HMO Insurance Guide
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What is an HMO?
Accepted HMOs at Unihealth Southwoods
What Do HMOs typically cover?
- Inpatient Services
- Outpatient Services
- Emergency Care
- Additional Benefits
How to Claim Your HMO Insurance Benefits?
- How To Get Your Consultation Approved
- How To Get Your Diagnostic or Medical Procedure Approved
At Unihealth Southwoods Hospital and Medical Center, we are dedicated to making your healthcare journey an easy and smooth one. As an HMO-accredited hospital in Biñan, Laguna, this page serves as your comprehensive guide on all things HMO insurance-related information.
Discover what is HMO insurance, understand common HMO coverage, and how you can claim your HMO benefits during your visit.
What is an HMO?
A Health Maintenance Organization or HMO is a type of health insurance plan that provides various healthcare services to its members through a network of doctors, hospitals, clinics, and laboratories.
You will typically be required to acquire a Letter of Authorization (LOA) for certain procedures, tests, or consultations before you can receive them.
HMO LIST
Accepted HMOs at Unihealth Southwoods Hospital and Medical Center
Unihealth Southwoods Hospital is accredited by twenty-eight (28) renowned and trusted HMO health insurance providers in the Philippines, ensuring that we can provide more accessible and affordable top notch healthcare here in Laguna.
See the full, updated list:
1Coophealth
Amaphil
AsianCare
AsianLife/Etiqa
Avega
BenLife / Star Healthcare
Carewell
Cocolife
Dynamic Care
EastWest Healthcare
Flexicare
Generali Pilipinas
HMI
HPPI
IMS Wellth Care
Insular Health Care
Intellicare / Asalus
Kaiser International Healthgroup Inc.
Lacson and Lacson
Maxicare
MedAsia Philippines
Medicard
Pacific Cross / Bluecross
Philcare
Philippine British
Sunlife Grepa
ValuCare
Wellcare
What Do HMOs typically cover?
HMO providers have different packages that include different levels of coverage for members. Listed below are some common medical services that HMOs cover. However, it is best to check your HMO coverage with your provider and obtain a Letter of Authorization (LOA).
Inpatient Services:
- Hospital Confinement: Admissions requiring a stay of 24 hours or more.
- Room and Board: Hospital room and meals, usually up to a specific room type (ward, semi-private, private, etc.).
- Professional Fees: Fees for attending physicians or other specialists that provided medical care.
- Operating Room and Facilities: Usage of operating room, intensive care unit (ICU), or other hospital facilities.
- Medicines and Supplies: Prescribed medications, dressings, plaster casts, as well as other medical supplies directly used in treatment.
- Diagnostic Procedures: X-rays, laboratory tests, and other diagnostic tests performed during treatment.
- Maternity and Newborn Care: Typically included for members who are pregnant and their newborns. (Case to case basis depending on coverage.)
Outpatient Services:
- Consultation: Doctor's consultations from general physicians or primary care physicians (PCP) or referrals to specialists (ENT, gynecologists, internists, pulmonologists, etc.).
- Diagnostic Procedures: Laboratory tests, imaging services like X-ray, ultrasound, ECG, and 2D Echo.
- Annual Physical Examinations (APE): Usually required by employers and typically includes a physical exam, urinalysis, fecalysis, X-ray, and CBC. It may also include a breast exam and pap smear for women and a prostate exam for men.
- Treatments and Minor Procedures: Treatment of minor injuries and illnesses that do not require confinement, minor surgical procedures, and anti-rabies, anti-venom, or anti-tetanus shots.
- Other Benefits: Dental services and Eyes, Nose, Throat (ENT) treatments.
Reminder: Please check your HMO coverage with your provider and get a Letter of Authorization (LOA) before your hospital visit.
Emergency Care
What HMO providers consider as emergencies are usually life-threatening conditions or conditions that cause severe pain requiring immediate medical care.
- In Accredited Hospitals or Clinics, HMOs cover treatments on a cashless basis and typically, without requiring a Letter of Authorization (LOA). The coverage usually includes fees for the Emergency Room use, doctor's services, oxygen, IV fluids, basic lab and imaging tests, and initial treatments (e.g. dressings, casts, sutures).
- In Non-Accredited Hospitals or Clinics, HMOs usually offer reimbursements of up to a certain amount. They must also be notified immediately and payment may be needed upfront.
Additional Benefits:
Some HMO providers provide services beyond the typical inpatient, outpatient, and emergency services. These could include:
- Blood Transfusion
- Surgical Procedures
- Ambulance Services (case to case basis)
- Advanced Diagnostic Procedures such as CT-Scan and MRI
- Therapeutic Procedures such as Endoscopic Procedures or Rehabilitation Services (e.g. Physical or Occupational Therapy)
How to Claim Your HMO Insurance Benefits at Unihealth Southwoods Hospital
At Unihealth Southwoods, we aim to make your HMO processing experience as seamless as possible. Here are the step-by-step processes on how to get your consultations or medical procedures approved and claim your HMO benefits.
How To Get Your Consultation Approved:
- Ask our Information Desk if your preferred doctor is accredited by your HMO.
- If they are, go straight to our HMO touch screen queue machine located at the corner of the HMO Office and tap the information needed so you can get your ticket or queue number.
- Wait for your number to be called by the HMO staff (during off-peak hours) or look up at the TV display above the queue machine and wait for your number to appear.
- When your number is called or when it appears on the TV display, proceed to the HMO Receiving Window and present your HMO card and one valid ID for verification.
- Once your consultation or test is approved, you will be called again to claim your IDs and referral at the HMO Releasing Window. The HMO staff will then give instruction on your next step.
How To Get Your Diagnostic or Medical Procedure Approved:
- Bring your diagnostic test request or referral, with your HMO card and one valid ID to our HMO Office for verification.
- If your test requires scheduling, the HMO staff will instruct you to go to the testing clinic to get an appointment. After securing the time and date, return to the HMO office to have your schedule evaluated. Once approved, you will sign a Letter of Authorization (LOA), which you must bring when you return to the hospital on your testing day.
- If your test does not require scheduling, the HMO staff will ask you to sign a Letter of Authorization (LOA), after which you may immediately proceed to the testing clinic to get your test done.
- If your test or procedure requires fasting, please process one (1) day prior to your extraction or procedure date.
NOTE: FOR PATIENTS BELOW 18 YEARS OLD:
If you are below 18 years old, you must be accompanied by a guardian or parent, who will be asked to sign a Letter of Authorization by your HMO.
The Unihealth Southwoods Hospital and Medical Center HMO Office is open from Monday to Saturday, from 7 AM to 8 PM.
For inquiries, you may call our HMO Office directly at (02) 775 0361.
For our information desk, call:
0917 871 3159
0925 803 7725
0960 391 5493
Trunkline: Local 121 122
Important Reminder for HMO Members
Please note that releasing during peak hours is random based on your HMO company’s availability.
Need more help with your HMO claims? Get in touch with the Unihealth Southwoods Hospital team!
Trying to book an appointment for a specific HMO-affiliated doctor?
Check the Unihealth Southwoods Hospital Doctors’ Schedules page and filter by HMO affiliation to easily find your doctor.