1COOP HEALTH HMO PROGRAM FAQ
I. PROGRAM OVERVIEW & TIMELINE
1. What is the new HMO provider? The new provider is 1COOP Health, a specialized healthcare program tailored for cooperative members.
2. If I avail, when will I be able to use it? Once payment is received, we will endorse your enrollment to 1Coop Health. After endorsement, your Certificate of Coverage (COC) will be issued as proof of enrollment, and you may immediately use your HMO benefits.
3. Until when is the coverage valid? Regardless of when you register, HMO coverage will end on December 31, 2026.
4. What is the deadline for enrollment and payment? We are processing enrollees in three batches:
- Batch 1: Deadline was December 23, 2025.
- Batch 2: Deadline was January 10, 2026.
- Batch 3: The deadline is January 20, 2026.
All forms and payments must be submitted by these dates to ensure coverage.
5. Is there a minimum number of enrollees required? Yes. To maintain the quoted premium rates, a minimum of 100 enrollees (comprising the combined total of primary members and dependents) is required.
6. Is there a subsidy from the cooperative for this program? No. This program is offered to members with no subsidy. Members are responsible for paying the full premium amount.
II. ELIGIBILITY & DEPENDENT ENROLLMENT
7. Who can I enroll as a dependent? 1COOP Health offers maximum flexibility. Unlike previous providers with strict hierarchies, you can enroll any dependent (related or non-related) as long as they are endorsed by you, the principal member. You can access the registration form HERE.
8. How many dependents can I enroll? There is no limit to the number of dependents you can enroll, provided you can cover their individual premiums.
9. What is the age range covered? Coverage is available for individuals aged 1 year old up to 75 years old.
Note: Over-aged enrollees (66–75) must not exceed 10% of the total group enrollment.
10. What information is required for enrollment? For each enrollee, you must provide:
- Full Name
- Birth Date
- Gender (Male/Female)
- A government-issued ID (recommended)
- A signed declaration stating the principal member is responsible for the enrollees (Included on the last page of the registration form).
III. PREMIUMS, BILLING & HMO LOANS
11. What is the semiannual premium per enrollee? Premiums vary by age group for the Semi-Private room category:
- Ages 1 to 4: ₱12,510.00
- Ages 5 to 11: ₱10,480.00
- Ages 12 to 65: ₱8,450.00
- Ages 66 to 70: ₱16,900.00
- Ages 71 to 75: ₱25,350.00
12. How do I receive my Statement of Account (SOA)?
- Direct Payment: If you pay semi-annually on your own, you will receive an SOA for the full semi-annual period.
- HMO Loan: If you avail of the loan, you will receive an SOA for the initial cash-out of ₱2,500 per enrollee (primary and dependents included).
13. How can I pay the premiums? Payments can be made via Dragon Pay or a specific payment link provided to members.
14. What are the terms of the HMO Loan?
- Loan Limit: Up to a maximum of ₱50,000.
- Excess Balance: Any amount exceeding the ₱50,000 limit (after the initial cash-out) must be paid by the member upfront.
- Repayment: Payable within 3 to 6 months at a diminishing interest rate.
- Amortization: You will receive a separate email from the Credit and Savings Department regarding your monthly loan schedule.
IV. MEDICAL BENEFITS & COVERAGE
15. What is the Maximum Benefit Limit (MBL)? The plan provides a benefit limit of ₱70,000 per illness.
16. Are pre-existing conditions covered? Yes, pre-existing conditions are covered under this proposal.
17. Which major hospitals are included? Members have access to the "Top 6" major hospitals:
- Asian Hospital
- Cardinal Santos
- Makati Medical Center
- St. Luke’s (QC and Taguig)
- The Medical City
You may also access this link to view all accredited hospitals and clinics: https://dev.chmf.coop/accredited-providers-2/
18. Are there special limits for older enrollees? For members aged 66 to 75, "Dreaded Diseases" are capped at ₱5,000 per year, and injuries from Motor Vehicular Accidents are not covered.
19. Does the plan include a death benefit? Yes. Financial assistance is provided to beneficiaries:
- Natural Death: ₱10,000.00
- Accidental Death: ₱20,000.00
V. EMERGENCY & REIMBURSEMENT PROCEDURES
20. What should I do in an emergency at a non-accredited hospital?
- Seek treatment at the nearest facility.
- Notify the cooperative or 1COOP Health within 24 to 48 hours.
- Pay the bills upfront and secure all original receipts and medical documents.
21. How do I file for reimbursement? Submit the original Clinical Summary, Itemized Statement of Account, and Official Receipts within 30 days of discharge. Processing typically takes 15 to 30 working days.
22. How does PhilHealth affect my claims? PhilHealth is "first-payor." You must file your PhilHealth benefits at the hospital during discharge. 1COOP Health will only cover the costs remaining after the PhilHealth portion has been deducted.
VI. SUBSTITUTION POLICY
23. Can I substitute my current HMO slot with another member? Yes, you may substitute an enrolled slot with another person, provided specific conditions are met.
24. What are the conditions for substitution? To qualify for substitution, the following must be met:
- Endorsement Required: The request must be endorsed by the cooperative.
- Same Tier: The replacement must be within the same age group/tier as the original enrollee to ensure there is no difference in the premium already paid.
- No Availment: The current HMO plan must not have been used yet. If any benefits have been used, substitution is no longer possible.
- Deadline: Requests for substitution are only allowed until January 30, 2026.
25. How do I file a substitution request?
- Submit your request through a ticket via support.omsmpc.com.
- Our team will review the request and verify if the account is eligible.
- The cooperative will coordinate directly with 1COOP Health to process the endorsed substitution.