A Healthcare Management Organization is a type of managed care organized in accordance with law to provide pre-agreed or designated health care services to its enrolled members for a fixed periodic fee and for a specific period of time.
It uses a system of health care delivery called managed care that influences utilization and costs of services and measures performance resulting in quality cost-effective care.
It integrates financing and delivery of health care services through managed health plans which may be in the form of a comprehensive HMO Plan, preferred provider plan managed indemnity or self-insured plans, third party administration plan and such other that fall under the definition of a managed health plan under paragraph (k) of this section.
Benefits of HMO
Benefits vary per organization but they usually inclide:
- Inpatient care, including hospital charges and accommodations, pre/post outpatient treatment, and surgical procedures
- Outpatient care, including consultations, diagnostic scans, and laboratory investigations
- Emergency care
- Special Outpatient conditions like Dialysis, Radiotherapy, and Chemotherapy
- Special diagnostic procedures like CT Scans, MRI, Ultrasound, and various other tests
- Surgical procedures received as an outpatient
- Longevity Health Fund
- Life Insurance
- Accidental Death and Dismemberment Insurance
- Annual Physical Exam
- Dental care, including services like dental examination, oral prophylaxis, fillings, and emergency dental treatment
- Road ambulance transport
Is HMO paid monthly?
Generally, HMOs require payment of an annual premium. But they can also be paid “semi-annually” or “quarterly”, indicating flexibility in payment frequency for a specific health plan.
Sample price range of premiums
Based on the sources provided:
- The First Year Annual Premium shown for one individual (Age 34) with P1 Million benefit is PHP 36,405.70.
- The Annual Premium for subsequent years is also shown, with premiums increasing based on attained age at renewal.
- Payment options for the first year include paying the annual premium semi-annually (PHP 18,930.96) or quarterly (PHP 9,829.54).
- The premiums shown are noted as currently in effect but are not guaranteed and may change upon renewal.
List of HMOs in the Philippines
Insurance Commission page titled “LIST OF HEALTH MAINTENANCE ORGANIZATIONS ISSUED WITH CERTIFICATES OF AUTHORITY ISSUED BY THE INSURANCE COMMISSION As of 30 April 2025,” provides the following list of entities identified as Health Maintenance Organizations:
- Asalus Corporation
- Asiancare Health Systems, Inc.
- Avega Managed Care, Inc.
- Carewell Health Systems, Inc.
- Cooperative Health Management Federation
- Dynamic Care Corporation
- EastWest Healthcare, Inc.
- Forticare Health Systems International, Inc.
- Getwell Health Systems, Inc.
- Health Care and Development Corporation of the Philippines
- Health Delivery System, Inc.
- Health Maintenance, Inc.
- Health Plan Philippines, Inc.
- IMS Wellth 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. (Previously: Blue Cross Health Care, Inc. – name change effective 1 January 2016)
- PhilhealthCare, Inc.
- Value Care Health Systems, Inc.
- Wellcare Health Maintenance Inc.
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