HMO - Medicard, Maxicare, Medserv, Intellicare

[gandababae]

Anyone working from this industry? What can you say about these companies?

[zgeth]

ano ba mas ok? maxicare o intellicare? maxicare gold kasi sakin pati sa dependents ko.

[gandababae]

maybe you can help me with my thesis

[mark_mark]

yes, what about?

----------------------------------------------
Worried about Expensive Hospital Bills?
Secure yourself with MAXICARE!
For Individual, Family & Corporate
Tel: 4964690 Mobile: 09226047864
Email: bzkid82@yahoo.com

[greensloth]

About Intellicare, sagot ba dito ang medicine? My parents have monthly medicine expenses na maintenance due to stroke/high blood/diabetes. Thanks!

[mark_mark]

greensloth,

HMOs normally do not cover outpatient or prescribed medicines. what's only covered are those that are actually used while you are in the hospital during confinement or an outpatient diagnostic procedure when you are injected with pain relievers or oral medications.

rare will you find an HMO that will reimburse your medicines. in some cases cases HMOs do reimburse medicines but because the company where you got your HMO asked their HMO to administer the reimbursement and the HMO bills the company afterwards.

[treefingers]

i think medicard is still the industry leader. that's our HMO last eyar and we didn't have any problem. we have medserv now and it's quite a headache to be honest.

[treefingers]

i think medicard is still the industry leader. that's our HMO last year and we didn't have any problem. we have medserv now and it's quite a headache to be honest.

[superbad]

okay ba ang intellicare?

[qquixx]

maraming specialist doctors affiliated with medicard compared to the other HMO provider

[mark_mark]

treefingers, baket naman headache? Did u know that Medserv was formed by ex Maxicare employees?

intellicare is a younger HMO but is okay acco to my colleagues. They were initially positioned as the cheaper Maxicare but is now adjusting its premium.

qquixx, yes they have a lot. most HMOs have affiliated specialists otherwise they cannot serve their members. Medicard is also pretty agressive, their sales force is really thick and they are agency based.

Top 4 HMOs based on market share:
Medicard
Maxicare
Intellicare
Philamcare

[angst]

Our company uses Maxicare and I am completely satisfied with their services.

[mark_mark]

ah talaga, what company?

[monarchrising]

Which HMO provides for outpatients? Thanks!

[treefingers]

treefingers, baket naman headache? Did u know that Medserv was formed by ex Maxicare employees?

i just don't have the luxury of time to enumerate here the reasons why they are quite a headache. :)

we had medicard last year then we downgraded to medserv this year due to financial issues. our people can't help but compare and the difference is quite steep. if you ask me, i'm willing to shell out for personal counterpart just to get back to medicard rather than bear with medserv. im in hrd and i know the experience is across our organization. :)

[monarchrising]

to all those working for maxicare, medicard, intellicare, i believe you also do preemployment tests right... ano ba yung standard preemployment medical exams na yan? drugs? thanks!

[mark_mark]

monarchrising: almost all HMOs provide coverage for outpatients for corporate. r u considering an individual package?

standard pre employment is normally:
physical exam
CBC, complete blood count
urinalysis
fecalysis (stool)
chext xray
ECG
Pap Smear

treefingers, i hear that a lot from some of my corporate clients. medicard should have redesigned your program. i suggest you go back to medicard then have them redesign it. give them a budget and make them design a program that will match it. some benefits are extraneous, d mo naman talaga kailangan pero binibigay at nakakadagdag pa ng premium. some of my clients prefer Medicard since they have a stable organization, they are infact the leading HMO in the country for several years now. Their protocols and SOPs are already intacked, maayos na *** proseso and they have good credit standing with the hospitals.

i do know medserv dive their rates to get corporate accounts from others. hmm....

[annegelly]

hello, pano ba kukuha nito? wala kasing healthcard sa company namin, marami ang nag wo2rry. ako plan ko kumuha na lang sarili since mei dependent ako.

