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Health Insurance Benefits

What do health insurance benefits actually do for you? You probably hear about it all the time, whether on television, in
magazines, and assorted other media. Health insurance is an extremely helpful part of life if you can set yourself up with a plan
that will benefit you and yours for minimal cost. It's meant to protect your financial assets, as well as promote wellness and
health. There are an assortment of different perks and downfalls to each kind of health insurance plan, and its important to know
what will help you and what wont.

Defining Health Insurance Benefits

The benefits of health insurance can be summarized as the services you receive from your health insurance company. Every
company has an assortment of different plans that may or may not work for you. Most companies are also willing to work with
you to determine your needs. You can have certain areas of your health insurance plans cover certain types of injuries or illnesses
more specifically, so that you pay less for recurring things like office visits and medicine, or you can spread out your coverage as
a more general purpose plan.

Single person plans have a smaller array of benefits and can be more tailored to the person they cover. A person that needs more
extensive eye care coverage might eliminate some other options in order to afford a vision plan. These plans also cost less than
family plans simply because there is only one person to cover.

You can also have family plans that will cover all the people in your family equally. These family plans are usually cheaper than
having multiple single-person plans, and also have higher coverage rates that are shared among everyone in the family. Family
plans can be customized in the way single-person can, but usually not as specific as a single person plan. So you need to consider,
overall, if your family has a lot of office visits or not.

The way health benefits work is you get the bill, submit it to your insurance provider, (or have it automatically submitted to the
insurance provider) and they will pay a certain percentage, or up to a certain amount that is dependent on plan. With most plans
you will have to pay a deductible before the insurance will do anything. Frequently you will pay a co-pay at each office visit
which is indicated up front. It is generally higher for a visit to a specialist than to your primary care physician. After that, the
insurance will split the cost of the bill with you, typically with the insurance company paying the majority.

Tips For Finding the Best Health Insurance Benefits

Health insurances main goal is to make it so that you dont pay an extreme amount whenever you get sick or injured. Health
insurance can help pay for things like hospital bills and regular doctor visits. Your health insurance plan really depends upon
your personal lifestyle. Comprehensive, catastrophic, basic and supplemental plans are all available.

The most important thing to do before taking steps to find health insurance is to take into account your personal needs. Past
accidents or injuries may play a part in what kind of plan you get. Your risk of injury on the job can also be a major factor into
your choice of benefits. Your familys needs, should you have one, will also be an important consideration for your health

What Do Health Insurance Benefits Cover?

There are three popular types of health insurance: Health Maintenance Organizations (HMO), Point of Service (POS) plans, and
Preferred Provider Organizations (PPO). An HMO is a monthly premium plan that states you must go to specific providers of
health care on a list to have your insurance cover it. A POS is a plan where there is a network of doctors; however, if one refers
you to another doctor in or outside the network, the insurance will cover it. You can refer yourself to care outside the networks,
but youll have to pay coinsurance. A PPO is similar to an HMO, but like a POS plan you can go outside the list given to you,
with much less coverage. Granted, should you go to one on your list, you will retain your full coverage.

Your exact benefits will differ plan to plan. Most insurance companies have tiers of coverage. The more coverage you get, the
higher your premium goes. As mentioned above, there are a multitude of factors that can affect what plan you choose, because
they will raise and lower your premiums. There are other factors that can lower premiums as well, such as having a long record
of good health, no life-affecting diseases, broken bones, or an array of other things. Its important to ask your service provider
about these factors.

Health insurance is important to have, as it lowers the out of pocket amount you have to pay for health care. It also ensures that
you will be well taken care of when you are sick or injured. You can use the tool above to see what companies have policies that
interest you, so you can get excellent coverage for as little as possible. Get started comparing free health insurance quotes right

The Philippine Health Insurance Corporation (PhilHealth) was created in 1995 to create
a universal health coverage for the Philippines. It is a tax-exempt, government-owned and
government-controlled corporation (GOCC) of the Philippines, and is attached to the Department of
Health. It states its goal as insuring a sustainable national health insurance program for all.[1] In 2010,
it claimed to have achieved "universal" coverage with 86% of the population, although the 2008
National Demographic Health Survey showed that only 38 percent of respondents were aware of at
least one household member being enrolled in PhilHealth.[2] Nevertheless, this social insurance
program provides a means for the healthy to pay for the care of the sick and for those who can
afford medical care to subsidize those who cannot. Both local[3] and national government allocate
funds to subsidize the indigent.[4]

