{"id":3863,"date":"2018-01-26T12:38:43","date_gmt":"2018-01-26T04:38:43","guid":{"rendered":"http:\/\/keymaninsurance.ph\/index.php\/home-full-screen\/?p=3863"},"modified":"2018-01-26T13:30:08","modified_gmt":"2018-01-26T05:30:08","slug":"5-tips-optimize-hmo-benefits","status":"publish","type":"post","link":"https:\/\/keymaninsurance.ph\/?p=3863","title":{"rendered":"5 TIPS TO MAXIMIZE YOUR HMO BENEFITS"},"content":{"rendered":"

Earlier today, I received a call from Tina, the HR Manager of one of our clients. She asked: \u201cHow can the employees maximize the use of our HMO program without increasing the premium cost during our contract renewal? Can you identify some ways on how we can optimize our usage without causing a surge in our utilization?\u201d <\/em><\/p>\n

\u00a0<\/em>Before I enumerate the ways on how the members can use their healthcare coverage without causing an increase in renewal costs, let\u2019s define some terms first. HMO or Health Maintenance Organization is the company that provides access to its network of hospitals, clinics, and doctors. HMOs guarantee the payment of the services obtained from their network as defined in the contract. There are two main types of HMO programs: Premium-Based and Third Party Administration (TPA). The former is the insurance type where 100% of the risks are shouldered by the HMO provider while the latter is the complete opposite where it is a self-insurance program and 100% of the risks are on the hands of the employer. But regardless if it\u2019s Premium-based or TPA program, an improper use of the healthcare benefits can lead to increase in costs.<\/p>\n

So, how do we maximize the benefits without increasing the costs? Follow these tips below:<\/p>\n

1 \u2013 MAXIMIZE THE USE OF PRIMARY CARE CENTERS (PCC)<\/h2>\n

PCC\u2019s are HMO-owned clinics that has access to primary care doctors and basic laboratories. Most HMO providers give free unlimited consultations from their own PCC\u2019s to encourage members. The laboratories are also cheaper in PCCs than in the hospitals. Thus, by using PCC\u2019s, the members can help lower the utilization costs. It is also wise to go through the PCC\u2019s first so members avoid depleting their benefit limits and reserve them for other more dreaded conditions.<\/p>\n

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Some of the services available at these PCC’s are:<\/p>\n