[mark_mark]

hi annegelly, maybe u can just ask your HR kung baket wala. Pag madaming nagtatanong, they seemed to notice and take action. You might also want to get quotations from an HMO yourself and show it your HR for her reference come budget season.

may union ba company mo?

[manok00]

Paano mga ibang HMO? Like Asianlife, etc.,etc.

[clone19]

does intellicare provide for outpatients na family of covered employees?

[mark_mark]

Asian Life came really agressive 2006. Their protocols are similar with that of Generali Pilipinas. They have an HMO and medical reimbursement. They have corporate programs also. Their office is in Buendia. Im not sure if they offer individual programs. Asian Life offers reimbursement to non accredited doctors/hospitals.

As for intellicare, HMOs in general have outpatient programs for dependents BUT this depends on the company whether they would want to get that package from Intellicare. Pde kasi siyang ichop chop. Like Outpatient Only, Outpatient & Emergency only, Inpatient only. I think clone19, that company decided to get the unbundled program of Intellicare for the dependents of the employees.

[aries2008]

mark, ask ko lang if what HMO ang pwedi namin applayan na meron ganito ;
1. ito yong priority, mababa ang premiums( mas cheaper than maxicare)
2. meron coverage for consultation & outpatient checkup
3. meron din option for ward or semiprivate or any lower room,kasi base
sa room rate yong galaw ng mga cost if hospitalized di ba?
4. at may mga ilang coverage like warts removal,PT session covered
etc....
Medyo mahal kasi Maxicare,maybe you are not biased, to suggest other hmo na competitive but mas chaeper yong premiums di ba kasi most of the time ay consultation lang at bili na lang ng gamot.I would prefer yong ipapasok ko as members are mostly kids age 4 & 8.
BTW,i am an OCW sana meron kayo for this type of members or for individual category na hinde mataas ang premiums like Caritas sabi nila mas mura daw.Please advise us and suggest a HMO na maganda service but not expensive.Thanks in advance.

[mark_mark]

i sent u a pm. :)

[metropolitan]

my inaanak had problems with her father's maxicare coverage. maxicare does not want to cover her hospitalization due to measles. however her mother's medicard plan covered everything.

i cannot believe an HMO does not cover measles!

[aries2008]

..thanks Mark, wait does anyone here have contact# of Icare and Fortune Care.Also pati Bluecross na rin kasi mura yong mga premiums nito.maraming salamat po...

[thinkbiglinus]

alam ko HMO's coverage ay depende sa plan na kukuhanin ng mga company nyo. this will depend on the premium paid by your company. dati medicard kami pero this year we are shifting to Intellicare kasi mas maganda daw ang offer at leading ang Intellicare sa HMO.. daw sabi ng HR ha

[luks7210]

yung HMO ng mom ko, narereimburse *** medication bills. Matagal lang nga sila magreimburse, but still... I think it is EA before and I believe it's from Ayala group of companies. Right now, Maxicare gamit ng mom ko.

I have a question ... hinohonor ba ang Maxicare if gagamitin mo siya abroad (e.g. US)? I hope someone can answer. Thanks in advance! :)

[metropolitan]

has anyone heard of Caritas Health Shield? my parents has this, its like an HMO but after five to ten years members can get their premiums back.

[aries2008]

honga ,ano name ng product na yan?at magkano naman ang babayaran annually?baka mahal yan?Nga pala ask ko lang if ok itong bluecross na insurance company na parang HMO na rin at mas mura pa ang premiums nya P3197/year na at 500000 ang coverage?Yun nga lang reimbursement type sya pero parang same na rin kasi isauli naman 100% lahat ng binayaran mo sa ospital so parang same lang HMO cards di ba,mas mura pa at di namimili ng doctors at hospital?what you think guys?Please advise naman and thanks in advance...

