Health insurance is an agreement where an insurer undertakes for a consideration to indemnify another against loss, damage, or liability arising from health-related events. It concerns the insurance of the health of a person.
Health insurance is a general term encompassing HMOs (Health Maintenance Organizations), Critical Illness Insurance, and MicroHealth Insurance, among others.
HMOs in the Philippines
The Philippine Insurance Commission provides a list of Health Maintenance Organizations (HMOs) in the Philippines with issued Certificates of Authority as of February 28, 2025 based from the Insurance Commission website. The list is as follows:
- Asalus Corporation
- Asiancare Health Systems, Inc.
- Avega Managed Care, Inc.
- Carewell Health Systems, Inc.
- Cooperative Health Management Federation
- Dynamic Care Corporation
- EastWest Healthcare, Inc.
- Getwell Health Systems, Inc.
- Health Care and Development Corporation of the Philippines
- Health Delivery System, Inc.
- Health Maintenance, Inc.
- Health Plan Philippines, Inc.
- IMSWellth Care, Inc.
- Insular Health Care, Inc.
- Kaiser International Healthgroup, Inc.
- Life & Health HMP, Inc.
- Maxicare Healthcare Corp.
- Medicard Philippines, Inc.
- Medicare Plus, Inc.
- Medocare Health Systems, Inc.
- Metrocare Health Systems, Incorporated
- MI Healthcare Inc.
- Optimum Medical and Healthcare Services Inc.
- Pacific Cross Health Care, Inc. (Formerly: Blue Cross Health Care Inc. – name change effective 1 January 2016)
- PhilhealthCare, Inc.
- Value Care Health Systems, Inc.
- Wellcare Health Maintenance Inc.
Specific Benefits of an HMO
I am an HMO policy-holder of Axa, and here are the summary of benefits they offer, some of which I am entitled to:
General Benefits of Health Care Access:
- It is presented as a “comprehensive health protection plan“.
- It is described as flexible and affordable.
- It is a health care plan for individuals and all types of families to cover their health care needs.
- It is suitable for entrepreneurs or freelancers without an existing health care plan.
- It can act as additional protection on top of existing HMO coverage for employed individuals.
- It aims to provide the total health protection you need.
- It gives you health care coverage from 0 – 75 years old, plus a Longevity Health Fund that can be used for future medical needs at age 76 onwards.
- It includes comprehensive women’s health coverage for diagnosis, prevention, hospitalization, treatments, and even mental health.
Specific Benefits under Different Coverage Areas (primarily described for Health Care Access Prime but some also apply to Lite):
- Inpatient Care: Covers hospital admission costs including doctors’ fees, inpatient surgical and special diagnostic procedures plus medicines and usage of the ICU and operating rooms. The specific room and board category and limits depend on the chosen plan (e.g., Regular Private up to 4,500, Large Private up to 6,500, Executive Suite up to 15,000).
- Outpatient Care: Covers medical consultation, lab tests, and diagnostic procedures. Specific annual limits apply based on the plan (e.g., Up to 25,000 for Plan 500K, Up to 125,000 for Plan 5M).
- 24/7 Teleconsultation: Provides access to medical teleconsultation via the Emma App by AXA. This allows for medical advice from a practitioner anytime, anywhere.
- Emergency Care: Covers emergency treatment, including emergency room use, doctors’ services, medicines, and laboratory and diagnostic procedures done during treatment.
- Preventive Care (primarily Prime): Includes coverage for your annual physical exam (Basic 7 Exams) and dental care.
- Longevity Health Fund: A guaranteed health fund equivalent to 50% of your plan’s Annual Benefit Limit which can be used for any future medical needs at age 76 onwards.
- Life and Accident Insurance: In case of untimely demise or dismemberment, beneficiaries will receive an amount equivalent to 10% of the Annual Benefit Limit of the chosen plan.
- Mental Health Counseling: Offers consultation services for self-care.
