Can I Use 2 HMO at the Same Time in the Philippines?

Having health insurance is crucial in the Philippines to protect yourself and your family from the high costs of medical care. Many Filipinos rely on Health Maintenance Organizations (HMOs) as their primary form of health coverage. But is it possible to be covered by two HMOs at the same time for extra protection?

The short answer is yes, you can absolutely have two HMO plans concurrently in the Philippines. However, there are some important factors to consider to make this dual HMO coverage work effectively for you.

In this comprehensive guide, we’ll cover:

• What is an HMO and how does it work?
• Is it allowed to have two HMOs in the Philippines?
• What are the benefits of dual HMO coverage?
• What should you look out for with dual HMOs?
• How to maximize dual HMO coverage.
• FAQs on having two HMOs

Let’s dive in!

What is an HMO and How Does It Work?

An HMO, or Health Maintenance Organization, is a type of health insurance plan that provides its members access to a network of partnered doctors, hospitals, and other healthcare providers.

Here are some key things to know about HMO plans:

• Fixed premiums: You pay a fixed monthly fee for membership, regardless of how much medical care you actually use.

• Limited provider network: You can only use doctors and facilities partnered with the HMO. Going out of network is typically not covered except for emergencies.

• Primary care gatekeeping: You need to get a referral from your primary care doctor before seeing a specialist.

• Pre-approval for procedures: The HMO must approve non-emergency procedures in advance.

• Annual coverage limits: HMOs have a maximum limit on coverage per year. Once you hit the limit, you pay for all other costs out of pocket.

• Inpatient and outpatient coverage: HMOs cover both hospital stays as well as outpatient services like doctor visits, medications, and diagnostics tests.

• Preventive care: Checkups, screening, and some vaccinations are covered.

Is It Allowed to Have Two HMOs in the Philippines?

Yes, it is perfectly legal and allowed to have concurrent coverage from two HMOs in the Philippines.

There are no laws prohibiting double HMO membership. Some key points:

• Employer HMOs – Many employers provide HMO coverage as a job benefit. You can absolutely get your own private HMO plan in addition to this.

• Dependent status – Spouses and dependents can be covered under two separate HMO plans (e.g. yours and your spouse’s employer plans).

• Different HMO providers – You can choose any two HMO companies and be a member of both at the same time. No restriction on the provider.

• Premium payments – You simply have to keep up with the monthly payments for both plans.

So you have full flexibility to sign up for two HMOs as you wish.

What Are the Benefits of Dual HMO Coverage?

There are several advantages to having dual HMO coverage:

1. Higher Annual Limits

Each HMO plan has an annual coverage limit, typically ₱100,000 to ₱300,000. Getting two plans doubles your total annual limit, providing much more comprehensive coverage.

2. Wider Provider Network

Since each HMO has its own network of accredited hospitals and doctors, dual membership gives you access to a larger combined network. This provides more choices and flexibility.

3. International Coverage

Some HMOs like Pacific Cross provide international coverage across Southeast Asia. Pairing this with a local HMO gives protection when traveling.

4. Deductible Funding

If one HMO has a high deductible, the other can be used to cover that gap and reduce your out-of-pocket costs.

5. Higher Benefit Limits

Certain benefits like hospital room limits per day or how much is covered for procuring medications can be increased with two plans.

6. Continued Care with Job Loss

Losing your job doesn’t result in an abrupt loss of health coverage since your private HMO remains intact.

So in essence, dual HMO coverage provides you much more comprehensive protection overall.

What Should You Look Out For With Dual HMOs?

While having two HMOs provides added benefits, there are some important considerations as well:

Coordination Issues

You’ll need to carefully coordinate between both HMOs to ensure you maximize benefits and don’t run into any coverage conflicts. This may require some extra admin work on your part.

Pre-Existing Conditions

Check if pre-existing conditions are covered by both plans, otherwise you may not get full coverage.

Claim Reimbursements

You’ll likely need to file claims and get reimbursed separately from each HMO for the same procedure. This can mean more paperwork.

Overlapping Networks

If both your HMOs have partnerships with the same hospitals, you won’t really expand your provider options that much. Research the networks carefully.

Non-Emergency Care Restrictions

Some HMOs may impose restrictions on using out-of-network providers even in dual HMO scenarios.

Premium Costs

Of course, paying two sets of premiums means higher overall costs for you. The extra benefits may justify it but consider your budget.

So you’ll need to evaluate both plans carefully and coordinate properly between them to maximize value.

How to Maximize Dual HMO Coverage

Follow these tips to make the most of having two concurrent HMO plans:

• Thoroughly review what is and isn’t covered by each HMO before signing up. Look for exclusions.

• Understand the claim filing procedures for each so you can submit documents correctly.

• Inform both HMOs that you have dual membership for proper coordination of benefits.

• Use each plan strategically – high cost care under higher limit plan, routine care under lower limit.

• Maximize access – use specialist referrals from one HMO to see doctors on the other HMO as well.

• Distribute annual spend across both plans to optimize coverage limits.

• When using overlapping hospitals, present both HMO IDs to avail of higher combined benefits.

• Track claims and re-evaluate dual membership at renewal if benefits not justified.

With some research and planning, you can optimize dual HMO coverage to protect your family in a cost-effective manner.

Frequently Asked Questions on Having Two HMOs

Let’s go over some common questions people have about maintaining dual HMO coverage:

1. Do I have to inform the HMOs I have dual membership?

• It’s highly recommended you inform them to facilitate coordination of benefits and claims payments. But it’s not legally mandatory in the Philippines.

2. Can I use one HMO for inpatient care and the other for outpatient?

• Yes, you have the flexibility to allocate expenses like this across plans. Just be aware of annual limits.

3. What if both my HMOs are Maxicare – will that work?

• Even if both plans are from Maxicare, each will have a separate coverage limit so dual membership can still provide added benefits.

4. Is coordination of benefits automatic or do I need to intervene?

• Unfortunately, you’ll have to coordinate directly with the HMOs yourself to ensure they process claims properly.

5. Can I get double insurance coverage if I submit the same receipt to both?

• No, that would constitute fraudulent activity which is illegal. Legitimate expenses can only be claimed once.

6. What if my company provides Pacific Cross – can I get another Pacific Cross plan myself?

• You actually cannot get two plans from the same HMO company. But you can complement your corporate Pacific Cross with a different private HMO.

7. I have PhilHealth too – how does coordination work with that?

• PhilHealth will typically provide coverage only after your HMO limits are reached. You still claim directly from PhilHealth as normal.

Getting clarification on such questions will help you better leverage dual HMO coverage.

Conclusion

Dual HMO coverage can provide substantial benefits like increased coverage limits, wider provider access, and deductible funding. This can give you and your family more comprehensive protection.

Just be sure to coordinate carefully between your two plans – inform them of your dual membership, strategically allocate claims, and file documents properly.

Evaluate both HMO networks, coverage gaps, and premium costs as well before signing up. With some diligence, having two HMOs can provide you invaluable security and peace of mind.