A: It is a standard rule in the HMO industry that enrolment of dependents should follow a hierarchy rule. By following this rule, The risk of principal members only enrolling their sickly dependents or dependents with the highest probability of availing benefits making the basis for computation of membership fees inaccurate.
Frequently Asked Questions
A: There are exceptions to the hierarchy rule that may be allowed by the HMO provider. Documents are required to be submitted and this will be subject to evaluation by the HMO:
- Copy of HMO enrolment with another company
- Birth certificate proving over the age limit
- Death Certificate
- Annulment, Legal Separation, Barangay Certificate for single parent
- In case spouse is an overseas filipino workers (ofw), please provide copy of overseas employment contract
A: Reimbursement will be processed within thirty days from receipt of complete documents.
A: If the doctor would ask for additional fees on top of what is covered by the HMO, do not agree to the doctor. Report this to us so that we can ask the HMO officer to speak to the doctor. If you will agree to paying the extra fee, then this would already be a direct transaction between you and the doctor.
A: Yes. However, accreditation is a two-way contract between the HMO and the doctor. Both parties should agree to the terms and conditions set forth by both parties. Just email us the name and contact details of the doctor so that we may request if from the HMO provider.
A: Report the lost/stolen card to us immediately so that we can email you the instructions on how to file for a replacement card. If you need to avail of benefits, please contact us so that we may be able to endorse you. However, there are hospitals with strict no ID no availment policy.
A: No. The HMO benefit is co-terminus with your employment
A: Pre-existing illness/conditions are any illnesses/conditions that are already present with the member prior to enrolment with the HMO. This maybe known or unknown to the member.
A: You should file for reimbursement as soon as you are discharged from the medical facility. Normally, the grace period for filing reimbursement is thirty days from date of discharge. Failure to file within this grace period would disqualify the application for reimbursement.
A: No. The limit is on a per member basis and is non-transferrable.
A: No. This would result in automatic cancellation of membership and the utilized amount will be charged to you plus corresponding administrative fees.
A: One the limit of your benefit is exhausted, all applicable hospital and professional fee charges is already chargeable to your personal account. This should be settled prior to discharge.
A: Newly eligible dependents should be enrolled within thirty days from date of eligibility.
A: Aside from referring to the HMO guidebook or website, the HMO coordinator of the hospital can be located via the information department of the hospital. HMO coordinator office is usually open during regular business hours.
A: No you can’t. Emergency department access is reserved for life threatening conditions only. The ER department can refuse to accommodate you if your condition is not classified as emergency in nature. Please visit the coordinator office at regular business hours.
A: Some plans allow for a 48 hour allowance to accommodate the next higher category except suite. However, if there are no available rooms, you may occupy a lower category room to avoid incremental charges or arrange for a transfer to another accredited hospital.