HMO Advisory: Coverage for PPEs

Due to the demand in extra protection in administering healthcare services during the COVID-19 pandemic, ActiveLink reached out to HMO providers to clarify if personal protective equipment (PPE) used in availments are covered by HMO.

To uphold transparency, our partner HMO providers have issued their response relative to the coverage of PPEs and other supplies.

PhilCare
As of June 15, 2020

PhilCare will cover PPE charges for outpatient, inpatient, and emergency cases, provided that the PPEs were utilized by COVID-19 patients, or individuals who are probable or suspected with COVID-19. Otherwise, all PPEs utilized for non-COVID-19-related cases are not covered and becomes miscellaneous items since PPEs are not medically necessary in such conditions.

Intellicare
As of June 17, 2020

Intellicare will cover PPE charges for inpatient and emergency cases only for COVID-19 and related cases only. PPEs used for non-COVID-19 cases will not be covered and may be charged to the patient

Avega
As of June 17, 2020

Avega will cover PPE charges for inpatient and emergency cases only for COVID-19 and related cases only. PPEs used for non-COVID-19 cases will not be covered and may be charged to the patient.

Etiqa
As of June 17, 2020

Etiqa will cover PPE charges for emergency and inpatient availments for COVID-19 and related cases only, subject to the usual coordination of benefits, limits of the plan, and applicable PhilHealth coverage. PPEs used for outpatient and diagnostic services may be charged to the patient, depending on the existing policy of the healthcare plan.

Maxicare
As of June 25, 2020

It has come to our attention that some hospitals, clinics, and doctors charge additional fees for services or items that are not covered by Maxicare, such as:

• Requiring members to undergo COVID-19 testing prior to consultation
• Charging the costs of PPE to patients

While it is possible that these extra measures adhere to their clinic or hospital’s safety protocols, these additional costs cannot be reimbursed by Maxicare, because they deviate from the testing protocol prescribed by the Department of Health (DOH) and not part of Maxicare’s coverage.

When can Maxicare reimburse the cost of COVID-19 testing?

• Only if the patient displays symptoms consistent with DOH guidelines that require testing
• And only after consultation, when the doctor has prescribed a COVID-19 test
• If the cost is defined as reimbursable based on the benefits schedule of your HMO plan

What happens if the member decides to pay additional fees?
Maxicare will be unable to reimburse any charges beyond the coverable services if the conditions above are not met

What can you do as a member?
Suggested steps that Maxicare members can take if faced with such situation:

• Seek medical consultations through Maxicare’s 24/7 Teleconsult hotline at (02) 8582-1980 or visit their Primary Care Centers
• Call Maxicare’s Customer Hotline to report the incident:
  • (02) 8582-1900
  • (02) 7798-7777
• Search for other affiliated specialists who are following Maxicare’s guidelines
• Refuse to pay and Maxicare will refer you to another provider

Please be guided accordingly. Should you have further questions, you may get in touch with us through your dedicated helpdesk email. Thank you and stay safe!