8 Best Health Insurance in the Philippines – Grit PH (2024)

Last Updated on – Jul 13, 2023 @ 1:15 pm

Health and medical costs grow by about 8 percent every year. In 2021, every Filipino spent P9,839.23 on health-related expenses.

Which was 17% higher compared to the average amount spent per capita in 2020.

In 2022, the Philippines’ health expenditure reached about P639.4 billion. And of this amount, over half was paid by patients out of their pockets.

Only 20 percent was covered by the government (both local and national), 17 percent was covered by PhilHealth, 5 percent was covered by HMOs or Health Maintenance Organizations, 2 percent by private health insurance, and 2 percent by other means.

With the cost of treatment for serious illnesses like cancer and stroke rising, it’s a wonder why health insurance is not considered a priority in most Filipino households.

One of the reasons may be the lack of information about health insurance and its benefits.

Well, this article will tell you the basics that you need to know about health insurance, including a list of the top health insurance companies in the country and how you can get coverage.

What is Health Insurance?

According to Investopedia, health insurance is an insurance coverage type that is specifically for the coverage of medical or surgical expenses of the insured.

It can either pay the hospital directly or reimburse the insured for their expenses. Health insurance is usually part of the benefit packages offered by companies to their employees.

Related: Types of Insurance Products in the Philippines

What is the Difference Between Health Insurance, PhilHealth, and HMO?

There are three types of medical insurance in the Philippines that you can choose from.

Let’s take a look at what each offers and what their differences are.

PhilHealth

The Philippine Health Insurance Corporation or PhilHealth is a government-run insurance provider. Compared to private providers, this type of insurance is more affordable.

PhilHealth has an established insurance program that provides financial assistance to Filipino citizens who are employed or otherwise, and in need of medical attention or surgery.

If you are an employee, half of your monthly contribution will be shouldered by your employer and the other half will be deducted from your salary.

Senior citizens aged 60 and over are automatically covered by PhilHealth, and recently, the Republic Act 11228 has been passed, which means Persons with Disabilities in the country will also receive special benefits from PhilHealth.

How much financial assistance will you get as a PhilHealth member? It depends on the illness or medical condition.

Related: How to Get Business Insurance in the Philippines

HMO

HMO or Health Maintenance Organizations are private organizations providing healthcare insurance to members.

Their difference from private health insurance is that they have a network of doctors and healthcare providers. Their members can only avail of the benefits from those within that network.

The plans that are offered by HMOs are often customizable but there is usually a limit to how much financial assistance you can get in a year. The higher the premium you are paying, the bigger your annual allowance will be, too.

There are several HMO providers in the country but the most popular ones are Maxicare and MediCard. HMO membership is usually provided by private companies to their employees on top of their PhilHealth contribution.

Health Insurance

Unlike HMOs that offer access to a limited network of healthcare providers, private health insurance companies offer access to a more extensive network.

It is not that common for companies to offer this type of insurance as a part of their benefits package, although there are a few that do.

Private health insurance premiums can be a little pricey. They are fully paid for by individuals voluntarily if they want to be insured.

If you want your family members to be covered, that would be at an additional cost. Note that this only applies to immediate family members.

These private health insurance companies are comparable to international ones and some of their policies still apply even when the insured member is out of the country.

The most well-known private health insurance providers in the country include Manulife, PRU Life U.K., and Sun Life.

Also Read: How to Get a Life Insurance: Top 10 Life Insurance Companies in the Philippines

PhilHealth, HMOs, and private health insurance providers share the same goal of covering their member’s medical bills and expenses.

It is their approach or their method of transmitting their services that vary. Take a look at this table to better understand how each health insurance provider works.

What are the Benefits & Features of Health Insurance

The three health insurance providers offer almost the same benefits but since there are a few differences, let’s talk about what each offers.

