Case Study #1

Multinational company with 4000 employees

Provider: HMO with an Annual Benefit Limit of 90,000/head

Annual Utilization: 20M

A multinational company approximately 4000 employees nationwide can harbor either an HMO or TPA party. Using the variable stated above as an example, the company that decides to avail of an HMO paid an outright premium of 32M. A company chooses a TPA with the same benefits as HMO should have saved 12M.

Under TPA, the company pays for the amount of actual utilization spent. Between TPA and HMO the noticeable difference lies on the amount of savings, with the same benefit specifications.

 

Case Study #2

A national company with 500 employees

Provider: Self administered

A local company with 500 employees that avail of MEDI-access under self-insured/self-managed program now have the advantages of a TPA program which offers an array of extensive network, more panels of medical physicians, no more hospital bond requirements, proactive wellness program at no cost and ultimately significant savings because rates are negotiated.

 

Case Study #3

Multinational company (Metro Manila base) with 600 heads

Provider: TPA or an HMO

A multinational company based in Metro Manila which has 600 employees and dependents enrolled under another TPA provider, shifted to MEDI-access. Eighty percent of availment is on out patient. Substantial savings of 15% since MEDI-access does not charge administrative fee for all availments done in Healthway Clinics.

Other Scenarios

1. An executive of a multinational company has a Maximum Benefit Limit (MBL) of PHP 100,000/year. Given the circumstance wherein his hospitalization bill amounts to twice his MBL (PHP 200,000) in an HMO he will be asked to pay the total amount outright. However with TPA, the flexibility allows the executive to be discharged with no cash out upon approval of the HR Department. The Human Resources Department deducts the exceeding amount of bill from the salary.
2. In a situation where employees would like to extend benefits other than the immediate family, TPA can perhaps be referred as ideal. An HMO plan strictly follows what they call “underwriting guidelines” which basically constitutes the following:

2.1) Hierarchy

A. For Married: Declare immediate family in the following order:

· Spouse

· Eldest child to youngest child

B. For Single:

· Parents not more than 65 years of age

· Siblings not more than 21 years of age

2.2) Age

A. Siblings and Children no more than 21 years of age

B. Spouse and parents no more than 65 years of age

On the other hand, primarily because of its flexibility and convenience, TPA has no underwriting guidelines of hierarchy and age limit. Clients have all the freedom to declare whomever they want as dependents.