Health Insurance For Small Businesses

Health insurance for small businesses
Simple steps to secure coverage for your workers.
By Ging V. Valles



Medical insurance came about to fill people’s need for quality health care that should not be compromised by their limited budget. It is now more accessible to everyone, regardless of income, through the HMO or health maintenance organization — a kind of managed plan where you receive care from the HMO’s doctors at its hospitals or clinics.


The HMO provides a list of doctors and "requires you to select a primary care physician" for the specialized care you need," says German Zapanta, general manager of Fortune Medicare, Inc. Entrepreneurs and rank-and-file employees benefit from almost the same coverage as those provided executives, he says.


The HMO is especially helpful to entrepreneurs. "If your people are covered, you increase their work productivity," says Rey Samson, school owner and incoming president of the Marikina Private Schools Association. "HMO doesn’t give any burden at all to the entrepreneur and his people since payments are collected through salary deductions." It also encourages people to get a health plan to help the government expand its resources for medical care.


HMOs like Fortune Medicare, Medicard, and PhilamCare provide holders with both in-patient and out-patient services without their having to pay each time. The standard coverage for in-patient care includes room accommodation, medicines, diagnostic procedures, and operating and doctor’s fees. Out-patient services include preventive health care, dental care, annual physical exams and clinic consultations.
Some HMOs limit their coverage. "Others add [extras] to be more competitive in the market," says Zapanta. For example, Fortune Medicare’s comprehensive package includes add-ons such as laboratory, x-ray and other diagnostic tests, dressings and sutures — even hospital income. Its out-patient care includes consultations at any HMO-owned clinic for eye, ear, nose and throat ailments; treatment of cuts, sprains and other minor injuries; X-rays, ECGs and other diagnostic tests; minor surgeries; and treatment on the recommendation of the HMO director or his designate.
"For emergency treatment in a non-accredited hospital, we reimburse as much as 80 percent of what it would have cost if treatment had been done in an accredited hospital," says Zapanta.



Choosing the right plan

Some entrepreneurs say you should not jump into bed with the first HMO offering the lowest price on your medical plan. "In choosing the right health plan, you should select the best package that suits your needs and the price affordable to you. Ask about the premiums, terms of payment, schedule of benefits, list of accredited hospitals and doctors," says entrepreneur and Medicard holder Marian Aquinos.



Here are some tips to getting the best coverage:

• Compare costs by asking doctors, hospitals, friends and relatives. The annual premium for HMO membership is P3,000 for those in the 13-to-30 age bracket and P13, 000 to P30, 000 for infants and clients in their late 50s. HMOs offer monthly, quarterly, semi-annual and annual payment terms. Once you’ve picked out a plan, compare its price with the other plans offering the same services. Expect higher prices for the young and elderly.

• Know the different services that each plan covers and decide what kind of insurance you need. Most plans will cover only services considered as "medically necessary." "Try to know if the HMOs can adjust or customize their packages according to your company’s needs," says Zapanta.

• Verify the HMO’s service record by studying its portfolio. Does it have any plans that will work for you?

• Look at the HMO’s financial status and management team. You can inquire about the standing of various HMOs by surfing their websites or studying their profiles, which are available from the Association of HMOs of the Philippines Inc. Not all HMOs are members of the group, but the top 15 are, says Zapanta. Being backed by a large company gives you more confidence.

• Consider the HMO’s reputation. Some HMOs are frequently suspended by hospitals for delayed or non-payment of hospital bills. "Worse, there are companies on the verge of closing but are still trying to solicit coverage," says Zapanta.