DOH turning over HMOs to IC

MANILA, Philippines - The Insurance Commission (IC) is poised to take over the health maintenance organization (HMOs) industry.

IC commissioner Emmanuel M. Dooc revealed that a memorandum of agreement (MOA) will be signed with the Department of Health (DOH) transferring in principle the financial sector to the commission.

“We are also working with our legal team on the fastest and legal means of actually taking over the regulatory functions,” Dooc said.

There appears to be two options: through legislation or through the executive power of the President.

Industry sources said the fastest route would be through an Executive Order since the Department of Finance (DOF) is rumored to be batting for the regulatory transfer by yearend.

The same sources said the HMO is just another variant of health insurance, which is already being offered by life insurers.

“In fact, life insurers are launching new health-related products this year,” they added. 

Presently, the IC regulates the life and non-life insurance sectors as well as the pre-need industry.

The Securities and Exchange Commission (SEC) first regulated the HMO industry in the ‘70s, before it was transferred to the DOH, through a memorandum of agreement.

In 1993, the HMO industry urged the DOH and the IC to jointly regulate the industry. The rational behind the request being that the IC had the actuarial capability, not the health department.

Then in 2002, HMO players asked the IC to take over the industry, roughly the same time that the pre-need industry was likewise in the process of being transferred from the SEC to the IC.

There are reportedly 3.3 million HMO card members based on 2011 data.

There is no official consolidated data on the value of business or the actual number of card-bearing members of the industry.

There are only about 17 reputable HMOs, and a large number of “unregulated” smaller players.