HMO or Health Maintenance Organization is a healthcare delivery system that provides comprehensive healthcare and services for its members. It is responsible for the payment of an insured ’s medical expenses, doctor ’s fees, hospitalization, clinic visits, and other medical care such as outpatient consultation and diagnostics.
HMO coverage may be customized in any of these programs:
- In-Patient benefits (inclusion of Claimability Assessment)
- Out-Patient benefits including ancillary benefits (e.g. laboratory tests and diagnostic procedures)
- Emergency Care benefits
- Annual Physical Examination
- Dental Benefits
- Financial Assistance
- Daily Hospital Income Benefit
- Maternity Benefit
- Repatriation Clause
- Management of Medical Profile (e.g. Corporate Solutions, Wellness Programs)
What are the information/documents needed for HMO?
- With Existing Plan
- Copy of the contract/schedule of benefits
- 9-month utilization report
- List of employees and dependents with date of birth, civil status, and current plan cover
- Broker of Record (BOR) – form will be provided by Trinity
- Virgin account
- Preferred plan benefits, if possible
- List of employees and dependents with date of birth and civil status
- Broker of Record (BOR) – form will be provided by Trinity