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    Date: 2023-10-11 10:40:23.162612

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    Date: 2023-10-13 10:06:49.133188

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    Date: 2023-10-17 15:34:00.530160

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Follow-up on #IC-832845456482

Requested from IC by K. Doering at 10:40 AM on Oct 11, 2023.
Purpose: Transparency
Date of Coverage: 10/11/2023 - 10/11/2023
Tracking no: #IC-982747306021

Doering 10:40 AM, Oct 11, 2023 

Good day!

First of all thanks for the fast and comprehensive response.

Looking at the data it seems that the HMOs are losing right now quite substantially. Does the Insurance Commission check on reasons and even interfere?

HMOs are profit-driven and not charitable institutions. They only insure healthy people who are able to pay the premium. If HMOs are losing money (and I see a trend) what is the Insurance Commission doing with this information? Simply gathering them? Do you ask HMOs for reasons why their claims are increasing to the point that they are losing money?

Regards,

Kai

Ignacio 10:06 AM, Oct 13, 2023 

October 13, 2023

Dear Mr. Doering,

Thank you for your request dated Oct 11, 2023 under Executive Order No. 2 (s. 2016) on Freedom of Information in the Executive Branch, for Follow-up on information of HMO losses.

We received your request on Oct 11, 2023 and will respond on or before Nov 01, 2023 10:40:23 AM, in accordance with the Executive Order's implementing rules and regulations.

Should you have any questions regarding your request, kindly contact me using the reply function on the eFOI portal at https://foi.gov.ph/requests/aglzfmVmb2ktcGhyHAsSB0NvbnRlbnQiD0lDLTk4Mjc0NzMwNjAyMQw, for request with ticket number #IC-982747306021.

Thank you.

Respectfully,

Edmar Ignacio
FOI Officer

Vinzon 03:34 PM, Oct 17, 2023 

October 17, 2023

Dear Mr. Doering,

Greetings!

Thank you for your request dated Oct 11, 2023 10:40:23 AM under Executive Order No. 2 (s. 2016) on Freedom of Information in the Executive Branch.

Your Request

You asked for follow-up on information on HMOs losses.

Response to Request

In relation to your request, please be informed of the following as advised by our Health Maintenance Organizations (HMO) Division:

HMO Division is mandated to examine the financial condition of HMOs and monitor their compliance with the following regulatory requirements set forth by the Insurance Commission: (1) Net Worth, (2) Acid-Test Ratio, and (3) Risk-based Capitalization.  In case the losses incurred by the HMO will result to a deficiency or non-compliance in any of the regulatory requirements mentioned above, the Commission shall issue regulatory actions based on Circular Letter No. 2016-41 (attached herewith for reference) for the HMO to cover-up the deficiency and comply with the regulatory requirement.

As regards the claims increases and financial losses, determining the reasons for these necessitates further research which is outside the purview of the division.

For further inquiries, you may contact our Health Maintenance Organizations Division at 8523 8461 local 156.

For your information and guidance.

If you are unhappy with this response to your FOI request, you may ask us to carry out an internal review of the response by email at icrecords-foi@insurance.gov.ph. Your review request should explain why you are dissatisfied with this response, and should be made within 15 calendar days from the date when you received this letter. We will complete the review and tell you the result within 30 calendar days from the date when we receive your review request.

If you are not satisfied with the result of the review, you then have the right to appeal to the Office of the President under Administrative Order No. 22 (s. 2011).

The quality of services you deserve matter to us. To help the Insurance Commission monitor the progress in improving its services, we appreciate accomplishing the Customer Satisfaction Surveys (CSS) through the following link: https://bit.ly/ICCustomerSatisfactionSurvey

Thank you.

Respectfully,

Atty. Albert Lawrence Vinzon
FOI Decision Maker

Attachments:
 CL No. 2016-41_Minimum Capitalization and Financial Capacity Reqt for HMOs_PRENEED.pdf

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