HMO and health cover for seniors in the Philippines

Every senior citizen in the Philippines is covered by PhilHealth: the law says “All senior citizens shall be covered by the national health insurance program of PhilHealth” (RA 7432 as amended by RA 10645). Private HMO plans are a different matter. Each HMO sets its own age limits for joining and for renewing, and they differ from plan to plan, so a parent over 60 may find fewer plans open to them.

PhilHealth for seniors

For senior citizens not already covered under another membership category, RA 10645 pays for their enrolment from PhilHealth’s National Health Insurance Fund, out of sin tax proceeds, so they do not pay premiums. A senior who is still employed or earning may remain a paying (direct) contributor. Under the Universal Health Care Act, every Filipino is part of the programme (RA 11223, Sec. 5). PhilHealth pays set amounts toward hospital bills, which often leaves part of the bill to pay. See PhilHealth for senior citizens for how it works and how to use it.

What changes after 60

• Age limits. Many HMO plans and health policies have a top age for new members, and some a top age for renewal. Ask for both before you rely on a plan.
• Pre-existing conditions. Older people are more likely to have conditions such as high blood pressure or diabetes when cover starts. For HMOs and health insurance contracts, the Insurance Commission limits how far back the company can look for a pre-existing condition to two years, and how long it can make you wait for that condition to be covered to one year (IC Circular Letters 2018-65 and 2018-66). These limits apply to contracts that exclude pre-existing conditions, and they do not apply to critical illness or disability income insurance (IC Circular Letter 2018-65). Within them, the plan defines the condition and sets the waiting time.
• Waiting periods for some benefits, separate from pre-existing conditions, are common in plans sold to older members.
• Cost. Premiums are based on age, so cover for a parent over 60 costs more than for a younger person, and usually rises at renewal.

Kinds of cover older parents can still look at

• Senior HMO plans. Some HMOs sell plans meant for older members, with their own age limits and benefit limits. See HMOs in the Philippines for how to compare plans.
• Hospital cash cover. Pays a fixed amount for each day in hospital, whatever the bill. Some policies accept older applicants up to a set age.
• Critical illness cover. Pays a lump sum on diagnosis of a listed illness. Entry ages are usually limited. See critical illness insurance.

These are kinds of cover, not products. Whether one is open to your parent depends on their age and health and the company’s rules.

Senior citizen discounts on medicine and hospital bills

Senior citizens get a 20% discount and VAT exemption on medicines and on medical and dental services, diagnostic and laboratory fees (RA 9994, Sec. 4(a)(1) and (a)(4)). This lowers what is left to pay after PhilHealth. See the senior citizen discount guide.

Paying for a parent’s cover from abroad

Many OFWs pay for a parent’s HMO plan or health policy. A few points:

• HMO plans and health policies are usually taken out in the parent’s name, with the parent as the member. You can pay the fees. The parent normally signs the application and answers the health questions, so they should answer them fully and truthfully.
• Life insurance on a parent is different. The Insurance Code lets you insure your own life, your spouse’s, your children’s, and the life of anyone you depend on for education or support or in whom you have a money interest (Sec. 10). Parents are not named on their own. An insurer may ask how you have an insurable interest in your parent’s life, and that interest must exist when the insurance starts (Sec. 19).
• Keep copies of the plan, the card and the hospital list with someone at home who can help your parent use them.

This page explains health cover for seniors in general terms. It does not describe any company’s product, and each plan’s own terms decide what it pays.