What is Health Insurance?

Health insurance is an insurance product that covers expenses incurred from an illness or injury.

Fundamentally, it can reimburse the insured for any medical, surgical, and dental expenses, as well as pay the healthcare provider directly. It can also provide an individual with financial security amid any health issue he or she may face—right when it is needed the most.

Getting a comprehensive health plan can help you spare your wallet and protect your savings while battling a rough health condition. Ultimately, it helps ensure that you and your loved ones will get the medical attention needed to stay healthy or recover from an illness or injury.

What is a Health Subscription?

Traditionally, healthcare plans are expensive and have rigid requirements for individuals and MSMEs. They are also burdened with high upfront fees and forced to commit to annual plans. To address these concerns, Kwik.insure has created KwikCare Health Subscriptions focused at addressing the needs of unserved companies, freelancers, and dependents.

A health subscription plan is a medical insurance that provides free access to check ups, in-patient and out-patient care, and emergency hospitalization. One of the main features is that there is no cash-out needed in its accredited clinics and hospitals nationwide. They function like traditional healthcare plans but with the following advantages:

Importance of Health Insurance

Having health insurance can provide you with financial security amid any health issue you may face. It also ensures that you or your dependents will get prompt and uninterrupted care.

On that note, here are four particular reasons why getting health insurance is not only important but also worth it:

1. It protects you from financial burdens

Sickness or injuries can happen unexpectedly. Unfortunately, such unforeseen health issues often require expensive health care—costs that you may not be able to pay on your own. In the worst cases, these may give you an overwhelming financial burden or discourage you from seeking the care that you need.

With a health insurance plan, however, you’ll have a policy that will reduce your burden and cover your medical expenses. Some plans may also help you navigate the confusing billing process.

2. It allows you to focus on recovering

Aside from protecting you from high and unanticipated costs, health insurance can help ease your worries as you face a rough health condition.

Whether you’re lying in a hospital bed or the emergency room, knowing that you have an insurance plan that will cover your medical expenses can calm your anxious mind. In the end, this allows you to focus on getting better.

3. It gives you access to preventive services

Maintaining your health and well-being also involves disease prevention and control. This is something that health insurance can also help with.

Insurance plans give you access to routine and preventive health care such as annual checkups, vaccinations, lab work, and screening tests at little to no costs. These services make it easier for you to avoid getting sick while detecting any illness you might have as early as possible.

4. It makes managing any chronic conditions easier

Health insurance is also very helpful in covering the costs of managing chronic conditions.

Insurance companies typically offer disease management programs for diabetes, heart disease, depression, and other similar conditions. Moreover, insurers can refer you to specialists and give you access to helpful resources.

Health Insurance Terminologies You Need to Know

There are plenty of intimidating jargons that you will encounter as you start researching your options. To help you understand your choices and find the right health insurance plan for your needs, here are key terms you must know:

Pre-existing Condition

These are health problems that a person has been getting treatment for or been diagnosed with prior to buying your insurance plan. Some common conditions are allergies, asthma, hypertension, and diabetes. Pre-existing conditions are required to be declared prior to purchasing an insurance plan.

In-Network Provider

This is a network of health care professionals or hospitals that are accredited by a health plan. Your health plan usually comes with a list of accredited doctors and hospitals where you can go and use your plan to get services for free or a much lower payment.

Out-of-Network Provider

Opposite of in-network providers, these are doctors and institutions who are not accredited with your health plan therefore you will need to pay for their services out of pocket.

Rider

A rider is an additional benefit on top of a health insurance policy. There are other insurance features that you can add on a plan to ensure that your plan covers all your needs. A good example is a Maternity rider which covers childbirth.

Explanation of Benefits

A document attached to a hospital bill detailing the procedures, services, and medicines that your insurer will cover and not cover. Reasons for non-coverage are also usually included here.

Health Maintenance Organization

Health Maintenance Organization or HMO is a network of doctors, specialists, clinics, and hospitals that enables an individual to avail of their services for less or even free upon membership.

Premium

This refers to the cost you will be paying for your health insurance plan. This cost highly depends on the coverage you choose, the more add-ons, the higher the cost.

Insured

Refers to the person or group of persons protected by the health insurance plan.