Optional Benefits:
- Critical Illness Booster: Provides an additional cash benefit to cover treatments for any of the 56 identified critical illnesses upon diagnosis or can be used as income replacement.
- Annual Benefit Limit Booster: Allows for an automatic increase of your Annual Benefit Limit by 10% every 3 years with a minimum increase in premium.
- Optical Care (primarily Prime): Covers eye consultations and prescription glasses.
- Dental Care (primarily Prime): Provides treatment for your dental needs.
Specific to Health Care Access Lite:
- Designed to supplement existing health care plans or personal health funds for hospitalization needs.
- Comes with deductible options: P100,000, P150,000, and P200,000. This means your existing plan or you would pay up to the deductible amount first.
- Still provides Inpatient Care, Emergency Care, 24/7 Teleconsult, Longevity Health Fund, and Life and Accident Insurance.
Additional Benefits/Features:
- Access to over 1,400 AVEGA (now Maxicare [April 2025]) accredited clinics and hospitals in their network.
- COVID-19 treatments are covered subject to a 30-day waiting period, and COVID-19 testing is covered if prescribed by a physician (medically necessary). However, COVID-19 testing for leisure purposes like travel is not covered, and COVID-19 vaccination is also not covered, though complications due to vaccines are.
- A 10% discount on total premiums if you add at least one dependent.
- Requirement for pre-approval from AXA Philippines’ Health Care Access support team prior to availing of benefits for scheduled treatments to avoid unexpected non-reimbursable costs. Their 24/7 support team can be contacted at (+632) 8-581-5207 for pre-approval and assistance.
In summary, Health Care Access by AXA Philippines offers a range of health insurance plans (Prime and Lite) designed to provide financial protection against various healthcare expenses, from hospitalization and outpatient care to emergency services and even preventive care, with additional features like telemedicine, life insurance, and a longevity health fund. The specific benefits and coverage levels vary depending on the chosen plan.
Life and Non-Life Insurance Companies with Health Insurance as Riders
Life and non-life insurance companies primarily focus on life insurance, not health insurance. But you can opt to add an “add-on” such as a Critical Illness Rider, Hospital Income Benefit, or Female Critical Illness Rider, among others. I was once a licensed life insurance advisor (VUL and Traditional).
Here are the lists of life and non-life insurance companies with valid and existing Certificates of Authority as of 25 March 2025 based from the Insurance Commission website:
I. LIFE COMPANIES
- Allianz PNB Life Insurance, Inc. (Formerly: PNB Life Insurance, Inc.)
- Apex Life and General Assurance Corporation (Formerly: The Travellers Life Assurance of the Phils., Inc.)
- BDO Life Assurance Company, Inc. (Formerly: Generali Pilipinas Life Assurance Company, Inc.)
- Beneficial Life Insurance Company, Inc.
- BPI AIA Life Assurance Corporation (Formerly: BPI-Philam Life Assurance (BPLAC) corporation)
- Country Bankers Life Insurance Corporation
- East West Ageas Life Insurance Corporation
- First Life Financial Company, Inc. (Formerly: First Guarantee Life Assurance Co.)
- Fortune Life Insurance Company, Inc.
- FWD Life Insurance Corporation
- Generali Life Assurance Philippines, Inc.
- Insular Life Assurance Company, Ltd., The
- Manufacturers Life Insurance Company (Phils.), Inc., The
- Manulife Chinabank Life Assurance Corporation (Formerly: The Prudential Life Insurance Co., Inc.)
- Maxicare Life Insurance Corporation
- Philippine Life Financial Assurance Corporation (Formerly: Asian Life Financial Assurance Corporation)
- Pioneer Life Inc.
- Pru Life Insurance Corporation of U.K.
- Sealnsure Life Insurance Co., Inc. (Formerly: Reliance Surety Insurance Co., Inc.)
- Singlife Philippines Inc. (Formerly: Singapore Life (Philippines), Inc.)
- Sun Life Grepa Financial, Inc.
