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.

Before You Look for Health Insurance

Before You Look for Health Insurance
by: Richard Keir


Shopping around for medical insurance can be a confusing business. You need to keep your wits about you and keep track of the benefits and costs of each policy and each type of policy. Too often we tend to look at the price first and the rest of the policy becomes a blur of fine print. And we're off to check the next policy.

Slow down. There some important things you should do before you start chasing around to get a policy. Doing these few things will make the whole process simpler and clearer - and you're much more likely to make a good decision.

You need to carefully consider your situation. Think about these questions and note your answers:

What's the general state of your health?

How old are you?

Do you have any serious medical problems currently or in your medical history?

Do you have any history of recurring or on-going medical needs?

Do you use tobacco? How much?

Do you drink? How much?

Are you over- or under-weight for your height, body-type and age?

Is your job hazardous?

Do you participate in any activities or sports that could affect your health?

Now this may be unpleasant but if there's any chance an insurance company could discover a history of drug or alcohol abuse or sexual behavior that might put you in a high risk group, you may want to be direct and upfront about it - especially if it's in the past. Having a claim denied later because you had failed to disclose medical information to the insurance company would be far more upsetting - and very expensive. The same goes for any significant medical condition. Insurance companies are in it to make a profit - at least most of them are. Paying large claims isn't their favorite activity, so they often do investigate.

If you're seeking a family policy you'll need to make the same analysis for everyone and consider carefully what kind of coverage you want.

Do you need dental, orthodontic, pregnancy, mental health, and/or drug coverage? Do you need long-term care coverage, either inpatient or in a nursing facility? Assisted living coverage? What about traveler's or international coverage?

If there's a possibility that you may require - or want - in-home care as opposed to a residential nursing or assisted living facility, be sure that coverage is included and be sure you understand exactly what you can expect to receive.

Think about deductibles and what you could afford pay to reduce your insurance costs. But be very careful here, because medical expenses tend to pile up quickly and reach nearly insane levels for complex treatments or inpatient stays. Many drugs in common use are ridiculously over-priced and depending on the specifics of your insurance you may not be able to use the least expensive sources.

If you will end up with multiple sources of coverage, be clear about how they fit together and what the rules are about overlapping or combined benefits.

Once you are clear on your current situation, your (and other family member's) medical history, and your projected needs, you can begin looking in a organized way with a better sense of where you're going and what will actually meet your needs. This may seem like a tedious process, but it will serve you well in finding appropriate and affordable health insurance and making sure your health care needs can be met by the medical insurance you choose.

Take some time to work through these questions. Write down your answers. Make a chart with your desired coverages and any special conditions the policy must meet. As you look at health insurance policies, note the rules, exclusions, information about pre-existing conditions, any limitations, the dollar amounts covered and especially any deductibles.

Don't try to do too much at once. If you hurry, it'll become confusing and tiring. You may hate it (I know I do), but you really do need to read all that fine print and understand it. That's not a task to rush through. You might as well face up to it, because it's a lot better to do it BEFORE you need medical services than after you get a bill for the uncovered portion that sends you into shock.

So is it an impossible job to find health insurance that works for you? Not at all. There's a world of resources on the internet to help you find the policy you need. Just be sure to do your homework first.


About the author:
Richard is a writer, educator and consultant providing services to medical, scientific and business professionals. For more on choosing a health insurance policy or finding the best medical plan for you, visit http://www.aboutinsurance.info/