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Friday, March 29, 2024

IC: No fixed rule on HMO coverage of Covid vaccine

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THE administration cost of Covid-19 vaccines to individual plan holders may be covered by health maintenance organizations (HMOs), though the regulator itself has set no fixed rule on the matter, saying it depends on the terms of the plans taken out by companies or individuals.

Association of Health Maintenance Organizations of the Philippines, Inc.  (AHMOPI) Executive Director Carlos D. Da Silva told the BusinessMirror that HMOs may cover the cost of administering the vaccines for individual plan holders, but not the cost of vaccines per se.

Da Silva explained that the cost of vaccines is not coverable under an HMO setting except for the first doses of anti-tetanus and anti-rabies that are more ‘preventive’ in nature rather than ‘curative.’”

“However, while administration of vaccines is normally coverable, and are usually done in the HMO’s stand-alone clinics (where costs are better contained), and administered only once or twice to a plan holder within a contract year, it’s another story if an anti-Covid vaccine is to be administered across hundreds to tens of thousands of employees of a corporate client or of several huge corporate accounts, in which case may, or in all probability will, have a cost component to it,” Da Silva said in an emailed response to BusinessMirror recently.

At present, the private sector and local government units (LGUs) are not yet allowed to directly purchase their own Covid-19 vaccines. They are allowed to buy the vaccines only through a tripartite agreement with the vaccine manufacturers and the national government.

Resolutions have already been filed by lawmakers in both houses of Congress urging the national government to allow LGUs and the private sector to directly buy vaccines but the national government earlier said it has to be one to mainly procure the vaccines since these are still under development —without full commercial license —and their effects on the persons inoculated needed to be monitored.

Should HMO plan holders inoculated with Covid-19 vaccines manifest adverse reactions or complications requiring medical interventions, Da Silva also said this is “non-coverable except when pre-negotiated with the HMO concerned and/or provided for in the plan holder’s Service Agreement.”

No fixed IC rule

For his part, Insurance Commissioner Dennis B. Funa said the Commission is not imposing any regulation when it comes to the coverage or non-coverage of Covid-19 vaccines under an HMO plan.

“According to actuarial, there is none. This is subject to the different kinds of products offered by HMOs, if the vaccines are included in the membership fee pricing,” Funa said in a message to BusinessMirror.

Information Technology (IT) Manager Edward Nataniel Apostol, who works in a multinational consumer goods corporation, said their company has told them that they are already discussing the inoculation of employees but he said no final decision has been made yet.

However, Apostol said he hopes that their HMO plan in the company can cover the cost related to inoculation with the vaccines.

“I live more than 2 hours away from our office and I will need to ride the public transport everyday to be able to come to work. Covering the cost of vaccines will be helpful to me since I can allocate my budget to other expenses such as transportation expenses,” Apostol said.

But 29-year-old Joseph Rabeje, a seafarer for eight years now, is still in search of an HMO provider that can cover the hospitalization costs when one gets infected with Covid-19.

While their office informed them that they have a health card, its benefits can be availed of only if the seafarer is on board the ship and gets into an accident.

“Mahal kase magka-Covid, I mean ’yung malala, ’yung may mga [It’s costly to contract Covid; the worse cases require using] ventilators, apparatus, etc,” Rabeje said.

Rabeje also plans to spend P30,000 of his budget for an HMO plan per year but he said it is fine with him that the HMO plan that he will be getting will not cover the cost of vaccines and its administration.

“Okay lang sa akin kahit hindi, afford ko naman ’yun dahil may work ako, pero okay na rin if ’yung employer namin ang sasagot ng expenses ng bakuna,” he said, adding it would not be too far-fetched to assume that being inoculated with Covid-19 vaccines would be a requirement soon for seafarers before they leave the country.

Asked whether it would be fine for him to shoulder the costs should the vaccine have any side effects, Rabeje hopes that the government could cover the cost of dealing with “side effects,” which he hopes would be “minor.”

The government is facing a one-week delay in the  delivery of the initial doses of 117,000 doses of Pfizer-BioNTech vaccines due to processing of documents, but it assured the public it is still expecting the delivery within the month.

Meanwhile, Da Silva said 2020 still “turned out to be positive for most HMO industry players despite having covered a great number of patients with SARS CoV-2 infections and attendant co-morbidities, if any.”

Da Silva expressed optimism that 2021 would be a “year of recovery for the country and for most businesses — albeit slow and perhaps towards the end of the year.”

He added, “But this outlook is tempered with caution and will depend on how government and our people will work together to address the new SARS CoV-2 variant already in our midst; and how fast the anti-Covid vaccines will be made available to the populace, its effectiveness moving forward included, if not centered upon.”

On Friday, the Department of Health reported 19 new cases of the more transmissible Covid-19 variant, raising the number of UK variant (B.1.1.7) cases in the country to 44.

As of Saturday, Covid-19 cases in the country have reached 547, 255 after 1,960 more infections were recorded.

The nationwide death toll due to Covid-19 has also risen to 11,507 while 500, 781 people have already recovered from the disease.

Read full article on BusinessMirror

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