether you’re a freelancer with a limited budget or an entrepreneur just starting to get your feet wet, we’ve got you covered. Visit our site or drop us a line at


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