- Sun Life of Canada (Philippines), Inc.
- United Coconut Planters Life Assurance Corporation
- United Life Assurance Corporation
- Cooperative Insurance System of the Philippines Life and General Insurance
- AIA Philippines Life and General Insurance Company Inc. (Formerly: Philippine American Life and General Insurance Company corporation)
- AXA Philippines Life and General Insurance Corporation (Formerly: Philippine Axa Life Insurance Corporation)
- CLIMBS Life & General Insurance Cooperative
- Etiqa Life and General Assurance Philippines, Inc. (Formerly: AsianLife and General Assurance Corporation)
- Manila Bankers Life and General Assurance Corporation Doing business under the name and style of Manila Bankers Assurance (Formerly: Manila Bankers Life and General Insurance Corporation)
- Paramount Life & General Insurance Corporation
- The Premier Life and General Assurance Corporation (Formerly: The Premier Insurance & Surety Corporation)
II. NON-LIFE COMPANIES
- AIG Philippines Insurance, Inc. (Formerly: Chartis Phils. Insurance Inc.)
- Alliedbankers Insurance Corporation (Absorbed Corporation : Summit General Insurance Corporation)
- Alpha Insurance & Surety Company, Inc.
- Asia Insurance (Philippines) Corporation (Formerly: Asia Traders Insurance Corporation)
- Asia United Insurance, Inc.
- Bethel General Insurance & Surety Corporation (Formerly: BF General Insurance & Surety Corporation)
- BPI/MS Insurance Corporation
- CARD Pioneer Microinsurance Inc. (Formerly: Pioneer Asia Insurance Corporation)
- Cibeles Insurance Corporation
- COCOGEN Insurance, Inc. (Formerly: UCPB General Insurance Company, Inc.)
- Commonwealth Insurance Company
- Corporate Guarantee and Insurance Company, Inc.
- Country Bankers Insurance Corporation
- Fortune General Insurance Corporation
- FPG Insurance Co., Inc. (Formerly: Federal Phoenix Assurance Company, Inc.)
- Insurance Company of North America
- Intra Strata Assurance Corporation
- Liberty Insurance Corporation
- Oona Insurance Corporation (Formerly: OONA Insular Insurance Corporation)
- M Pioneer Insurance Inc. (Formerly: Republic Surety & Insurance Company, Inc.)
- MAAGAP Insurance Inc. (Formerly: MAA General Assurance Philippines, Inc. effective 30 July 2024)
- Malayan Insurance Company, Inc.
- Metropolitan Insurance Company, Inc.
- Milestone Guaranty and Assurance Corporation
- Pacific Cross Insurance, Inc.
- Pacific Union Insurance Company
- People’s General Insurance Corporation
- Perla Compania de Seguros, Inc.
- PGA Sompo Insurance Corporation (Formerly: PGA Sompo Japan Insurance, Inc.)
- Philippine British Assurance Company, Inc.
- Philippines First Insurance Company, Inc.
- Pioneer Insurance and Surety Corporation
- Pioneer Intercontinental Insurance Corporation
- Prudential Guarantee and Assurance Inc.
- Sealnsure General Insurance Co., Inc. (Formerly: AA Guaranty Assurance Co., Inc.)
- SGI Philippines General Insurance Company, Inc. (Formerly: Monarch Insurance Company, Inc.)
- Standard Insurance Company, Inc.
- Starr International Insurance Philippines Branch
- Sterling Insurance Company, Inc.
- Stronghold Insurance Company, Inc.
- The Mercantile Insurance Company, Inc.
- Travellers Insurance & Surety Corporation
- Visayan Surety and Insurance Corporation
- Western Guaranty Corporation
Please note that some companies have name changes indicated in parentheses. Also, there are footnotes regarding Cease and Desist Orders and Conservatorship Orders for some companies, and information about mergers. These footnotes are indicated by superscript numbers in the original document next to the company names.
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