Health Insurance and Other Preventive Healthcare: Which Focuses More on Wellness?

Safeguarding your family’s health and well-being is important to achieve peace of mind.

Aside from investing in good health to prevent diseases, the best way to protect your loved ones is to get health insurance. However, the usual problem you’d encounter is not knowing which options are best for you.

You’d often hear the HMO vs. health insurance debate during such discussions and there’s a high chance you’ll feel overwhelmed even before reaching a decision.

To help you make an informed decision about your health plan, it’s important to understand how the Philippine healthcare system works first. Check out how primary health care functions in the Philippines:

A look at Philippine public and private Healthcare

The Philippines has a mixed health system organized from a national to a local setting. It is composed of the public and private sectors which fund the Primary Health Care (PHC) services that Filipinos receive.

With the passage of the Universal Healthcare Act in 2019, the local government must ensure that all Filipinos have access to a comprehensive set of quality and cost-effective, promotive, preventive, curative, rehabilitative, and palliative health services.

The Philippines Health Insurance Corporation or PhilHealth is the government-owned company that oversees public healthcare in the country. If you’re employed, part of your salary goes to PhilHealth as your contribution. In exchange, it covers some of your medical treatments and expenses when you get hospitalized.

The private sector’s role in providing PHC Services

The health insurance plans from companies like Pru Life UK are under the private sector. The way it works is that health care is generally paid for by you as a client through user fees at the point of service.

The Philippines healthcare system relies heavily on private PHC providers with 30% of the population using it as their main source of care. The private sector also accounts for 60% or more than half of the health spending in the country.

Over the years, there has been a significant growth in the use of private prepaid insurance plans. The number has grown from 5.92% of the total health expenditure (THE) in the year 2000 to 10.79% in 2018. The jump in the figure can be attributed to the health maintenance organization (HMO) plans provided as employment benefits.

In addition, many Filipinos find that they spend a lot of money paying out-of-pocket because Philhealth, the government-owned public PHC provider, offers limited benefit coverage. Oftentimes, it does not cover the entire cost of medication, tests, and hospitalizations.

Is HMO the same as health insurance?

Since HMO health insurance plans and preferred provider organization (PPO) plans are both under the private sector, are they considered the same? The simple answer is no.

HMO is a type of health insurance plan structure that provides care coverage through a network of physicians in contract with an organization.

To help you understand what type of insurance is HMO, explore its major misconceptions first:

1. Coverage scope

While health insurance plans typically provide coverage for a wide range of medical expenses, including hospitalization, surgeries, and prescription drugs, HMOs often have a more limited network of healthcare providers and may only cover services provided within that network.

Traditional health insurance offers more flexibility in coverage. For example, the PRUHealth FamLove plan allows you to share coverage against critical illnesses with eligible family members with just one plan. In addition, you can automatically renew your plan and get protection until you’re 85 by paying premiums continuously.

2. Pre-existing Conditions

You might have heard that  HMOs reject members who have pre-existing conditions such as hypertension, diabetes, cancer, and more. However, most HMOs in the Philippines will still accommodate individuals with such conditions. The catch–you’ll have to pay higher premiums to qualify for coverage and it might not include out-of-network care.

With a typical health insurance plan, you get what you pay for. Insurance company Pru Life UK offers a wide range of comprehensive protection for critical illness patients. In case you are diagnosed with moderate or severe critical illness, you can claim a lump sum to support your needs. Certain policies have a Hospital Income benefit, which you can claim to reimburse your hospitalization expenses.

Ask your financial adviser about what critical illness insurance policy would best match your needs. They may ask you about any pre-existing conditions upon your application. Higher premiums may be charged if one has existing health conditions. With this, you can rest easy knowing that you’ll be financially prepared for any unexpected illnesses.

3. Quality of care

Since HMOs are cheaper than traditional health insurance plans, there’s a misconception that it offers subpar quality of care. While HMOs emphasize preventive care and may have mechanisms in place to manage costs, they often provide high-quality care through their network of healthcare providers.

Benefits of wellness focus in preventive healthcare

Have you ever heard of the phrase “prevention is better than cure”? In the past, healthcare systems have always focused on curative care. Nowadays, however, the landscape is shifting to put more emphasis on preventive healthcare.

This proactive approach which includes various screenings, immunizations, and counseling aims to address risk factors before they escalate into severe conditions. Whether you have an existing HMO coverage or a plan from providers like Pru Life UK, look more into the preventive healthcare benefits they offer, especially those focusing on wellness.

Investing in your health is always a good choice. Take advantage of preventive care coverage from your HMO or health insurance plan to get regular screenings for chronic and acute illnesses, wellness check-ups, and vaccinations.

Now that you’ve safeguarded your family’s health, consider adding an extra layer of protection with personal accident insurance. This will make handling the unexpected costs of accidents more manageable for you and your loved ones.

Choose your family’s wellness first

Healthcare costs will never be an easy topic to bridge. However, it’s vital to improving your quality of life and achieving peace of mind. If you’re still thinking about getting a health insurance plan or supplementing it, remember the following:

• Leverage preventive health care benefits for overall well-being. Start reviewing your health plan and take advantage of the preventive care services that it covers. This is key to enhancing your overall well-being and promoting wellness

• Check out wellness-focused insurance options. Don’t just focus on insurance options that only provide curative care coverage. Check out which plans focus on wellness and proactive healthcare.

• Get an extra layer of protection with personal accident insurance. You can never be too safe. Adding an extra layer of personal accident insurance will bring you and your family peace of mind against the unexpected.

To learn more about the options available get in touch with a Pru Life UK agent today on Facebook, Twitter, or LinkedIn. You can also contact us via email at contact.us@prulifeuk.com.ph, or on the official Pru Life UK website.