Philhealth offers coverage and medical benefits that include:

1. Inpatient and Outpatient services
2. Ancillary services
3. Catastrophic coverage
4. Maternity benefits
5. Surgeries

Included in the covered services of most HMOs are:

1. Outpatient services
2. Laboratory tests, medications, and other ancillary services
3. Surgeries
4. Hospitalization
5. Dental services

Private health insurance companies offer a lot of features and benefits. Here are some of them:

1. Critical illness benefits
2. Financial assistance for hospitalization and surgical expenses
3. Ancillary services like laboratory tests and medication
4. Financial assistance for loss of income in case of illness or accident
5. Higher compensation (depending on the medical condition)
6. Life insurance savings (this is offered only by some providers)

You might be thinking that what each type of health insurance offers is pretty much the same, which makes choosing a difficult or at the very least, confusing thing.

They do have ‘strengths’ of their own that should help you in making a decision.

PhilHealth is like your default insurance as anyone who is employed has this. It may not be at par with the other two when it comes to benefits, but its Z-benefits sure can be helpful in case of a critical illness.

Of course, its affordability makes it easier for Filipinos to be members, especially those from low-income families.

HMO coverage works perfectly during emergencies. You can just go to any of their accredited clinics or hospitals if you need medical attention and present your HMO card.

There will be no need to fill out long forms only to wait for days for their response nor will you need to worry about having to pay upfront just to get treated or checked.

Health insurance offers more comprehensive coverage, especially for serious illnesses for which they give higher compensation.

Being covered by a private health insurance provider will come in handy, should there be a need for a long term hospitalization or expensive medical procedures and treatments.

Then there are those additional plans and investments that come with the premium, which are not bad at all.

If your financial state allows it, availing all three is a really good idea, but if you need to choose, you have to carefully consider the coverage each provides.

What’s the Average Cost of Health Insurance in the Philippines?

PhilHealth, which is the most affordable of the three will cost you P1,400 to P6,600 a year.

This depends on how much you earn, and whether you are under the formal or informal (voluntary) bracket. If you are employed, half of the contribution should be covered by your company.

The cost of HMO premiums vary depending on the coverage you’re getting. The plans would cost anywhere from P10,000 to 60,000 per year.

As for private health insurance, the lowest plan you can get would cost you P40,000 per year.

Top 8 Health Insurance Companies in the Philippines?

As we have already explained some of the basics about PhilHealth, it won’t be included in this list anymore.

Of course, it’s still worth noting that it’s the only health insurance organization for you if you prefer one that’s run by the government and not a private company.

1. MediCard

Medicard is considered as one of the best HMOs in the country that has an extensive network of accredited healthcare providers across the country.

They are partners with no less than 40,000 doctors and dentists and over a thousand clinics and hospitals.

They offer prepaid health cards that can be purchased without any medical exams and are valid for a year.

Medicard Health Check Card

Benefits & Features:

• Unlimited check-ups with their primary care physicians and select specialists
• 20% discount on labs and tests
• One-time annual physical exam
• Valid for one year at any MediCard free-standing clinic where the card was bought

Price:

• Php 500 for 1 year

My Medicard

Benefits & Features:

• Unlimited check-ups with select MediCard-accredited doctors.
• One-time oral prophylaxis

Price:

• Php3,600 for 1 year

Medicard Family Individual

Health insurance plan for individuals and families who want coverage for hospitalization, out-patient, preventive healthcare, emergency, financial assistance, and dental care.

Benefits & Features:

• Hospitalization
• Out-patient
• Preventive healthcare
• Emergency
• Financial Assistance
• Dental Care

Price:

• Starts at Php10,000 per year

2. Kaiser International

Kaiser International Healthgroup Inc. offers corporations, groups, families, and individuals various short-term and long-term packages that suit many healthcare requirements.

This way, people can build a secure future by having a way to cope with inevitable medical expenses.

Long Term Care

This innovative program offers long-term care even after you go over 60 years old. It includes health insurance, savings, insurance, and emergency funds all rolled into one.

The accumulative self-earning investment even comes with a Return of Payment for non-utilization in the first 7 years of coverage.

