AXA Insurance’s Global Health Access (GHA) is a yearly renewable health product with HMO-like features. It was launched in 2016. Certain features would qualify it as a non-insurance product. It lies in the gray area, where the regulator continues to grapple, between HMO products and health insurance. In any case, it does not directly compete with any HMO product in the market because of its high benefit payout.
It has several Plan Options one can choose from (Platinum which is the most comprehensive, Gold, Silver, Gold Lite Plus, and Gold Lite which is the least comprehensive), the highest of which offers a yearly coverage limit of P175 million (Platinum). GHA can be availed of locally and anywhere else in the world (worldwide). It can support you in any health issue, any sickness, including critical illnesses and terminal illnesses—there are exceptions, of course. It also covers pandemic diseases, subject to policy provisions. It is available for both inpatient and outpatient treatments (except in the Gold Lite plan where outpatient benefit is available only for 90-day pre & post hospitalization coverage). The policyholder can choose his own doctor even outside AXA’s medical network. This is one distinction of GHA from the regular HMO where the physician must be accredited by the HMO. It is cashless—meaning payments are made to the hospitals and the doctors directly with the patient not touching a single amount in cash. This feature makes GHA unlike a health insurance product where payments are made to the insured. And this is why it is HMO-like.
Of course, there are also value-added services such as the global concierge, the international emergency medical assistance, the road ambulance transport services, and a 24/7 health support. GHA is available (issue age) to a person as young as 15 days old and up to the age of 70. It is guaranteed renewable until the age of 99. The policyholder must be at least primarily residing in the Philippines.
Since there are five Plan Options with differing features, we will adopt the GOLD PLAN for purposes of discussion and presentation. It is the second most comprehensive of the plans. It has a yearly coverage limit of P100 million. Just like the Platinum Plan, it offers all the major product specifications: Inpatient, Outpatient, Alternative Treatments (wellness), Maternity/Optical/ and Vaccination, Health Screen/ Psychiatric, and Dental. In comparison, Gold Lite, the least comprehensive, only offers Inpatient and Health Screen/Psychiatric products. An inpatient coverage includes surgery, consultations, organ transplants, consumables, and surgical implants.
Its outpatient benefit is limited up to P300,000. Alternative treatments are limited up to P60,000. The Health Screen is limited up to P40,000 per year with inner limit of P2,500 for over the counter vitamins and supplement reimbursements. Other benefit coverages include maternity, optical, dental, vaccination, hospice, and second medical opinions. For daily accommodation charges, outside the Philippines, it is limited to a standard single room. For within the Philippines, it is limited to P15,000 per night. For the accommodation of a companion, it is limited to P8,000 per night. There is also a cash benefit of P10,000 per night. There is a benefit for hospice and palliative care with a lifetime benefit limit of P1,250,000. But this is available only after 12 months of cover. There is also an HIV/AIDS lifetime benefit of P2 million.
Inpatient rehabilitation is available for a limit of 28 days. For Outpatient services, primary and specialist care, diagnostic scans including physiotherapy, occupational therapy, and speech therapy, are limited to P300,000. Other outpatient services also available are: a) pre & post hospitalization outpatient treatment (within 90 days prior to hospital admission and 90 days following discharge from hospital); b) radiotherapy and chemotherapy; c) kidney dialysis treatment; d) surgical procedures received as an outpatient; and e) alternative treatment including consultation and treatment, prescribed vitamins and supplements, which is limited to P60,000.
Maternity, Dental, Wellness and Optical benefits are available as well. For the maternity, pregnancy and delivery is covered up to P200,000. Routine dental and restorative dental care (available after six months only) is covered 80 percent of eligible expenses up to P60,000. For Wellness, psychiatric treatment is available up to P400,000. Vaccination is covered up to P15,000. Finally, routine optical care is covered up to P12,000. The coverages are subject to exclusions such as congenital diseases, developmental delays, illnesses due to dangerous sports, treatments as a result of alcohol abuse and drug abuse, self-inflicted injuries, sexually transmitted diseases (except HIV/AIDS acquired occupationally or through blood transfusion), among others.
For my age bracket, all these are available for an annual premium of a ball park amount of P184,320, payable annually or semi-annually. For a 35-year-old, annual premiums can be as low as only P49,900 for a P100 million coverage.