Considerations in choosing a fitting HMO partner for your organization
Health maintenance organizations (HMOs) can be trusted and reliable partners for any business if they can readily address employees’ healthcare needs and adequately meet them during medical emergencies.
Choosing one partner among several HMOs in the market is a crucial decision to make; thus it requires thorough deliberation on what an HMO can offer, whether these will meet at least most of what employees need for their health and well-being, and whether these will bring the best value possible for an organization’s budget.
In comparing different HMOs and selecting that plan to suit the workforce, several considerations are worth keeping in mind, beginning with the needs of employees. As health needs vary for every individual, it is important to select a plan that will suit them as comprehensively as possible.
“Different age groups have varying health needs. Younger employees may prioritize reproductive health, mental health, and preventive care, whereas older employees might need more comprehensive coverage for chronic conditions and specialist care. Tailoring health plans to these needs ensures all employees benefit,” Jake Jorgovan, a business-to-business growth expert and founder of consultancy Alpha Apex Group, wrote in an article published on his website.
“Employees with families may require plans that offer better pediatric care, maternity benefits, and family coverage options. Single employees might prefer plans with lower premiums and essential health benefits,” he added.
Mr. Jorgovan suggests employers to uncover the specific health needs of their workforce through demographic analysis.
“We recommend conducting a detailed demographic analysis of your workforce to identify specific health needs and preferences,” he wrote. “That way, you can select health insurance options that comply with legal requirements and maximize employee satisfaction and health outcomes.”
“You should find out what package benefits are a priority for your employees. Are there more mothers on the team? Maybe they would need labor fund assistance. What about professionals with existing comorbidities?” online employment marketplace SEEK, which operates Jobstreet in the Philippines, advised in an article published on its website.
With employees’ demographics as a guide, employers can proceed to other considerations, such as the coverage and flexibility of a plan.
“[E]mployees have diverse medical needs based on their health conditions, lifestyles, and family responsibilities. Flexible plans can cater to these varying requirements, ensuring everyone can access necessary services,” Mr. Jorgovan highlighted.
Among the factors under a plan’s coverage that should be highly considered is pre-existing conditions (PECs).
“All illnesses [or] medical conditions present before availing of the HMO will not be covered unless specifically included in the contract, so be sure to confirm that PECs are included in the package,” Philippine HMO and insurance brokerage firm Pascual Brokers Co. explained in an article published on their website.
The firm also recommends employers to ask if the health plan includes an annual physical exam, other medical tests, as well as dental coverage and vision care.
The network of providers and its accessibility to employees is another critical consideration for an HMO plan.
“The primary reason for getting an HMO is to provide a sense of security to your employees that any time there’s a medical emergency or sickness, they don’t need to stress over how to fund their medical expenses,” Pascual Brokers pointed out. “Hence, it is highly important to choose an HMO provider that has a wide network of hospitals, clinics, and doctors nationwide.”
An expansive and accessible provider network can also heighten the chances of employees continuously receiving care from their preferred services and medical professionals.
“Employees with existing healthcare providers or ongoing treatment plans must know they can continue seeing their current doctors without interruption or additional costs,” Mr. Jorgovan noted.
Another consideration worth taking are a plan’s wellness and preventive care benefits, which could contribute to the health and productivity of employees. Benefits employers can check out include preventive care (i.e., early detection of diseases through routine screenings and checkups), chronic disease management programs, as well as mental health support programs.
With all these considerations factored in, organizations must nevertheless determine whether an HMO plan is good value for their money.
“List down all the benefits you can get and even the cons of the HMO being offered to you, and then compare that to the amount you are paying,” Pascual Brokers suggested. “It would be best if you also considered the Maximum Benefit Limit (MBL) or the consumable limit one can use per year because once you go over your MBL, the extra cost will be shouldered by you or your employees.”
These considerations will be handy not just in choosing an HMO partner but also in assessing later on whether a healthcare plan serves employees well, especially as employees’ healthcare coverage needs and providers’ offerings will likely change over time.
“Continually review coverage performance and cost in addition to employee satisfaction so you can keep on top of your employees’ needs and keep offering cost-effective healthcare coverage,” online recruiting company Monster Worldwide wrote on its website. “By keeping track of and evaluating your offerings and benefits on a regular basis, your team will be able to adjust and improve upon your plan as needed.”