Benefits and features:

• Basic medical benefits
• Over 500 accredited hospitals, hospital ICU, and Operating Room
• Over 1,000 accredited Physicians, Specialists, Surgeons, and Anesthesiologists
• Annual Physical Examination
• Unlimited dental check-ups, once a year free dental prophylaxis, unlimited simple tooth extraction
• Special and extended benefits
• Long term care benefits
• Yearly health care hospital benefit limit
• Long term health care experience incentive hospital benefit limit
• Lifetime access to over 1,000 doctors, over 500 hospitals as long as you have funds available in your health benefits
• Cost-free health benefits
• Additional yearly health care hospital benefit limit
• Term life insurance
• Accidental death and dismemberment insurance
• Waiver of the installment due to death
• Waiver of the installment due to disability and permanent disability

Short Term Care

This package offers a responsive immediate health care program through the Kaiser Health Card.

Benefits and features:

• Dental Care
• Emergency Care
• Preventive health care
  • Complete Blood Count
  • Urinalysis
  • Fecalysis
  • Chest X-Ray
  • Electrocardiogram (Adults age 40 and above, or if prescribed)
  • Pap Smear (Women age 40 and above, or if prescribed)
• In-patient care
  • No deposit upon admission (for surgical cases, please contact Kaiser)
  • Room and board according to plan benefit
  • Operating Room and Recovery Room
  • Administered medicines
  • X-Ray and laboratory examinations
  • Services of Kaiser Specialists like anesthesiologists, internists, surgeons, etc.
  • Services and medications for general/spinal anesthesia or other forms of anesthesia necessary for a surgical procedure
  • Intravenous fluids and transfusion of fresh whole flood
  • Modern therapeutic modalities and interventional surgical procedures
  • ICU confinements, dialysis, chemotherapy, and radiotherapy subject to the maximum limit and pre-existing condition coverage
  • Complex diagnostic procedures
• Out-patient care
  • Referral to specialists
  • Regular consultations and treatment (except prescribed medicines)
  • Laboratory and X-Ray examinations
  • Treatment of minor injuries and surgery not requiring confinement
  • Eye, ear, nose, and throat treatment

Price:

• Health 600 Plan: Starts at Php21,435 per year
• Health 800 Plan: Starts at Php23,579 per year
• Health 1200 Plan: Starts at Php32,154 per year
• Health 1600 Plan: Starts at Php38,196 per year

Senior Care Plan

This plan is designed for people aged 61 years old and up, and renewal is guaranteed up until the age of 100.

Benefits and features:

• Basic hospital benefits
• Room and board, maximum 45 days per disability per year
• Miscellaneous hospital expenses for required drugs, laboratory, and diagnostic procedures
• Physicians visit
• Specialist’s fee
• Critical care benefits
  • Intensive care unit
  • Coronary unit
  • Surgical benefits
• Surgeon’s fee
• Anesthesiologist’s fee
• Artificial limb including rental of mechanical devices
• Emergency out-patient for emergency treatment
• Emergency dental services due to a covered accident
• Emergency local ambulance service to the nearest facility
• Private duty nurse when certified necessary by the Physician for 5 days maximum after hospitalization

Price:

• Plan 250K: Starts at Php25,300 per year
• Plan 500K: Starts at Php39,600
• Plan 1M: Starts at Php68,200

3. PRU Life U.K.

This life and health insurance company offers a comprehensive health insurance product called PRUWellness which can provide you with either daily or lump sum cash benefits to cover hospitalization costs.

The cash benefit you’ll get is double if you are confined due to a critical illness. You’ll also get extra funds if you need surgery or an ICU confinement.

Benefits & Features:

• Daily Hospital Income Benefit
• Long-term Hospitalization Benefit
• Dread Disease Benefit
• ICU Benefit
• Surgical Expense Reimbursem*nt
• Death Benefit from the Term Insurance

Price:

• Premium is based on the age of insured

4. Sun Life

Sun life is a known insurance company in the Philippines that offers a variety of products from insurance for education, life, retirement, and of course health.

