A podcast episode (Ep. 118) by John Jonas explaining differences between the Philippines' PhilHealth social insurance and private health insurance/HMOs. PhilHealth primarily contributes to inpatient hospital bills (partial payment), while HMOs/ private insurance sit on top of PhilHealth to cover outpatient/preventive care and gaps. The host also describes his company policy: employees become eligible after six months, the employer pays roughly $400/year per person for coverage with typical policy caps around PHP 2,000,000.
Questions this episode answers
John Jonas
May 10, 2022
No — PhilHealth mainly applies to inpatient (hospitalization) bills.
Employees must have worked for six months before becoming eligible.
Approximately $400 per year per person (speaker hedges uncertainty).
Chapters
Welcome to the Secret Sauce of Outsourcing podcast that's dedicated to making you better at outsourcing to the Philippines. This is episode 118, PhilHealth versus Health Insurance. What's the difference? Yuck. Health insurance. It's one of my least favorite topics. It's something people always want to talk about. I always get questions about it. In the US we assume it's a. Health insurance is a right. Like someone else should pay for my health. I think if we treated health insurance more like an insurance product and less like a charity in the US Then maybe it wouldn't be so bad. But we don't. And so I don't want to get political here. So let's talk about the Philippines. One of the perks that my team gets is we pay for private health insurance for them on top of paying for their PhilHealth. Even in the Philippines, a lot of companies don't offer health insurance, private health insurance and hmo, because it's not required. It's. It's kind of not super common for them. But we started offering it because we saw PhilHealth just wasn't enough. Now this is confusing because PhilHealth health insurance isn't. That isn't Philhealth health insurance. So let me explain what Philhealth actually is. So PhilHealth is the socialized medicine of the Philippines. Now, really what it does is it only kicks in if you're hospitalized. So if you have to stay overnight in the hospital and then really it just lowers your bill or it pays for part of your bill. And typically it'll pay for like half your bill. Or It'll pay for 30%, depending on. Depending on what it was for. It also won't kick in for everything. Like it'll cover the hospital's bill, maybe not the anesthesia or. We started offering private health insurance because we just saw this isn't sufficient. Like someone in the Philippines gets a bill for $100,000. Philhealth kicks in and now they owe 55, 100,000 pesos. Philhealth kicks in and now they owe 55,000 pesos. But this person only makes 30,000 pesos a month. Like this is going to take them a long time to pay this off. This, you know, like this is insufficient for them. So health insurance in The Philippines and HMOs are on top of PhilHealth. So they cover what PhilHealth doesn't cover. But you're still required to have Philhealth if you have an hmo, which is what they call it in The Philippines. So signing up for an HMO, you have to be a PhilHealth member. You have to be current on your contributions so that if you're hospitalized, PhilHealth will kick in and then the HMO will kick in on top of the PhilHealth payment. Another good thing about an HMO is that it covers preventative services like checkups or outpatient services. Our team could get physical exams or they can get emergency treatment. They don't have to worry about inpatient treatment. So there's a whole bunch of things that, that it'll cover for them that PhilHealth doesn't. And then also once a year they can visit the dentist for annual cleaning, which came with this HMO. With HMOs that we have had, some of, our team also pays extra to include their family in their coverage. Like they're willing to pay this out of pocket because it ends up being cheaper in the long run for them and gives them peace of mind in case their family has an emergency. So I've talked about this before. This is definitely not something you have to be offering to people. It took us a long time before we offered it and we still don't offer it to people right when they start. They have to have worked for us for six months before they are eligible for health insurance. What's the cost of health insurance? Well, we pay something like $400 per year per person. I believe I could be wrong about this, but I believe that there's options for us to include other family members in their health insurance for less than like another $400 per person. It's like $400 for them to sign up for the insurance and then to include the family. It's like another $200 or something like that. Don't quote me on that because I'm not completely sure. But at $400 per year for health insurance for them, which is basically going to cover anything up to a limit. There's like a cap, like a 2 million peso per year limit on it. It's pretty affordable. So this is. It's an easy way if you want to buy some loyalty with your team. If you have other questions about hiring ofs and things that you should do. The top nine questions that I get asked, which I get asked almost every day, are covered@ofsguide.com.
