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How to Avoid Getting Trapped With a Crappy HMO Plan

  • Jul 24, 2020
  • By Miles Malferrari

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Getting health insurance has become almost everyone’s top priority these days. Especially considering how easy it can be to contract diseases like COVID-19 which could potentially be deadly. For SMEs, several prepaid and HMO plans have begun popping up left and right. With the jargon and confusing details, it’s easy to fall prey to a proposal that seems good on paper but ends up becoming a headache after you’ve committed to a year of premiums for all your employees. Here are some things you should consider before signing that contract with any health insurance provider.

                                          


1. Analyze what you need and come up with a budget. 

As a budding business, it’s important you don’t pay too much for HMO plans nor too little for what you and your employees need. Each HMO will specify certain premiums you would need to pay annually or quarterly (whether or not you use the services provided). ALLCARE, for example, can have you pay as low as P4,200/quarter per head to get access to over P200,000 worth of HMO and employee benefits including P100,000 worth of medical services for any condition - pre-existing included.

                                      


2. Look up the provider’s track record, seek stories or testimonials.

It’s natural for HMOs to go after big companies - that’s where the money is. But the pitfall of going to providers that prioritize big companies is they do not necessarily understand the needs of smaller companies. And often, you end up paying more than what you intended for less service than what you hoped to receive. Instead, consider ALL providers and if you can, go with a provider that can take care of your needs especially as a small business.

                                         


3. Don’t be blinded with the shiny gold number, the MBL.

We’ve heard countless stories from SME owners falling prey to this a lot. Due to their lack of information and education, when they see an HMO plan with a high MBL, say 185,000 per disease per year, they jump on it right away. Later on, these same owners regret signing up for the plan when they try to claim some medical benefit and are declined or turned down. Oftentimes, SME owners and young HR managers do not get a chance to fully scrutinize their plans until after they’ve signed on to a full year program and, quite unfortunately, after they get turned down for a specific benefit they thought would be included.


Scrutinize your benefits plan to the last page and give a second think about the benefits that an Annual Benefit Limit (ABL) Plan provides you. The main difference between ABL and MBL is that the ABL is more ‘comprehensive’ in that it covers any and all claims provided it is medically necessary. On the other hand, a Maximum Benefit Limit (MBL) per disease is a program where certain diseases are covered and certain diseases are not covered. In an MBL program, usually the condition must be approved for a medical claim before it is authorized by the HMO provider. For a business owner, that means an MBL of 250K coverage may look appealing on the surface but when you read the fine print it may only include certain rare illnesses and won’t even cover the most common ones you could experience. By the time you become sick and try to claim your health plan you’ll be disappointed that your illness is not covered by the MBL plan, no matter how high the coverage is. Meanwhile with ALLCARE’s ABL plan, you can get an annual budget of 100K where you can use it to manage your health including all medical claims you have for any disease provided it is medically diagnosed and necessary. 


Ultimately, it is not primarily a question of “how much?” that we should be first asking but instead “which provider and what plan” can best cater to your needs. Proper research and thorough study of their benefits can help you avoid the pitfalls of poor HMO coverage and headaches when claiming medical conditions, hospitalizations, and the like.


Get the right health plan now with ALLCARE’s SME Package.You can get access to important benefits like HMO, Life and Accidental Death Insurance, 24/7 Telehealth Consultation, Mental Health Survey, Dental Care, Optical Care, and other awesome perks from just one easy-to-apply membership.








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