What are the Illnesses Covered by a Typical HMO?

If you have an HMO (Health Maintenance Organization) as one of your company benefits, you should know the limits and illnesses of your health care. In my company, we are truly blessed to have an active and caring HMO. They even conducted a seminar for us to get to know the health care and its benefits. What I am about share with you is a summary of the Categories of Illnesses/Cases that you may experience in life.

Category 1: Ordinary Illnesses

Ordinary Illnesses are those that we may have once or twice a year. These illnesses don’t need confinement (If needed, then it moves to Category 2). They are as follows:

• Fever
• Influenza
• Acute Upper Respiratory Tract Infection
• Typhoid Fever
• Dengue Fever
• Appendicitis
• Diarrhea
• Tonsilitis
• Urinary Tract Infection
• Injuries resulting from accidents or assaults

Category 2: Pre-existing Conditions

Any illness, injury or any adverse medical condition shall be considered pre-existing if during the entire period prior to and within the first twelve (12) months from the date of affectivity. These conditions develop over time in the body. Pre-existing Conditions are as follows:

• Dreaded Diseases
• Hypertension
• Goiter (Hypo / Hyperthyroidism)
• Cataracts / Glaucoma
• ENT conditions requiring surgery
• Bronchial Asthma / Allergy
• Tuberculosis
• Chronic Cholecystitis
• Acquired Hernias
• Prostate Disorder
• Hemorrhoids and Anal Fistulae
• Benign Tumors
• Uterine Myoma, Ovarian Cysts, Endometriosis
• Burgher's Disease
• Varicose Veins
• Arthritis
• A migraine Headache
• Gastritis / Duodenal or Gastric Ulcers

Category 3: Dreaded Diseases

Dreaded Diseases are potentially or actually life-threatening conditions or illnesses which may require prolonged or repeated hospitalization or intensive care management. These are as follows:
-CVA (Cerebrovascular Diseases)

• Cancers (of any form)
• Cardiovascular Diseases
• Chronic Obstructive Pulmonary Disease
• Diabetes Mellitus
• Sepsis (from any cause)
• Respiratory / Renal or any form of Multiorgan failure
• Blood Dyscrasia
• Chronic Liver Parenchymal Disease
• Collagen Vascular Disease
• Any illness that may require an ICU confinement
• Complications or morbidities that may arise from a previous surgical procedure
• Any complications related to above-mentioned illness

My Experience in Using Our Health card

Last October 22, I was rushed to the hospital because of a severe stomach ache and I passed out at the office. Using my HMO, I didn't pay for anything. The diagnosis is UTI, and Acidity on the stomach. Good thing I got to get home after that incident.

Knowing the illnesses covered by your HMO is important so you know what benefits you can use for it. I am now loving our health provider but I hope I don't use it again anytime soon (or ever haha!). But it still pays off if you have a health card ready to cover any emergency.

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