What to Consider When Looking for HMO for your Company

Factors to Consider When Choosing an HMO

Before even evaluating different HMO providers, it’s important to assess the specific needs of your company. With many options available, understanding your budget, provider network, benefits, and more will help avoid any challenges with the many proposals you will go through and help streamline the decision-making process.

Budget

Your allocated budget for healthcare benefits will largely determine which HMO plans are within reach. When considering cost, keep the following in mind:

1. Premium vs. Benefits - Cheaper plans may lack essential coverage, while more costly plans may offer features that aren’t high priorities for your team. Strike a balance that maximizes value and offers comprehensive benefits that your employees will actually use.
2. Cost Efficiency - Look for long-term savings through preventive care benefits, which can help reduce overall healthcare costs by minimizing expensive emergency treatments for both principals and dependents.

Read more: HMO Glossary: All the Definitions You Need to Know for HMO

‍

Network Coverage

One of the most important considerations when selecting an HMO is the provider network: the hospitals, clinics, and doctors your employees will have access to.

In the Philippines, convenience matters. If your workforce is concentrated in Metro Manila, ensure that the HMO has strong partnerships with major hospitals, diagnostic centers, and clinics in the area. If you have remote employees or branches in Cebu, Davao, or other regions, check for nationwide coverage to ensure accessibility for all team members.

View the Hive Health directory of accredited providers here https://app.ourhivehealth.com/provider-directory

Additionally, here are additional questions or considerations to remember:

• Accredited Hospitals & Clinics: Are they well-rated and accessible?
• Specialists & Treatments: Does the plan provide access to a range of specialists who can offer comprehensive treatments, or is it limited to general consultations with primary care doctors?
• Emergency Care Accessibility: Are emergency services readily available under the plan?

‍

Benefits

A strong HMO package doesn’t just cover the basics; it provides additional support that enhances employee health and well-being.

1. Non-negotiable requirements - These core benefits would be the standard coverage to offer your employees. The most commonly covered benefits would be:
   
   1. In-Patient (confinement or hospital stays) and Outpatient Services (doctor consultations, laboratory tests, etc.)
   2. Emergency Care (immediate medical attention for accidents or sudden illnesses)
   3. Annual Physical Exams or APEs
   4. Dental Coverage 
2. Additional benefits - Aside from the standard benefits mentioned above, there are other benefits you might want to consider for the team. These are modern benefits that provide more holistic care, including but not limited to:
   
   1. Online Teleconsultations (virtual doctor consultations for convenience)
   2. Mental Health Support (therapy sessions, counseling)
   3. Wellness Programs (fitness and lifestyle perks and/or discounts, vaccination drives, wellness webinars or classes)
   4. Pre-Employment Medical Exams (pre-employment checkups to certify your applicants or new hires as fit-to-work)

Ease of use

A good HMO should not only provide comprehensive benefits from top-quality healthcare providers—it should also be intuitive and easy to use. When the system is simple for employees to navigate, they’re more likely to take advantage of their benefits without needing to rely heavily on HR for support. Here’s what to look for to ensure a seamless, low-lift experience for both your team and your admins.

‍

A good HMO should not only provide comprehensive benefits from top-quality healthcare providers to your employees, but it should also be intuitive and easy enough to use to encourage its members to take advantage of their benefits— without needing to rely on HR for support. Here’s what to look for that will contribute to a more seamless experience:

1. Onboarding and Education - A clear orientation facilitated by the HMO provider upon the start of coverage ensures that employees know how to use their benefits properly. 
2. Accessibility - A self-service online portal for members to request their LOAs directly, or a 24/7 responsive customer service hotline that members can contact to relay their queries, allow your employees to avail care as they need it.

‍

Company Size and Employee Needs

The size of your company plays a big role in what HMO options are available to you. The size categories for companies is as follows:

• Small businesses (3-50 employees) - Many providers require a minimum headcount, so it’s important to check if they offer SME-friendly plans.
• Medium-sized businesses (51-200 employees) - More flexibility in plan options, but balancing cost and benefits is key.
• Large enterprises (200+ employees) - If your growing organization already includes a nurse and/or Occupational Safety & Health personnel, it would be best to get their thoughts on what benefits must be included and requested in your HMO plan. If you don't have OSH personnel yet, some HMO providers can deploy one to further optimize your HMO benefit administration.

Beyond the headcount of your employees, some additional considerations to be made are the following:

• Eligibility - Companies may opt to provide HMO coverage to full-time employees either upon start date or upon regularization date.
• Dependents - Companies may opt to extend HMO coverage to loved ones of their employees, whether as a company-shouldered benefit and/or an optional benefit that employees may request to avail but shoulder. HMO providers have their own hierarchy and eligibility policies when it comes to dependents.

Our dependent policy has streamlined hierarchy requirements, no minimum participation rate, and allows for cohabiting / same-sex partners. Learn more here.

• Industry - The nature of your business may influence the kind of healthcare coverage your employees need. For example, companies in physically demanding industries (i.e. Food & Beverage, Fitness, etc.) may prioritize access to specialists like orthopedists or rehabilitation services, while those in high-stress environments may benefit from stronger mental health coverage. Preventive care is considered a high priority for many companies, including hybrid employees with a sedentary lifestyle. Consider the unique health risks or needs associated with your field when evaluating plans.

Ease of Benefits Administration

Managing employee benefits shouldn’t feel like a full-time job in itself. An HMO that helps streamline healthcare administration for HR teams is definitely a must-have on top of the comprehensive benefits, as this allows a positive and sustainable experience for you and your company in the long run. Here are some factors to consider that can ensure the ease of managing your HMO:

• Account Management - Having a dedicated and responsive account manager makes a big difference. It ensures you have a go-to person who understands your company’s coverage and needs, helps you resolve issues quickly, and proactively supports you throughout the year: be it onboarding, renewals, and check-in meetings in between.
• Self-service Dashboard for HR - An intuitive HR dashboard or portal allows the team to handle tasks like enrollments, monitoring availments, and finance-related documents with ease.
• Reports and Quick Updates - With the help of both an account manager and a dashboard for HR, automated reports and real-time updates can reduce the need for manual tracking and back-to-back messaging. If HRs can see claims, invoices, APE results, and members’ utilization, that would free up HR’s time to focus on the people, and not paperwork.

‍

Common Pitfalls to Avoid When Choosing an HMO

Many HR teams make the costly mistake of selecting an HMO that checks their qualifications but might not serve its purpose as the partnership continues – the most common instance being HMO plans that are inexpensive, but not cost-effective in the long run. To avoid this, it’s valuable to watch out for the following:

• Not understanding exclusions and limitations - Like all contract agreements, it’s important to read the fineprint. In the Schedule of Benefits, some pre-existing conditions, certain treatments, or specific providers might not be covered. These are ideally discussed during initial discussions, but not required, which makes it more important to be thorough at your own discretion.

• Choosing based solely on cost - The cheapest plan may not always be the most cost-effective plan. Assess coverage, provider network, and overall value before deciding, because these factors might amount to a bigger cost, whether for the company or employees’ out-of-pocket expenses.