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KNOWING AND UNDERSTANDING YOUR HMO'S PRE-EXISTING CONDITIONS

Part of what makes the use of HMO cards effective is the cardholder's knowledge and keen understanding of the coverage of the plan. If a member does have a clear understanding of what his or her health policy covers, the member is able to maximize the use of the card to its best potential.

The set of pre-existing conditions in particular is a critical portion of a health plan. This is one aspect that leading HMO Intellicare pays meticulous attention to.

For Intellicare, a health plan's set of pre-existing conditions defined early on is something they could never overemphasize. To them, no one should ever underestimate the repercussions of a misunderstood health plan.

By standards, pre-existing conditions are usually not covered on the first year of one's membership. However, for corporate accounts, the one year waiting period may be waived depending on the agreement based on negotiations. Examples of pre-existing conditions include hypertension, goiter, cataract, tumor, cyst, arthritis, diabetes and cancer.

Knowing and understanding your health plan fully up to the last small detail will definitely lead to a smoother facilitation of services. It helps minimize the hassles of looking for proper information at crucial times.

Intellicare makes sure that from the very beginning, their Business Development Officers (BDOs) clearly define what's in the plan, or the vastness as well as the limits of the coverage. It is important for all cardholders to be very astute about the coverage since an HMO plan is a significant aspect of their lives as working professionals—these are often benefits given to them by their employers. In the end, because this concerns their own well-being, it is the entire family that benefits from a good understanding and proper use of the plan.

How to Avert Troubles that Spring up in Crucial Times

When an orientation is scheduled, make sure to attend it, understand it.

Intellicare, like the other Health Maintenance Organizations usually hold orientations when they are signed up by a company. That is the HMO's opportunity to lay out what the company has planned for its employees. That is the opportunity to clarify certain pre-conceived notions of an HMO and what HMO cards are for and how they can properly be used. This is the time to find out what the pre-existing conditions are in your plan.

At some point in the orientation, the HMO representative will ask for questions. This is the best time for employees to ask questions.

Intellicare's Customer Services Department Head Josephine Sabuga puts it best, "This is your health we're talking about. Ask questions when you have to."

If for a valid reason, one cardholder is unable to attend an orientation, Sabuga says the company should be able to cascade to the employee what was tackled via intranet.

"It is also during orientations that the HMO give out the manual containing frequently asked questions. Tedious they can be, it is important for the cardholder to refer to it because it aids him or her with crucial information," Sabuga says.

When in doubt, consult with the customer services department of your HMO.

When the time comes one has to use the card, it is important to be fully aware of how the card can help the cardholder. If in the flurry of things or while stressed out by his or her condition and the cardholder forgets the plan coverage, the wise thing to do is to get in touch with the customer services department. They are the best people to turn to in these times of need.

Ideally, they should be able to answer questions regarding any aspect of your plan and are able to respond well when endorsing special cases to an expert—especially about the pre-existing conditions of one's plan.

Avoid comparing your HMO with other HMOs.

First-time cardholders usually have a problem with pre-existing conditions. So they are usually excited by the fact that their health is being taken care of with little effort on their part. When they get to conversing with their friends or family about their HMO, the conversation tends to take a muddled turn such that one of the parties ends up thinking their card can do everything that the others' card can.

"Companies have different needs. Intellicare tailor-fits the plan for each company. So the pre-existing conditions vary. Those who do not know his plan coverage, pre-existing conditions included of course, are the most susceptible to thinking that they are covered by the card no matter the case," Sabuga emphasized.

These are just some of the basic things a cardholder needs to keep in mind when availing of his plan benefits. Knowing what your health plan is all about or what it covers can greatly help you in times of medical need—far more than you ever thought it could.

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