PhilHealth

Philhealth is a health insurance provider governed by the Philippine government to provide health insurance benefits for the citizens of the country for a small sum of money covered by the citizen’s salary and employer.

Exclusion or limitation

A specific condition, services, or situations that the health insurance plan will not cover.

Group health insurance

A type of health insurance that covers the individuals of a certain group or organization under one policy.

Individual health insurance

Health insurance policy that individuals purchase to protect themselves and/or their family.

Dependent

Any person that is within the insured’s immediate family that is covered by the insured’s health insurance plan.

Different Types of Health Insurance

In the Philippines, there are three main types of health insurance that you can get:

1. PhilHealth (Philippine Health Insurance Corporation)

PhilHealth is a tax-exempt and government-owned and controlled corporation (GOCC) created to give Filipinos access to affordable health services. It extends financial assistance to citizens in need of medical help regardless of their employment status.

If you are currently employed, half of your monthly contribution is covered by your employer; the other half is deducted from your salary. Otherwise, you can apply for voluntary membership and be a self-paying member.

PhilHealth provides inpatient, outpatient, and Z benefits. The amount of financial assistance it provides to members varies according to the illness or disease.

2. HMO (Health Maintenance Organizations)

HMO is a healthcare delivery system comprising private health care insurance providers.

This type of health insurance is one that employees usually receive from their employees as part of their employee benefits. Furthermore, this is commonly provided to employees in private companies on top of their PhilHealth membership contribution.

HMOs give the insured access to doctors and healthcare professionals within their network. However, it’s essential to note that these plans are limited to a certain amount annually.

Read more: The Difference Between HMO & Health Insurance in the Philippines

3. Prepaid Health Cards (read more)

Prepaid health cards work the same as regular HMOs. However, the key difference is that the former lets you choose the exact coverage you need which is good for one year. This means that you can get the coverage of your choice for a year for a one-time payment of as low as ₱ 500.

With such features, prepaid health cards offer a simple and affordable way to get yearly consultation and hospitalization coverage. Keep in mind, however, that prepaid HMOs are usually single-use and will expire after a year.

4. Private Health Insurance

In the Philippines, this type of health insurance is usually bought by an individual voluntarily.

If you feel that the HMO you have is not enough for your needs, then purchasing private health insurance is a smart move.

Private insurance companies offer a plethora of benefits and features. They also offer health insurance packages that allow immediate family members to be insured on the same policy at an additional cost. To add to that, health insurance policies can give you access to more comprehensive private healthcare networks.

Aside from covering inpatient and outpatient services, surgeries, and medication, some policies can also provide cash assistance for loss of income due to accident or illness.

Here is a quick table to help you further understand the differences between these four types of health insurance in the Philippines:

Features and Medical Benefits of Health Insurance

Purchasing health insurance may seem like an added cost at first, especially if you are already covered by PhilHealth and/or an HMO.

In reality, having your own health insurance enables you to take care of your health conveniently and cost-effectively. It helps you ensure that you can receive the medical services you need right when you need them without breaking the bank.

Here are some of the many features and benefits you will enjoy with a private health insurance policy of your choice:

Inpatient Care

Getting a policy that’s tailored to your needs allows you to get the most out of your investment. If you require immediate care or specialized procedures that cannot be performed outside of the hospital, you will greatly benefit from having health insurance.

Some benefits under inpatient care are hospitalization, ambulance, rehabilitation, laboratory tests, and medications.

Outpatient Care

Private health insurance can also cover the costs for the care you receive at your own home. It also covers medical procedures, tests, and services that do not involve an overnight hospital stay.

Some benefits under outpatient care are annual physical examinations (APE), laboratory tests, consultations, as well as rehabilitation services.

Emergency Care

Having a private policy can also ensure that you will receive immediate attention. This answers medical costs for critical cases and serious conditions such as injuries from accidents.

Optional Benefits

The biggest advantage of getting private health insurance is that it allows you to enjoy more comprehensive coverage. While this naturally entails paying higher premiums, it can help you and your loved ones manage and maintain your health better.

Some examples of optional benefits that you can add to your chosen health insurance package are:

1. Dental services
2. Optical services
3. Maternity benefits

With all of that said, keep in mind that the key is to find the insurance product with features relevant to your needs. Limiting your choices to those that comfortably fit your budget is also a smart and practical strategy. Ultimately, it is best to partner only with health insurers you know you can trust.

