Finding an HMO in the Philippines that covers pre-existing conditions is difficult. Many Filipinos struggle to get health insurance because of this. They often end up paying a lot of money themselves, which takes up almost half of their budget.

However, not all hope is lost. Some health cards offer coverage for pre-existing conditions. Companies like Maxicare and Medicard are good examples. They start with limited coverage but after some time, it gets better. They might cover up to 100% by the second or third year.

There are also plans by Philcare and Valucare that start providing some help. They cover common conditions like high blood pressure or diabetes after a short waiting period. For those specifically seeking an hmo that covers pre existing conditions Philippines, these plans can be particularly beneficial.

Many workers, from trainees to full-time staff, want an HMO that covers their family’s needs. They look for plans that cover important tests such as CT scans and MRIs. When signing up, it’s crucial to mention any pre-existing conditions clearly. An HMO that covers pre-existing conditions in the Philippines can ensure people understand what their insurance can do for them and provide the necessary coverage.

Understanding Pre-existing Conditions and HMO Coverage in the Philippines

A pre-existing health condition is a medical issue you had before joining an HMO. This includes any symptoms or treatments before you sign up. When you get HMO coverage, it’s important to tell the truth about your past health. This honesty helps you know what your plan covers and any applicable limits or conditions.

What is a Pre-existing Condition?

Have you heard of pre-existing conditions? They are health problems you already had when you got your medical coverage. Things like heart issues, diabetes, and mental health concerns count. Sharing this information ensures you get the right care for your conditions. It also helps you use your benefits properly.

General Exclusions and Limitations

Most health cards in the Philippines don’t initially cover pre-existing conditions. They usually have specific rules about what they do and don’t cover. But they might help with emergencies or pay for certain tests and scans. Some plans even cover CT scans or MRIs up to a certain amount.

After a year, some plans will help cover your pre-existing conditions. They might start with half the cost in the second year. Then, in the third year, they could fully cover it. Always check the details of your plan to avoid surprises about what it includes.

Common Pre-existing Conditions Not Covered

While some health plans have good benefits, they often don’t help with certain serious conditions. Issues like AIDS/HIV or certain pregnancy problems are usually not covered. Different HMOs, like Maxicare or Philcare, have rules about this. For example, Valucare might help cover your old conditions after one year. They might give you half the maximum benefit the second year, then fully cover it the next year. But this doesn’t include kidney or gallstones.

Some of the top health insurance companies in the Philippines have plans that help with even big conditions like heart attacks or cancer. But these plans might cost more. When you sign up for a health plan, be honest about your past health. This can ensure you get the best care and benefits.

Top HMOs in the Philippines Offering Coverage for Pre-existing Health Conditions

Maxicare, Medicard, Philcare, and Valucare are top HMOs in the Philippines. They offer structured plans with coverage for pre-existing conditions. But, there are specific terms and limitations you should know about.


Maxicare is known for its detailed approach to coverage. Its Eready Advanced and Maxicare Prima Gold plans offer flexible health card coverage, including help for inpatient, outpatient, and emergency room services. In the first year, partial coverage is available, which grows to full coverage for non-dreaded conditions in the next year.

Members also enjoy quarterly wellness webinars. And, they get their medicine reimbursements quickly, within 5 to 7 days. Maxicare aims to provide a complete healthcare package for its members.


Medicard has the Medicard Standard Plan, Medicard VIP Plan, and Medicard ExER. These offer different levels of pre-existing condition coverage. The Standard Plan handles common health issues, while the VIP Plan includes tests like CT scans and MRIs for chronic conditions.

Members like Medicard for its broad services. These include teleconsults, mental health, maternity, and dental care. Medicard also covers COVID-19 benefits, such as RT-PCR and antigen tests.


Philcare focuses on continual healthcare management for pre-existing conditions. They offer Philcare consultations as part of their healthcare packages. These consultations are to give ongoing medical care and advice.

Philcare also includes many HMO benefits and wellness webinars. This keeps members informed and helps them stay on top of their health. Their plans support long-term health management.


Valucare’s approach to pre-existing conditions is progressive. Members see their coverage grow each year. After the first 12 months, they get part of the Maximum Benefit Limit (MBL), which increases throughout the years. Valucare is committed to offering lasting and full healthcare.

The Hive member portal and HR dashboard are also part of Valucare’s service. These tools provide real-time updates on healthcare admin and make it easier for members to manage their care.

The top HMOs in the Philippines provide thorough healthcare packages. These ensure that members get the best of both immediate and long-term care.

Benefits and Challenges of Getting HMO Coverage for Pre-existing Conditions

Getting HMO benefits for pre-existing conditions can help with medical costs. HMO subscribers pay a premium to get medical care in the network. This is good news for people with long-term health problems. HMO plans usually have lower premiums than PPO plans, which makes healthcare more affordable.

Still, HMOs come with their own set of challenges. You can only see doctors within the HMO’s network. This limits your choice of healthcare providers. Also, you might have to live or work near the network area to get coverage. Picking a Primary Care Physician (PCP) from the network is necessary. They help manage your health and handle referrals to specialists. This can sometimes make things more complex.

The HMO Act of 1973 set the rules for HMOs, bringing both good and strict parts. HMOs usually don’t have high deductibles and just need co-pays for most medical needs. But, they have coverage limits and you might have to wait for pre-existing conditions to be fully covered. These waiting times can be tough for those needing immediate care.

Despite these challenges, HMOs are key in offering broad healthcare. The McCarran-Ferguson Act of 1945 lets states oversee insurance, including HMOs. This ensures that healthcare is balanced for both patients and providers. Anyone considering an HMO should carefully consider the pros and cons. This helps choose the right HMO that fits their health and budget needs.

Finding an HMO That Covers Pre-existing Conditions in the Philippines

Looking for health insurance in the Philippines? Think about what you need and how much you can spend. Most health cards here don’t cover illnesses you had before getting the card. But they might pay up to a certain amount for some tests, like CT scans or X-rays. This might be Php 5,000 or even Php 20,000.

Companies like Maxicare and Medicard have plans that cover some ongoing health issues. For the first year, Maxicare might cover some of this cost. Then, in later years, they might pay for more. Medicard’s VIP Plan also helps with some conditions. They limit how much they will pay for tests or scans. Philcare and Valucare can also help more and more as you keep your plan over time. This can make dealing with long-term health problems less stressful.

It’s important to know what your insurance won’t cover. Some major illnesses might not be included, like AIDS, diabetes, or high blood pressure. But, some HMOs, including AllCare and Affinitas, cover more. They might help with mental health or illnesses you were born with. Doing careful research into these options helps a lot. If you share all your health history with your insurer, you may lower how much you pay out of your pocket. This is key because medical costs can eat up to 40% of a person’s income in the Philippines.