They have a number of plans for health insurance including SUN Fit and Well, SUN Senior Care, SUN LifeAssure, SUN Healthier Life, SUN First Aid, and more. You will surely find one that fits your needs from their offerings.

Sun Fit and Well

Life and health insurance plan that provides critical illness and life insurance benefits until age 100 with bonus disease prevention programs.

Benefits & Features:

Health and wellness coverage

• Preventive wellness benefit
• Comprehensive critical illness benefit
• Specific cancer booster benefit
• Life insurance protection
• Special bonus and dividend earnings
• Limited payment period

Price: Varies, based on insured

SUN Healthier Life

Convenient and affordable life and health solution that offers protection benefits for helping clients get through any stage of a critical illness.

Benefits & Features:

• Health protection
• Insurance coverage
• Simplified issue offer (SIO)

5. Maxicare

Maxicare is among the HMO pioneers in the country and remains one of the top health insurance companies.

They have excellent healthcare programs and a large network of medical providers nationwide.

They have over 56,000 doctors and 1,000 partner hospitals and clinics offering services that you can benefit from. They cater to individuals, families, and companies of all sizes.

My Maxicare

A specialized program created for individuals and families, that can be customized to fit their budget and needs.

Benefits/Features

• In-Patient Care
• Out-Patient Care
• Preventive Care
• Emergency Care
• Annual Check-Up (ACU)
• Dental Care (Optional)
• Maxicare’s International Assist Program
• Dreaded Disease/Condition

MyMaxicare LITE

A prepaid health card that provides one-time Confinement coverage for eight (8) identified illnesses: Dengue, Malaria, Cholera, Typhoid and Paratyphoid, Gastroenteritis, Pneumonia, Leptospirosis, and Chikungunya.

Plan 1999 – Access to all Maxicare-affiliated hospitals excluding six (6) major hospitals

Plan 2499 – Access to all Maxicare-affiliated hospitals including six (6) major hospitals

Benefits/Features

• Up to Php 25,000 coverage for confirmed cases of the following eight(8) common viral diseases
• Easy registration via SMS. No preliminary check-up, no paperwork needed.
• One-time availment only
• Membership valid for 1 (one) year upon registration
• Room and Board Accommodation – Regular Private
• Use of Operating Room, Intensive Care Unit (ICU), Isolation Room and Recovery Room
• Professional Fees
• Standard nursing services
• Medicines while in confinement
• Whole blood products and IV fluids transfusion
• X-ray laboratory tests and diagnostic tests
• Anesthesia, oxygen and its administration
• 10% discount on selected Metro Dental Services.

Maxicare EReady

This prepaid health card provides one-time coverage for illnesses or injuries that require immediate medical assistance.

Titanium Php 699 – Access to all Maxicare-affiliated hospitals excluding the 6 major hospitals.

Titanium Php 899 – Access to all Maxicare-affiliated hospitals including the 6 major hospitals.

Benefits/Features

• Provides up to Php 15,000 one – time coverage on illnesses or injuries that arises from medical-related emergency conditions
• Eligible for individuals from 15 days old to 65 years old
• One-time availment, but up to two enrollment registration per person per year
• Easy registration via SMS and Online! – No preliminary check-up, no paperwork
• Nationwide ER access to over 1000 Maxicare-affiliated hospitals
• Member can avail in one accredited hospital only within 24 hours
• Card Validity is up to one (1) year upon activation
• Doctor’s Services for Emergency Treatment
• Emergency Room Fees
• Medicines used for immediate relief and during treatment
• Oxygen, IV fluids, whole blood, and human blood products
• Dressings, casts, sutures
• X-ray, laboratory, and diagnostic exams

Maxicare EReady Advance

A prepaid health card that provides a one-time coverage for Emergency related cases including those requiring confinement with unlimited Outpatient Consultations within Maxicare’s network of Primary Care Center (PCC).

Platinum Php 2950 – Access to all Maxicare-affiliated hospitals excluding the 6 major hospitals.

Platinum Php 3950 – Access to all Maxicare-affiliated hospitals including the 6 major hospitals.

