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Health Insurance for Midlife

Health is wealth. It is very important to take care of our health regardless of age. More so for midlife people. It is in this phase of our life, we become vulnerable to illness like hypertension, diabetes, even going through the various stages of menopausal may bring us to make appointments with our doctors. Medical treatments are costly and this article is about how we can alleviate the burden of shouldering steep medical expenses. 


Creative Common License, Woman by Cuba Gallery taken on April 19, 2012, All rights reserved, https://www.flickr.com/photos/cubagallery/8360030698
We need an insurance plan to cushioned us from expensive medical expenses that we will incur if we need to attend to our medical needs. We have two options that we can avail to address our financial concerns about our medical needs.

The 2 options available are:

1. Private health insurance
2. PhilHealth programme

Private health insurance is widely available and it can be very expensive. If you are still active in the workforce, your company may have provided their employees with health care insurance. The premium may either be paid 100% by the company or it will be on a sharing basis. The employee may be required to pay a certain percentage of the annual premium. If you are self-employed, you can get health insurance for yourself and pay the whole premium.
These are the general benefits that a patient can receive if he is enrolled with private health insurance:

INPATIENT:

  • Room and board accommodation
  • Use of the operating room, intensive care unit (ICU), isolation room and recovery rooms
  • Professional fees of attending physicians, surgeons, and anesthesiologists
  • Standard nursing services
  • Medicines for inpatient use
  • X-ray, laboratory examinations, diagnostic tests and therapeutic procedures incidental to confinement
  • Dressings and conventional casts
  • Anesthesia and its administration
  • Oxygen and its administration
OUTPATIENT:

  • Consultation, except for medicines prescribed
  • Eye, ear, nose & throat (EENT) treatment prescribed by an accredited physician or specialist
  • Treatment for minor injuries such as lacerations, mild burns, and sprains
  • Dressing, conventional casts & sutures
  • X-ray, laboratory examinations, diagnostic tests and therapeutic procedures prescribed by an accredited physician or specialist

What I have listed above are the general provisions the members can avail when enrolled in private health insurance. The benefits may vary depending on the provisions of the health insurance company and the type of plan a member wants to avail. The premiums may also vary depending on the type of plan. 

I am enrolled with Maxicare and this is provided as a company benefit. When I was hospitalized because of a mild stroke, all my medical expenses were shouldered by Maxicare except for the professional fees of my neurosurgeon and my take home medicines.

Members are required to avail the services of Maxicare's accredited hospitals and doctors to enjoy the full benefits of the plan they are enrolled.

As an outpatient, all diagnostic tests and laboratories prescribed by my cardiologist and ob gynecologist were shouldered by Maxicare except for medicines prescribed by my doctors.

I can truly say, I was saved from shelling a big amount of money for my medical needs because I have health insurance.

An alternative option is the PhilHealth programme which is government subsidized in the Philippines. The beneficiaries of the PhilHealth programme have access to a comprehensive package of services, which includes: Catastrophic coverage
  • Inpatient care
  • Ambulatory surgeries
  • Deliveries
  • Outpatient treatment for malaria & tuberculosis
If one is identified as indigent or an Overseas Filipino Worker (OFW), they are entitled to outpatient primary care benefits.

These  are the benefits that PhilHealth members can receive:

INPATIENT:

  • Room and board
  • Medicines
  • Diagnostic and other services
  • Professional fees and operating services under the "all case rate" payment scheme


OUTPATIENT:

  • Day surgeries
  • Radiotherapy
  • Dialysis
  • Outpatient blood transfusions
  • TB-DOTS - Tuberculosis - Directly Observed Treatment, Short Course
  • Malaria treatment
  • HIV/Aids treatment
  • Animal bite treatment
  • Cataract operations
  • Vasectomy
  • Tubal ligation


Patients have free choice of providers both public and private. Providers, meaning hospital or clinics are allowed to charge the patient the difference between the total cost of care and the balance of the billing which PhilHealth will pay.


Indigent and sponsored members, lifetime members, senior citizen members, household members are entitled to avail the free hospitalization under the no-balance billing scheme when they are admitted in a nonprivate room of public or government hospitals.


To enjoy the other half of our life it is imperative that we take care of our health. We have to strive to live a healthy life for prevention is best than cure. 



If you want to avail of private health insurance, research about the different plans and its premium and choose which fits best your budget.



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Middle life is beautiful.

Till next time. God bless.



























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