Steps in Buying Health Insurance in the Philippines

STEP 1: Assess your medical needs

Before proceeding, it’s a smart strategy to first study your medical needs as well as your current coverage. What does your company’s HMO cover? Do you have other health plans aside from this? Do you have medical needs that aren’t covered by your existing policies? Do your dependents have adequate coverage as well?

Answering these questions will enable you to determine the coverage that’s right for you and your loved ones.

STEP 2: Make a list of your top health insurance providers

Now that you have a clearer idea of your medical needs, the next thing to do is determine the best insurance provider to partner with. You can start by creating a short list of up to five insurers. However, this step can be quite tricky.

Aside from looking for reliable insurance companies in the country, you need to make sure that the hospitals and clinics in your area are accredited providers of these insurers. You must also study their coverage offerings to see if they meet your medical needs.

At Kwik.insure you can find hundreds of different offers from different insurance providers you can choose from.

STEP 3: Contact health insurance agents

After narrowing down your choices in Step 2, it’s time to get in touch with representatives to ask for quotes. Feel free to approach agents and ask questions about their products. This will enable you to find the best plan for you based on your needs, preferences, and budget.

While appointments with agents have been usually done face-to-face, you may opt for an online chat or video call instead.

Going Online

Kwik.insure lets you conveniently compare, purchase, and manage your policies in a single platform.

You may use our Kwik Assistant Tool (KAT) to help you find the best offers from trusted insurance providers in the Philippines based on your age, budget, and coverage needs. You can also take advantage of the live chat support to ask questions about a policy’s coverage, terms and conditions, and claims procedure.

STEP 4: Compare plans before signing

Before finalizing anything, make sure you have compared similar plans thoroughly first. Look through their medical benefits as well as their costs, payment schemes, and other factors. You may also pull out your list of coverage needs from Step 1 to help you remember the features you are looking for in a plan.

Studying the items in your policy one last time before signing is the last and most crucial step you need to ensure that you will have adequate coverage for yourself and your loved ones.

Read more: Starter Tips on Buying the Right Health Insurance Policy

How to Make a Health Insurance Claim

The steps involved in making a health insurance claim will naturally differ depending on your insurer and insurance type. Nevertheless, here is a basic outline of the procedure you will need to follow when filing a claim:

STEP 1: Notify your insurance company about your claim

There are different ways for you to notify your insurance company about your claim. Some insurers in the Philippines may need you or your representative to call their hotline, mail your notice, or visit the nearest client service center.

When you buy your health insurance at Kwik.insure, you can contact us through this form and we will help you file the claim.

STEP 2: Know and submit the requirements

Making a claim for different health conditions naturally require different sets of documents. You may consult your advisor regarding this.

Aside from case-specific papers, here are the fundamental requirements you need to present:

• Two (2) valid government-issued IDs of the claimant or beneficiary
• Two (2) valid government-issued IDs of the representative
• Authorization letter from the claimant or beneficiary

Here are other documents you may be asked to submit:

• Attending Physician’s Statement (APS)
• Hospital Statement of Account (SOA)
• Medical certificate
• Original official receipts
• Prescription forms

Make sure to secure and upload clear copies of the required documents for your claim. Once all your requirements are complete, you may seek help from your advisor regarding the best way to submit them.

During this stage, you may also be asked how you prefer to receive the pay-out if your request is approved.

STEP 3: Wait for feedback

After submitting all the requirements, you may need to wait for a few days as your insurer reviews your claim request. Then, they will advise you if they need additional documents, or if your request is approved or denied.

STEP 4: Receive your payout

If your claim request is approved, you will receive your payout through your preferred method.

Find the Right Health Insurance for You Today

As you set out to find more comprehensive medical coverage for yourself and your loved ones, remember that the benefits will far outweigh the costs.

Having health insurance means having financial assistance that you know you can depend on in case of any unforeseen health situations in the future. Rather than worry about hospital bills and other expenses, it allows you to focus on recovering, or on taking care of a family member dealing with an illness.

If you are yet to obtain the right policy for your needs, let Kwik.insure help. We partner with trusted insurance companies in the Philippines to bring various health insurance plans in one convenient platform. Sign up today and find the one that’s best for you and your family.