[mark_mark]

my inaanak had problems with her father's maxicare coverage. maxicare does not want to cover her hospitalization due to measles. however her mother's medicard plan covered everything.

i cannot believe an HMO does not cover measles!

i doubt that this information is true. his father may have another illness and measles was just a complication, maybe a pre existing condition.

what was the exact diagnosis?
ur inaanak has corporate plan or family plan?*okay*

[mark_mark]

alam ko HMO's coverage ay depende sa plan na kukuhanin ng mga company nyo. this will depend on the premium paid by your company. dati medicard kami pero this year we are shifting to Intellicare kasi mas maganda daw ang offer at leading ang Intellicare sa HMO.. daw sabi ng HR ha

this is partly correct. here are the factors that make a GOOD hmo plan:

BUDGET iF your company is generous, your company can afford higher limits, higher room accommodations, pregnancy coverage, STDs and coverage for dependents/beneficiaries.

COMPANY SIZE HMOs will give better coverage to companies which are 100+ in size. Pre Existing conditions are waived, no medical evaluation is needed. HMO policies vary but the bottomline is that HMOs will give you more if the size is bigger. HMO business operates on risk management. The bigger the size, the lesser the risk kasi mas madaming tao pedeng pag "spre-spreadan" ng risk. Example, a company with 10 employees, if 2 doon ma hospitalize, lugi na ang HMO doon sa binayad nilang premium as compared to 100employees. Mas may leverage ang HMO to assume a higher risk.

HEALTH RISK OF THE COMPANY HMOs are picky or "discriminate" industries. Meron silang high risk industries kaya they limit the coverage or charge a higher premium. Mas prefer ng HMOs kung bata ang population. Pag may edad na karamihan, they will charge higher or limit the coverage. Again, the policies vary per HMO but this is the norm. Some HMOs will charge higher for government agencies, media, police etc or limit the coverage.

Its the perception sa market na kailangan i correct. Si Employee A from company A will say na maganda si MAXICARE/MEDICARD/INTELLICARE etc while si Employee B from company B will say na pangit si MAXICARE/MEDICARD/INTELLICARE etc.

HMOs are homogenous. Halos pare pareho lang lahat.

[mark_mark]

yung HMO ng mom ko, narereimburse *** medication bills. Matagal lang nga sila magreimburse, but still... I think it is EA before and I believe it's from Ayala group of companies. Right now, Maxicare gamit ng mom ko.

I have a question ... hinohonor ba ang Maxicare if gagamitin mo siya abroad (e.g. US)? I hope someone can answer. Thanks in advance! :)

EA is not an HMO, its a network/affiliated hospital. HMOs will buy the EA network para magamit nila ito.

Maxicare only covers emergency cases abroad on a reimbursement basis.

HMOs in the PHILS on a non cash out basis can only be used here. Coverage is only a reimbursement basis.*okay*

[mark_mark]

I am not sure what the exact rankings are but the top 4 (market share) would be:

MEDICARD, MAXICARE, INTELLICARE, PHILAMCARE

[mark_mark]

has anyone heard of Caritas Health Shield? my parents has this, its like an HMO but after five to ten years members can get their premiums back.

Caritas is an HMO/Pension/Insurance rumored to be operating without a license.

Ang kagandahan ng package nila, u pay it for 5 years, u can use it for 10 years. parang buy1 take1. May kamahalan lang. The catch lang is that the limit is not replenished every year, u have a lifetime limit. There were rumors na ginigipit daw ang mga members dito pag gumagamit but then again these rumors naman are applicable to all.

