Is Health Insurance Necessary?

Health Insurance as an employee benefit seems to be a thing of the past. Well, maybe not for all. Due to the global crisis, many private businesses have resorted to outsourcing and some taking in contractual employees to cut costs on employee benefits. Fortunately, there is Philhealth. Businesses in the Philippines are required to contribute to employees' health plan via Philhealth. Philhealth provides basic healthcare (minimum member contributions apply) for medical emergencies of members and a member's declared dependents.

Although, during the second half of 2010, Philhealth runs the risk of being sued by private hospitals for the reported delay in remitting payments. I hope this does not lead to the institution's foreclosure because many low-income Filipino families depend on this crucial protection.

Philhealth covers hospitalization costs, medicine, emergency and laboratory fees. Out-patient and dental care is not covered at all, although there has been a plan to expand the services covered. Perhaps, one great value is that Philhealth covers hospitalization related to maternity. Most standard private health insurance exclude maternity-related medical care. Unless you get the executive plan or avail plans with a big group, maternity medical care is not covered.

It is interesting to note, however, that 9 out of 10 Philhealth claims come from private hospitals. It can only mean two things: the poor and low-income earners do not know that they are entitled to medical reimbursements even when they seek medical care in government hospitals. A study shows that misconceptions and perceived difficulties in claiming member benefits lead to the underutilization of healthcare benefits. Or the poor and low-income families are not Philhealth members, thus they can not avail of Philhealth's benefits.


Private healthcare, on the other hand, remains to be the preferred choice for those who can afford. Inpatient services are comprehensive and expand to higher maximum coverage of up to Php 1 Million. Moreover, out-patient services include consultations, out-patient medical procedures and annual medical check-ups. Medicine and immunizations are billed separately, on the account of the patient. Many private health plans can include dental services for an extra on the premium.

During my elementary and highschool days, me and my sister hardly took advantage of my dad's HMO benefit. We would only feel obliged to visit the clinic or affiliate hospital (the old Medical City) to have our annual medical check-up. Mom, on the other hand, made frequent trips to different hospitals. It was only in highschool that I was able to take advantage of my health coverage.

I remember going to the ER for an out-patient procedure.  I had this small accident at home when someone called to tell me good news. In my excitement, I jumped and my finger got caught in a splinter. Great news, huh. I had to get my pinky nail pulled. It was no big deal, really. Nevertheless, I was scared to see the tools they were about to use. I could have fainted if they did not administer anesthesia. A lot of blood spurted as the doctor jerked the nail out of my pinky. Poor little pinky!

My first year as a mom made me realize the true value of health insurance. Since we were advised about my son's health condition, we started to window shop for HMOs and health insurance. As a general consideration, when buying insurance (home, business or travel insurance) keep in mind that it is a means to prepare for something you do not anticipate. Anything expected, cannot be insured, that was how our family insurance adviser, Mr John Suedad, simplified it.

We were out of luck. Basically, we wanted to get health coverage for my son's maintenance, treatment and, possibly, his operation. We were disappointed to discover that we had few options, all of which were very expensive, to get medical care for my son's congenital defect. Since most of our hospital visits entailed out-patient services, there was no way we can get medical reimbursement for laboratory and consultation fees.

My husband and I used to think that we are lucky to be in the pink of health. We thought we would never need elaborate medical attention. Because we were healthy, we never expected to have any problem with our newborn. Now that the family is growing, it deems to us that we need more protection than before. It is also beside the realization that we won't stay as healthy forever.

Good health depends on a number of factors. It is unwise to think that good health is only manifested in physical appearances. Perhaps, I will sleep better when I know there's Plan C, when A and B fails. So is health insurance necessary? Yes, if you want to sleep better.

Posted in: congenital defect, dental care, health insurance, HMO, medical check-up, Medical City, Philhealth