03 September 2011

HMO Coverage - Why I value this benefit?

I have never fully maximized my HMO coverage (hey, I am not complaining!) as an employment benefit.  Neither have Don.  Until Julia came along. 

Don has an extensive health care benefit coverage with an HMO. His employer not only covers the employee, they also extend it to the employee's dependents. So, when I gave birth, the hospital bill was barely P3,000. And that amount was to cover extra pillows, binders and other extras to make my stay more comfortable. Had we not availed them, we will not be paying a single cent.

After Julia was born, I have regrets about not being able to breastfeed longer.  Aside from the health benefits of breast milk to Julia, we missed out on the supposed savings on formula milk (We pay P930 for a can of milk every 5 days!). However, we surely saved a lot in medical expenses because of Julia's health care benefits as Don's dependent.

Imagine, I only pay P50 for her pedia consultation. Most of the vaccines needed for Julia are free. Oh and to add icing on the cake, because Don works for a pharmaceutical company, Julia's vitamins and medicines (specifically for her allergic rhinitis) are free or are bought at an employee price.

The key is not to marry a pharmacist who works for a pharmaceutical company that has an extensive health care benefit (*wink*). Here are some pointers on how to maximize your health care plans:
  • Before you give birth, review the health care benefits provided by your (or your husband's) employer.
  • Inquire form your HR Department the requirements you need to submit to enroll your newborn as your (or your husband's) dependent.  
    • Almost always, they require for a photocopy of your child's birth certificate.  Some companies require the NSO-authenticated birth certificate because they need this to enroll your child as a dependent or beneficiary in SSS, Philhealth and PAG-IBIG.  The NSO-authenticated birth certificate is available 3-4 months after giving birth.
    • You may visit the business center of any SM (P150 per copy but will take 3-4 weeks processing time) or request online at www.ecensus.com.ph (P350 per copy and delivered through courier in 3-5 days). 
  • If your health care benefit includes full coverage of a dependent, inquire from your HR Department or HMO Coordinator the complete list of medical benefits that you may avail:
    • Preventive Care (annual physical examination, routine immunization, dental, etc.)
    • Out-Patient Care (consultations, treatment of minor injuries, laboratory tests, etc.)
    • In-Patient / Hospitalization Care (room accommodations, covered procedures and illnesses, etc.)  
    • Emergency Care
    • Other Additional Benefits (some employers have unique medical benefits for their employees, which are not offered by HMOs to other companies)
  • If your health care benefit includes coverage of a dependent but on your expense, inquire from your HR Department the amount you need to pay for your child's health care coverage.  It will be cheaper if you get a coverage under your company's health care plan rather than getting a separate plan of your own.
    • Negotiate for payment terms and salary deduction facilities.  Of course, you must respect company policies that's why it is essential that you know these things prior to giving birth so that you can prepare for it. 
  • Remember, your health care benefits are not only for hospitalization and emergency care.  Discuss with your pediatrician (who should be accredited by your HMO) the health care benefits of your employer so she/he can help you maximize the preventive care benefits of your coverage.
  • Be familiar with with your preventive care exclusions, too.  Some vaccines are common exclusions.  Make sure you know what these are so that you come prepared when your child's pediatrician will require it.   
  • Do not throw away the guidebook provided by your HMO.  It contains the 24-hour hotline number, procedures and lists of accredited doctors, clinics, and hospitals. 
By knowing your benefit, you are able to save money on most of your preventive care needs and more importantly, you are able to sleep well at night knowing that you child is protected with a health care plan.
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