Benefits/Features

• Provides up to ₱50,000 coverage on emergency treatment including those requiring confinement, in a regular private room
• Eligible for individuals from 15 days old to 65 years old
• One-time use only
• Easy registration via SMS and Online! – No preliminary check-up, no paperwork
• Nationwide ER access to Maxicare-affiliated hospitals
• Card Validity is up to one (1) year upon activation

Emergency Room Coverage:

• Doctor’s Services for Emergency Treatment
• Emergency Room Fees
• Medicines used for immediate relief and during treatment
• Oxygen, IV fluids, whole blood, and human blood products
• Dressings, casts, sutures
• X-ray, laboratory, and diagnostic exams

Inpatient Care Coverage

• Room and board accommodation in a regular private room
• Use of Operating Room, Intensive Care Unit (ICU), Isolation Room (if prescribed by the accredited attending physician), and Recovery Room
• Standard nursing services
• Medicines when in confinement
• Whole blood products, and IV fluid transmission
• X-ray, laboratory, and diagnostic tests
• Anesthesia, oxygen and its administration

Additional Benefit

• Free and unlimited consultations in Maxicare Primary Care Centers nationwide
• Access to Maxicare 24/7 TeleConsult
• 10% discount on selected Metro Dental services. (www.metrodental.com.ph)
• Emergency medical evacuation for members who are more than 150km from the place of residence
• With Group Life with Accidental Death, Dismemberment and Disablement (ADD&D) coverage up to Php 50,000.00

Maxicare PRIMA

Maxicare PRIMA is a prepaid healthcare plan for individuals that offers unlimited Outpatient Consultations, and access to 255 types of laboratory and diagnostic procedures within Maxicare’s network of Primary Care Centers (PCC) and MyHealth Clinics.

PRIMA Silver Php 4,999

• For 0-59 years old
• Access to all Maxicare Primary Care Centers (PCC) only

PRIMA Gold Php 12,999

• For 60 years old and up
• With Emergency Care Coverage for up to Php 20,000
• Access to all Maxicare Primary Care Centers (PCC) and MyHealth Clinics for Outpatient Consultation and Lab Availments

Benefits/Features

Unlimited outpatient consultations with any of the following:

• Internal Medicine (IM)
• Obstetrician-gynecologist (OB-GYN)
• Ears-Nose-Throat (ENT)
• Dermatologist
• Pediatrician
• Ophthalmologist
• Internal Medicine (PCC physicians)
• FREE Dental Care Coverage from MetroDental
• Pre-existing conditions are covered
• With a consumable Php 20,000 annual emergency room coverage for Gold members in all Maxicare-affiliated hospitals nationwide
• Access to the 24/7 TeleConsult Service: 02 8582 1980

6. Caritas Health Shield

Caritas Health Shield is best known for its multi-year plans that their members get.

Their programs include the MAX Health Care Program, Enhanced Core 6 & 10 Health Care Program, Supreme Health Care Program, KIDDIE Health Care Program, and Ultra Health Care Program.

ENHANCED Core 6

Maximum health care coverage is up to 6 years. The payment period is 5 years.

Benefits/Features:

• Medical Expense Benefits
  • Special Diagnostic Procedures
  • Hospitalization Benefits
  • Medical Expense Benefit Outpatient Services
  • Emergency Care
• Membership Privileges
  • Annual Physical Examination
  • Preventive Health Care
  • Dental Care
  • Membership Privileges Outpatient Services
  • Other Services
• 4-Way Insurance Benefits
  • Credit Life
  • Term Life
  • Accidental Death
  • Waiver of Installment due to Disability

ENHANCED Core 10

Maximum health care coverage is up to 10 years. The payment period is 5 years.

Benefits/Features:

• Medical Expense Benefits
  • Special Diagnostic Procedures
  • Hospitalization Benefits
  • Medical Expense Benefit Outpatient Services
  • Emergency Care
• Membership Privileges
  • Annual Physical Examination
  • Preventive Health Care
  • Dental Care
  • Membership Privileges Outpatient Services
  • Other Services
• 4-Way Insurance Benefits
  • Credit Life
  • Term Life
  • Accidental Death
  • Waiver of Installment due to Disability

Kiddie Health Plan

The KIDDIE offers a comprehensive program for a child’s needs as well as insurance coverage for the payor. Maximum health coverage is up to 10 years. The payment period is 5 years.