Mandate and Functions[edit]

In 2000 and 2005, reform efforts were outlined to make decentralization and health insurance work
more effectively, including an expanded government subsidy for the enrollment of the poor, the
creation of local health service delivery/planning units to reduce fragmentation, and a
stronger DOH role in regulation.[5]

PhilHealth has four categories of enrollees encompassing nearly the entire population. The "formal"
sector is for workers employed by companies and other institutions. Indigents have no means of
support. Retirees (non-paying members) have already paid premiums for 120 months of
membership and are 60 or older. The individual paying program (IPP) is for those not eligible for the
other three categories. Although treated separately, the Overseas Filipino Workers (OFW) program
can be considered as part of the IPP category.

Since 1996, the benefits package and delivery system have improved. For example, PhilHealth now
has an Outpatient and Diagnostic Package limited to indigent enrollees. This addition creates nearly
comprehensive coverage for indigents. All other beneficiaries have access to nearly comprehensive
services, excluding some outpatient care. PhilHealth introduced an accreditation program for private

Some key reform indicators to date include:

Estimated coverage is 70% as of June 2013

Average period for payment of providers is estimated at 70 to 75 days. The law requires
PhilHealth to reimburse providers and/or members within 60 days. A recent move as of
December 1, 2009, implemented a simplified reimbursement scheme wherein 75% of the
claims amount is reimbursed after a rapid assessment of member and provider eligibility and the
remaining 25% follows after detailed review of the claims.

On average, 90 out of every 100 claims are paid, 3 to 4 are denied, and 6 to 7 are returned to health
care providers for more information. 28% of claims were submitted by public providers and 72% by
private providers.[6]

Program summary [8]

Group Premiums Enrollment Payment

Employer and worker each pay

half, up to 2.5% (maximum of
Formal As of hire date 3 months
3%) of income up to 30,000

National Government
Indigent 2,400 pesos annually fully subsidizes None
enrollment annually.

Age 60 with 10 years of

Retiree Free
premium payments

1,800 pesos annually for Enrollment date.
members earning P25,000 and
3,600 pesos annually for
members earning more than

No subsidy. Payment
1,200 pesos annually Emigration date is on emigration date
then annually.

All premiums are pooled nationally and in effect, there is cross-subsidization across districts.
National government payment is dependent on the availability of funds.
The benefits package is essentially the same for each group. The exception is for indigents and the
Overseas Filipino Workers (OFWs) who have additional outpatient primary care benefits (with the
providers paid by capitation) however these benefits are available only through public providers.

PhilHealth beneficiaries have access to a nearly comprehensive package of services, including

inpatient care, catastrophic coverage, ambulatory surgeries, deliveries, and outpatient treatment for
malaria and tuberculosis. Those identified as indigent and OFW are also entitled to outpatient
primary care.

Inpatient care includes room and board, medicines, diagnostic and other services, professional fees
and operating room services. These benefits are subject to some limits, which differ based on the
level of the health facility/hospital (level 1 to 4 hospitals and the Ambulatory surgical centers
equivalent to level 2 hospitals) and the severity of the cause of admission (case-type A, B, C and D).
Catastrophic conditions, ambulatory surgeries including ambulatory dialysis, deliveries and
outpatient malaria and TB-DOTS care.

Except for the outpatient primary care that the poor and OFWs are entitled to via public providers,
patients have free choice of providers, both public and private.

Annual or lifetime coverage limits exist. These limits are expressed in terms of volumes of services
(e.g., days) rather than a peso coverage limit. For example, households are eligible for 45 days of
inpatient admission, sharing 45 days among all household members. Each day of ambulatory
surgery counts as a day of admission.

Providers are allowed to charge the patient the difference between the total cost of care and what
PhilHealth pays (i.e., balance billing).
1. Health insurance is a type of insurancecoverage that covers the cost of
an insuredindividual's medical and surgical expenses. Depending on the type of health
insurancecoverage, either the insured pays costs out-of-pocket and is then
reimbursed, or the insurer makes payments directly to the provider.