Yes you can get your premiums back if and only if hindi mo siya ginamit. *okay*

[mark_mark]

aries, some people prefer a reimbursement type kasi u can choose kung sinong doctor kukunin mo. 1-2 months nga lang ang waiting time pero if u can wait and may pondo ka naman, go for bluecross.

careful ka lang, its not a 100% reimbursement, so double check the fineprints. :)

also, double check kung ano ang reimbursable. :)

[aries2008]

..thanks mark,btw aside fr bluecross, is there any similar health insurance company that runs on a reimbursment type para may comparison kami at makapili among the rest.If ok naman ang standing ng bluecross then,go for the bluecross,but i hope there is alternative here para malaman naman ng iba yong option di ba?You're right I should check first the fineprints and ask more kung ano yong covered ng 100% reimbursement,baka may TIPS po kayo dyan pashare naman po.Thanks in advance ulit...

[mark_mark]

aside from Bluecross, there is Generali Pilipinas. :)

critical thing to ask your HMO consultant about reimbursement, ask them if it's a 100% reimbursement based on actual expenses?

some HMOs reimburse 100% based on HMO values.

HMO values is the amount that the HMO would have paid the hospital had they covered the expenses. This is discounted, a preferential rate hospitals charge HMOs.

tip #2, know the documents required for reimbursement. HMOs will not reimburse if u lack one. some documents are hard to get like a police report especially when your accident is caused by a 3rd party (assault, motor vehicular etc).make u sure u keep a receiving copy of all your documents whe u submit them to the HMO.

tip #3, once enrolled, orient your family members about your HMO plan, the benefits etc kahit na ikaw lang ang naka enrol. Why? If something happens to you, and youre unable to speak, write or read or unconscious, your wife, husband, son etc can do the paper work, talk to the HMO etc. Make sure your HMO documents are stored where your family members can easily locate them when something happens. On my end, I do the storing for my clients. :)

Gudlak sa HMO hunting. :)

[sakura-tattoo]

im interested on getting an individual/personal account for me and my daughter. im eyeing on medicard kasi ito hmo na affiliated *** pedia ng anak ko.
anybody here knows how to get individual plan?

[hime]

for me, Maxicare and Medicard pa din pinakamaayos.

[jaLenpaRk™]

ano po pala yun HMO?:confused:

[tita_kikay]

Hi,

I would like to enroll my father in an HMO. He is already 66 years old. I have the option of enrolling him in my company's HMO, Cocolife, but it is subject to approval and costs 2x as much. My mom, who is only 62, is also enrolled. It costs around P7,000 annual premium for a maximum benefit of P100,000. If my dad's renewal gets approved, it would cost around P14,000 for the same maximum benefit.

Do you know of any other HMO programs covering senior citizens who are not dependents of a principal applicant, meaning my dad can be enrolled on his own?

I've been browsing the Net but can't find a cheaper health card for senior citizens.

Thank you.

[vinvinvin]

Nagpalit ng HMO ang company namin, Intellicare naging Maxicare! Wala naman akong problema sa Intellicare pero maganda ba yung Maxicare o nagtitipid na ang company namin?

[angel_11]

my friend, who's working in victoria court, pays for his and his dependents HMO (medicard). and that is NOT optional.

every payday, he has 9hund pesos deduction for HMO. he has 2 dependents (mom and dad).

normal ba yun? i don't pay for my HMO kasi (maxicare), my employer does. and optional ang dependent.

[ispammy]

Hi,

I would like to enroll my father in an HMO. He is already 66 years old. I have the option of enrolling him in my company's HMO, Cocolife, but it is subject to approval and costs 2x as much. My mom, who is only 62, is also enrolled. It costs around P7,000 annual premium for a maximum benefit of P100,000. If my dad's renewal gets approved, it would cost around P14,000 for the same maximum benefit.

Do you know of any other HMO programs covering senior citizens who are not dependents of a principal applicant, meaning my dad can be enrolled on his own?

I've been browsing the Net but can't find a cheaper health card for senior citizens.

Thank you.

I have the same problem, looking for a provider for my 71 year old dad.

Or do you think it's not worth it anymore?

[the_querent]

up...up..up

[fierce sasha]

ano po pala yun HMO?:confused:

HMO= Health Maintenance Organization
:lol: