3 Health Insurance Options Every Filipino Should Know About

Understanding Health Insurance Options in the Philippines

Choosing the right health insurance in the Philippines can feel confusing. Should you rely on PhilHealth alone? Is your HMO plan enough? Or should you consider getting private health insurance with more flexible benefits?
 

This guide breaks down the three main types of health insurance available in the Philippines—and helps you figure out which one fits your needs best.
 

Here’s what you’ll learn:
 

• What makes Oona Purple Shield different from regular health plans
  
  

• Who might need more than just PhilHealth
  
  

• Why combining different types of coverage can give you better protection
   

According to the Philippine Statistics Authority, only 4 in 10 Filipinos have private insurance beyond PhilHealth or HMOs (PSA, 2023). That leaves many at risk of big hospital bills when the unexpected happens. In fact, out-of-pocket health expenses reached ₱342 billion in 2022 (DOH), proof that being “covered” doesn’t always mean fully protected.
 

Let’s break down each type of health insurance—so you can choose the one that truly supports your healthcare needs and budget.

What Are the Three Types of Health Insurance in the Philippines?

When it comes to health insurance in the Philippines, there are three main types to know: PhilHealth, HMOs, and private health insurance. Each one offers different levels of healthcare coverage—from basic hospital bills to more flexible, full-featured plans.
 

PhilHealth is the government’s mandatory program and covers basic needs like confinement and selected treatments.
 

HMOs (Health Maintenance Organizations) are usually provided by employers and cover doctor visits, lab tests, and outpatient care.
 

Private health insurance gives you more freedom, offering customized plans, wider hospital access, and even global coverage.
 

So, which one is right for you? Let’s break down the three types of health insurance for Filipinos, starting with PhilHealth.

1. PhilHealth: Government-Mandated Universal Coverage

What It Is

PhilHealth is the Philippine government’s national health insurance program, created to make basic healthcare more affordable and accessible for all Filipinos. It serves as the foundation of universal health coverage in the country.
 

Whether you're employed, self-employed, unemployed, a senior citizen, or classified as an indigent, there's a membership category for you. Contributions are based on income and may be:
 

• Shared by employers and employees (for formal workers),
  
  

• Individually paid (for freelancers, OFWs, and informal workers),
  
  

• Or fully subsidized by the government (for senior citizens, indigent families, and sponsored members).

Who It’s For

PhilHealth is designed to cover a wide range of Filipino citizens, whether you're formally employed, working on your own, or receiving government support. Here’s a quick look at who’s eligible:
 

• Employed Filipinos – Contributions are automatically deducted from your salary and shared by your employer.
  
  

• Self-employed and informal workers – Freelancers, small business owners, and other independent workers can register and pay monthly or quarterly contributions.
  
  

• Senior citizens – Automatically covered by PhilHealth, with no need to pay contributions.
  
  

• Overseas Filipino Workers (OFWs) – Required to contribute to PhilHealth as part of their mandatory benefits.
  
  

• Sponsored members – Those supported by the government or local LGUs, including indigents, persons with disabilities, and low-income families.

What’s Covered

PhilHealth coverage helps reduce your medical expenses by offering partial reimbursement for a range of healthcare services. It’s not full coverage, but it can significantly ease the cost of treatment—especially in public hospitals.
 

Here’s what PhilHealth helps pay for:
 

• Inpatient care – This includes hospital room and board, doctor’s fees, surgery, medicines during confinement, and diagnostic tests.
  
  

• Selected outpatient treatments – Such as hemodialysis, tuberculosis treatment, chemotherapy, and even COVID-19 benefits.
  
  

• Z Benefits – A special package for catastrophic illnesses like cancer, stroke, heart surgery, and severe physical disabilities.
   

However, PhilHealth doesn’t cover 100% of your hospital bill—especially in private hospitals, where professional fees and room upgrades can be much higher. In many cases, you’ll need to pay out of pocket or rely on an HMO or private health insurance to cover the gap.

Strengths

• Mandatory and widely available – All Filipinos are eligible, so it's the most accessible health insurance option in the Philippines.
  
  

• Covers major illnesses – Includes support for serious conditions like cancer, stroke, and COVID-19 treatment.
  
  

• Accepted in public hospitals – Can be used in government facilities across the country, making it ideal for those who rely on the public healthcare system.

Limitations

• Low reimbursement rates – Often only covers a small part of the actual cost, especially in private hospitals.
  
  

• Long waiting times – Government hospitals can have overcrowded wards and long queues for services.
  
  

• Limited access to premium care – Doesn’t provide direct coverage for top-tier private hospitals or specialists.
  
  

• Outpatient, dental, and mental health not included by default – These services typically require an HMO or private health insurance to be covered.

PhilHealth Pros & Cons Table

Bottom line: PhilHealth gives all Filipinos a basic layer of healthcare protection, especially for hospital stays and serious conditions. But when it comes to everyday needs—like checkups, lab tests, or quick access to specialists—many turn to HMOs for more complete and convenient coverage.
 

Let’s explore how HMO plans in the Philippines work and who benefits from them most.

2. HMO Plans: Network-Based Everyday Coverage

What Is an HMO?

An HMO, or Health Maintenance Organization, is a type of health insurance plan in the Philippines that gives you access to a set network of doctors, clinics, and hospitals.
 

Most Filipinos first experience HMO coverage through their employer-provided health benefits, but you can also buy an individual HMO plan if you're self-employed or not covered at work.
 

What makes HMOs stand out is cashless, convenient access to day-to-day healthcare needs, such as:
 

• Outpatient consultations with general doctors and specialists
  
  

• Basic lab tests and diagnostic procedures
  
  

• Annual physical exams (in some plans)
  
  

• Hospitalization coverage—but only in accredited hospitals or partner facilities

Who It’s For

HMO plans are ideal for people who want easy, cashless access to outpatient care and hospital services within a trusted medical network. Here’s who benefits the most:
 

• Employees with company-provided health benefits – Most companies in the Philippines include HMO coverage as part of their employee package.
  
  

• Small business owners – Employers who want to offer basic healthcare coverage to their teams can choose HMO group plans.
  
  

• Individuals and freelancers – If you’re self-employed or don’t have employer coverage, individual HMO plans are available for routine checkups, diagnostics, and emergency care in partner hospitals.
   

If you prefer convenience and don’t mind sticking to a healthcare network, an HMO in the Philippines can be a practical and affordable option.

What’s Covered

HMO plans in the Philippines vary depending on the provider, but most offer a solid range of outpatient and inpatient services, especially for everyday health needs. Common HMO coverage includes:
 

• Doctor consultations – Both general practitioners and specialists, usually with no upfront payment.
  
  

• Lab tests and diagnostics – Includes common procedures like blood work, urinalysis, and X-rays.
  
  

• Minor outpatient procedures – Such as wound care, minor surgeries, and injections.
  
  

• Hospital confinement – Covers room, board, and treatment costs within accredited hospitals.
  
  

• Emergency room treatment – Some HMO plans include emergency care for sudden illnesses or accidents.
   

HMOs are great for routine medical care and sudden health concerns—as long as you stay within their network of hospitals and clinics.

What’s Not Covered

While HMO plans offer great value for everyday health needs, they do have important limitations. Here’s what’s usually not covered:

• Medical services outside the HMO network – If you visit a doctor or hospital not affiliated with your HMO, you’ll likely pay the full cost.
  
  

• Pre-existing conditions – Some plans exclude illnesses you already had before enrollment, or require a long waiting period before coverage kicks in.
  
  

• Advanced procedures and surgeries – High-cost treatments like organ transplants or specialized surgeries may only be included in upgraded or premium plans.
  
  

• Long-term critical care – Extended hospital stays, intensive care, or long-term treatment for serious conditions are often beyond standard HMO coverage.
   

To stay fully protected, many Filipinos pair their HMO plan with PhilHealth and private health insurance for wider coverage and flexibility.

Sample HMO Providers in PH

• Maxicare
  
  

• Intellicare
  
  

• MediCard
  
  

• PhilCare

Key Things to Consider

Before choosing an HMO plan, keep these important points in mind:
 

• Stick to accredited providers – HMO coverage only works within the network. If you go outside their list of partner hospitals or doctors, you’ll likely shoulder the full cost.
  
  

• Know your limits – Many basic HMO plans have a maximum benefit limit per illness or annual cap, so it’s important to understand how much coverage you really have.
   

If you want more flexibility or protection for serious illnesses, you might want to consider adding a private health insurance plan on top of your HMO.

Sample HMO Benefits Comparison

Disclaimer: Actual benefits vary by plan type and provider. This is a sample comparison for illustration purposes only.
 

The Bottom Line:
HMO plans are great for day-to-day care, checkups, and emergencies—as long as you stay within their network and benefit limits. But if you want more freedom in choosing doctors, higher coverage limits, or global protection, then private health insurance is the next level up.
 

Let’s take a closer look at how private plans work—and what makes them different.

3. Private Health Insurance: Flexible, Comprehensive Coverage

What Is Private Health Insurance?

Private health insurance is a standalone, customizable health plan that gives you more control over your coverage. Unlike PhilHealth or HMO plans, it’s not tied to an employer—and it offers access to a broader network of hospitals and doctors, both in the Philippines and sometimes even abroad.
 

You can choose the coverage level that fits your lifestyle and budget, with options to include:
 

• Outpatient care
  
  

• Maternity benefits
  
  

• Dental services
  
  

• Mental health support
  
  

• International or travel coverage
   

Private health insurance in the Philippines is ideal for those who want more freedom and long-term protection, especially in private or high-end hospitals.
 

Private plans work best for:
 

• Freelancers and self-employed individuals – Since they don’t receive corporate HMO benefits, a personal health insurance plan offers much-needed security.
  
  

• Families – Those who want a more complete, family-wide healthcare safety net.
  
  

• People with pre-existing conditions – Some private insurers offer coverage, subject to medical assessment or waiting periods.
  
  

• Anyone seeking portable, year-round protection – Coverage continues even if you change jobs, travel, or relocate.

What Can It Cover?

Private health insurance in the Philippines offers flexible and comprehensive coverage—with benefits tailored to your needs and lifestyle. Depending on your provider and plan, it may include:
 

• Hospitalization – Room and board, surgery, ICU, and specialist care in your hospital of choice
  
  

• Outpatient consultations and diagnostics – Doctor visits, lab tests, imaging, and preventive care
  
  

• Maternity and newborn care – Prenatal checkups, childbirth, and newborn coverage
  
  

• Mental health and chronic conditions – May include support for substance abuse, HIV/AIDS, and psychiatric care
  
  

• Dental and vision benefits – Often offered as add-ons or bundled in premium plans
  
  

• Travel and personal accident coverage – For added protection while abroad or in emergencies
  
  

• Annual wellness benefits – Health checkups, vaccines, and lifestyle screenings
   

You also get to choose your annual coverage limit—like ₱1 million, ₱3 million, or ₱5 million—depending on how much protection you want.
 

Still figuring out which type of health insurance is the best fit? Check out the next section for a side-by-side comparison that makes it easier to decide.

Oona Purple Shield vs Traditional Private Insurers

Disclaimer: Benefits and premiums vary depending on your age, health status, and chosen coverage. The details here are for illustration only.

Why Go Private?

While HMOs limit you to a specific network of doctors and hospitals, private health insurance gives you more freedom and flexibility. You can choose your hospital, enjoy higher benefit limits, and customize your coverage to match your unique needs.
 

It’s a smart choice if you:
 

• Have a growing family – Add maternity, pediatric care, and broader wellness support
  
  

• Are in between jobs – Keep coverage active no matter your employment status
  
  

• Want long-term, renewable protection – With plans that adapt as your health needs evolve
   

Oona Purple Shield stands out with an optional outpatient care rider—a rare feature in many private health insurance plans in the Philippines. It gives you everyday coverage typically found in HMOs, but with the flexibility and benefits of a private plan.
 

Still unsure which health plan is right for you? Let’s compare all three side by side so you can see the differences at a glance.

Side-by-Side Comparison Table: Which Health Insurance Is Right for You?

Still unsure which type of health insurance in the Philippines fits your needs? Here’s a quick feature-by-feature breakdown of PhilHealth, HMO plans, and Private Insurance like Oona Purple Shield:

Disclaimer: Features may vary by provider and plan level. This table is for general comparison purposes only.

Final Thought

Each type of health insurance in the Philippines plays a different role in protecting your well-being:
 

• PhilHealth provides essential, government-mandated support for basic hospitalization.
  
  

• HMO plans offer convenience for everyday checkups, diagnostics, and emergency care—within a set provider network.
  
  

• Private insurance, like Oona Purple Shield, gives you the most flexibility, highest benefit limits, and broader protection when your health needs go beyond the basics.
   

Now that you know how each one works, the next big question is: when should you go beyond just PhilHealth or an HMO?
 

Here are a few signs it might be time to upgrade your coverage—and make sure you’re truly protected for what life throws your way.

When Should You Upgrade to Private Health Insurance?

Still wondering if your PhilHealth or HMO plan is enough? Here are clear signs it might be time to upgrade to private health insurance for more complete, flexible coverage:

1. You're Freelancing or Self-Employed

Without company-sponsored HMO benefits, you need a health plan that works for you—wherever you are. Private insurance lets you choose your own hospital, doctor, and coverage level, whether you're in Metro Manila or the provinces.

2. You Have a Growing Family

Planning for a baby? Raising kids? Maternity, newborn care, and pediatric services are rarely included in PhilHealth or basic HMOs. Private plans like Oona Purple Shield can bundle these into your coverage for family-wide peace of mind.

3. You Want Mental Health or Wellness Benefits

Most local plans skip mental health services and preventive care. With Oona Purple Shield, you can access mental health support, wellness checks, and more, even with entry-level coverage.

4. You Need Higher Coverage Limits

Serious health issues can lead to hospital bills of over ₱1 million. Private health insurance gives you higher annual limits—up to ₱5 million—so you're protected against major financial setbacks.

5. You Move Often or Plan to Retire Outside the City

Whether you're working remotely or planning to live away from major hospitals, private plans offer nationwide coverage. No need to worry about HMO network restrictions in urban centers.
 

If these situations sound familiar, it may be time to explore a plan that grows with your needs. One of the most modern and flexible private insurance options in the Philippines today?
 

Let’s take a closer look at Oona Purple Shield.

The Role of Oona Purple Shield in Today’s Market

In a healthcare system where many Filipinos rely solely on PhilHealth or limited HMO plans, Oona Purple Shield steps in to fill a major gap. It offers the flexibility, high benefit limits, and comprehensive add-ons that many modern Filipinos need—but often can’t find in traditional plans.
 

With customizable private health insurance coverage and broader access to hospitals, Oona Purple Shield empowers individuals and families to take control of their health—on their terms.
 

What makes Oona Purple Shield stand out:
 

• Up to ₱5 million in annual coverage – Enough protection for major illnesses, surgeries, or long-term treatment
  
  

• Mental health support across all tiers – From counseling to psychiatric care, even entry-level plans offer mental wellness benefits
  
  

• Optional riders – Add outpatient care, dental, vision, and personal accident protection as needed
  
  

• Nationwide hospital access – No network restrictions—you choose where to get treated, even in top private hospitals
   

Oona Purple Shield is designed for:
 

• Professionals without HMO access – Freelancers, consultants, and small business owners
  
  

• Parents or couples starting families – With options for maternity and pediatric care
  
  

• Adults seeking long-term, flexible protection – Portable and renewable, wherever life takes you
   

Whether you’re building your career, starting a family, or just want peace of mind, Oona Purple Shield gives you health coverage that adapts to your lifestyle—not the other way around.
 

Ready for full protection that moves with you? Explore Oona Purple Shield and request a personalized quote based on your needs and budget.
 

In the end, there’s no one-size-fits-all solution. The best health insurance is the one that fits your life, health goals, and future plans. Here’s a quick recap to help you decide.

Conclusion

At first glance, the Philippine health insurance system seems straightforward. But once you factor in real-world medical costs, limited provider access, and your future health needs, it’s clear that one-size-fits-all doesn’t work.
 

Here’s the reality:
 

• PhilHealth provides an essential safety net—but it’s not designed to cover everything, especially in private hospitals.
  
  

• HMO plans offer helpful day-to-day coverage—but only within a fixed network of clinics and hospitals.
  
  

• Private insurance, like Oona Purple Shield, fills the gap with high-limit, customizable protection that moves with you—wherever you go, whatever stage of life you’re in.
   

Whether you’re starting a family, working independently, or just want true peace of mind, the right health plan—or combination of plans—can protect both your well-being and your wallet.
 

Start with what you have.
Upgrade where it counts.
Future-proof your health coverage.
 

Ready to take control of your healthcare journey?
 

Explore Oona Purple Shield today and get a quote built around your lifestyle, your needs, and your future.