A Stage 5 kidney disease is quite frightening. It means your organ can no longer work and dialysis will become a part of your routine. Can HMO products help me with my dialysis treatment? Let’s find out and see if there is a health card ideal for kidney disease patients.
In most cases, HMOs will have limited coverage on hemodialysis. Diseases related to the kidney are considered pre-existing conditions. As always, HMOs do not cover health problems that have existed prior to activation of a health plan.
Any way to help reduce medical cost will be ideal for a kidney disease patient. Here is a list of HMOs for dialysis in the Philippines.
1. Maxicare
You can get a Maxicare comprehensive plan that covers pre-existing conditions. This is in line with the terms and conditions of the member’s plan.
Price: Starts at Php 20,233 per year (estimate)
2. Medicard Standard
It covers pre-existing conditions such as dialysis subject to the maximum limit of the account. For CT scan, ultrasound and MRI for the kidney, it will cover up to Php 5,000 per member per year.
Price: Starts at Php 10,739 per year (estimate)
3. Etiqa
Etiqa health plans cover pre-existing conditions which will include dialysis treatment. The coverage starts after 12 months of membership. The coverage amount will be based on the Annual Benefit Limit (ABL)
Price: Starts at Php 26,000 per year (estimate)
4. Valucare
Valucare also offers benefits for dialysis. Initially, the coverage of pre-existing conditions will only be 50% of the MBL (maximum benefit limit) for the second year. However, 100% coverage of the MBL is applied in the 3rd year. For dialysis, up to 7 sessions are covered as a modality of treatment.
Price: Php 13,886 per year (30 years old for regular private room)
What can my HMO cover?
An HMO for dialysis may come only as a supporting service for other medical expenses. Covered kidney treatment costs may be minimal in this case because it usually falls into a pre-existing condition segment.
However, a health card may still be useful for kidney related problems. For example, doctor consultations will be covered such as for a nephrologist or urologist. There will be regular check ups with the doctor in which a health card may be able to help with.
Moreover, one may also get coverage when it comes to diagnostic tests such as CT scan, MRI or ultrasound for the kidney. The accredited doctor can prescribe the test to monitor your overall health and response to treatment.
Are there any other options?
Since no HMO will cover kidney disease completely, one may simply opt to get other options and minimize the cost of medical treatment.
For dialysis, Philhealth will be a big help for sessions. Initially, the government insurance only covers 90 sessions. Now, it has been raised to 156 sessions to help more Filipinos. (https://www.philhealth.gov.ph/news/2023/dialysis_coverage.pdf)
Health insurance will also be useful for a stage 5 chronic kidney disease diagnosis. Most of these products have specific coverage amounts that will be paid out for hemodialysis in particular. Always read the fine print about the number of sessions or amount covered.
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