Stricter regulation of HMO sector pushed

The Insurance Commission (IC) is pushing for stricter regulation of health maintenance organizations (HMOs) through a law ensuring that consumers will be better protected.

Insurance Commissioner Dennis B. Funa told reporters that legislation would be the best course to better regulate HMOs, similar to the move to institutionalize a Pre-Need Code for the troubled sector years back.

Funa admitted that existing regulations covering HMOs have “holes” and were limited to the executive order (EO) issued by former President Aquino that transferred regulatory oversight to the IC as well as a number of circulars it issued in the past two years.

The supervision of the HMO sector was moved to the IC from the Department of Health through EO No. 192 issued in 2015.

“There are a number of issues to be tackled—capitalization, for example. How much capital should we really require for HMOs? And can we do that just by issuing an office order or a circular letter? So to have it clarified by legislation would, of course, be the best,” Funa said.

Also, “the big issue now is how to settle disputes between HMO companies and their members or plan holders—who will have jurisdiction over those disputes?” Funa added.

“What we have now is a mediation process that just bring the parties together, let them talk and see if they can settle. We have a bill of rights, but that pertains to insurance companies,” Funa noted.

Funa said that the IC has a group working on a draft bill, which they aim to finish within the year.