Monday, November 20, 2017

Philippine HMOs required to seek regulator’s approval

Health-maintenance organisations (HMOs) in the Philippines are now mandated to get regulatory clearance first before they sell products to the public.

Insurance Commissioner Dennis Funa said that under the new guidelines, all HMO products need to clear with the Insurance Commission (IC) first.

HMOs are required to submit their client contacts, schedule of benefits, and application forms for approval.

As per IC rules, in order for the products to be approved, the HMO agreement must include in-patient, emergency care and outpatient benefits and services, pre-existing conditions, availment and claims procedure, exclusions and limitations, and eligibility requirements.

Funa added that to gain approval, companies should likewise present supporting documents prepared by actuarians accredited by the commission.

One expressed prohibition is for an HMO product to include any saving or investment component and any mortality risk.

HMOs have one year to change their existing HMO product agreements and contract forms in consonance with the new requirements of the IC.

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