Benefits/Features:

• Medical Expense Benefits
  • Special Diagnostic and Laboratory Procedures
  • Hospitalization Benefits
  • Medical Expense Benefit Outpatient Services
  • Emergency Care
• Membership Privileges
  • Annual Well Kiddie Check-Up
  • Preventive Health Care
  • Dental Care
  • Membership Privileges Outpatient Services
• 2-Way Insurance Benefits for the Payor
  • Credit Life
  • Waiver of Installment due to Disability

7. KanMend by FWD

Critical Illness – KanMend offers financial support for medical treatments for customers diagnosed with any of the covered illnesses.

If you’re between 18-50 years old, you can get coverage for Php100,000 for only Php1,799 per year.

Benefits & Features:

• Critical Illness Starter Plan
• Covers 42 Critical Illnesses
• Apply and pay online (Gcash, credit card, debit card are supported)
• 6 months free KonsultaMD telemedicine access

Premium:

• Php1,799 per year

8. Singlife

This insurance company started in Singapore and is now making waves in the Philippines. With their affordable and accessible health insurance plan, Filipinos can protect themselves better from unexpected costs that come with sudden medical bills.

The benefits of all plans mentioned below can be easily extended to your family members at flexible terms and affordable prices. These insurance policies can be bought via GCash, but you must be a fully-verified GCash user to avail of them.

With these plans, you can be protected in less than 5 minutes, and there’s no need to accomplish complicated documents or long forms.

Cash for Dengue Costs

• Coverage for dengue or COVID-19 confinement for mild and severe cases up to Php421,500

Cash for Medical Costs

• Coverage for medical costs from hospitalization and critical conditions with benefits up to Php1.2 million

3-in-1 Protection Plan

• Coverage for hospital bills due to COVID-19, Dengue, or accidents for up to Php250,000

How to Get a Health Insurance in the Philippines

For most of the health insurance products or programs in the country, you can apply online.

You would be contacted by a representative and depending on the product and company, you might have to go through some medical examinations.

If you are working, your human resources department will provide you with assistance or take care of it all for you.

What’s more challenging is choosing the right insurance if you plan to avail of one voluntarily.

These tips should make the selection process easier for you.

1. Create a list of your top HMO or private health insurance providers.

Make sure that you check with hospitals and clinics in your area if they are accredited health providers of those on your list.

2. Assess the coverage offerings of your top choices and compare them with your medical needs.

For instance, if you have a pre-existing condition or you are planning to have children in the future, you should get a plan from an insurance provider that offers coverage for those.

3. Contact their representatives, ask for a quote and compare.

Don’t hesitate to talk to health insurance agents to know more about their products and specifically, how much they cost. Most agents will be happy to help you decide on the best plan based on your needs and preferences.

4. Consider your budget.

Everybody wants a premium health insurance for sure but it might not be practical if it’s going to eat up a huge chunk of your earnings and if you don’t need some of those benefits anyway.

It would only go to waste if you sign up for an expensive plan and end up not being able to pay for it.

5. By now you should have the list cut down to two or three choices.

It’s time to ask around about them and find out about their reputation. It’s likely that there are conversation threads about them on online forums and social media, so you can check those too.

Getting feedback from real members will help you decide which one to choose.

Health insurance is a great investment – a safety net if you will. It’s something that you can depend on in case of a medical emergency or any unforeseen health situations in the future.

If you find yourself in a situation where you or a family member is dealing with an illness, the last thing you want to think about is how you would pay for the cost of the hospitalization, surgeries, and more.

Having health care insurance will give you peace of mind knowing that you won’t have to worry about that. So go ahead, find the right HMO or health insurance for you and your family, and someday you’ll be glad you did.