IC seeks HMO Code review

IC seeks HMO Code review | Daily Tribune

The Insurance Commission (IC) is pushing for new rules on health maintenance organizations (HMOs) to ensure more effective supervision of these businesses and promote complementary services to those offered by the state-run Philippine Health Insurance Corporation (PhilHealth).

IC chief Reynaldo Regalado said he aims to help create a new HMO Code that will define the responsibilities of the Department of Health and PhilHealth regarding HMOs.

HMOs are private firms that offer health insurance and are supervised by the IC, while PhilHealth is state-run and imposes mandatory memberships for all workers both in the public and private sectors.

Regalado said the new code should ensure HMOs remain profitable and provide efficient services to all Filipinos, especially since government workers now also receive government-issued allowances for HMO services starting at P7,000 per year.

“I want to know the thrust of PhilHealth and how we manage health issues in the country. Where does the IC come in?” Regalado said at the IC’s 76th anniversary celebration last week in Makati City.

“PhilHealth is improving their services and that will affect HMOs. Maybe, we can adjust the rules for HMOs which might lead to better offerings from HMOs,” he added.

Regalado said he will be meeting PhilHealth’s new president and chief executive officer Dr. Edwin Mercado as lawmakers are also discussing the Universal Health Law.

“The proposals for the HMO Code and the Universal Health Law are being reviewed by the Bicameral Conference Committee. Under the Senate’s version, the IC must be consulted by PhilHealth on adjusting its benefits,” Regalado said.

“I think lawmakers are also waiting for opinions from PhilHealth,” he added.

While the proposals are being discussed, Regalado said there are reasons for PhilHealth to take the primary role regarding various matters on health insurance.

“PhilHealth is like the HMO without competition. To some extent this is how PhilHealth operates because it also has a format where it accepts voluntary memberships,” he said.

About time for review

Individuals who are either not formally employed or working overseas can apply for a PhilHealth membership.

“This is the best time to review everything. I want to have insights to get a clear direction first on where the IC is supposed to be getting in,” Regalado said.

Demand for HMOs continued as the IC reported they posted a 123 percent growth in net income worth P979.8 million in the last quarter of 2024 compared to the same period in 2023.