Enhanced PhilHealth benefits on track, more to expect this year — Ledesma

State health insurance members and their beneficiaries can expect better and more responsive health benefit packages which can be availed of at any accredited health facility nationwide.

Declared Philhealth CEO Emmanuel R. Ledesma Jr., “We have already started improving our benefits last year and this will continue in 2024. We have many enhancements in place that members will definitely feel because of lower hospital bills or because there will be nothing to pay at all.”

This pronouncement by Ledesma came on the heels of President Ferdinand Marcos Jr.’s recent call that “any increase in premium will substantially be much more in value in terms of benefits and coverage to PhilHealth members.”

Already in effect

Ledesma recently announced that the 30-percent increase in most of its case rate packages already took effect for all admissions starting 14 February 2024, the first time that an across-the-board increase was implemented since the all case rate scheme was launched in 2013. “The 30 percent increase in case rates will restore substantial coverage affected by health inflation,” Ledesma said.

Coverage for breast cancer under its Z Benefits Package also jumped from P100,000 to P1.4 million or an increase of 1300 percent.

In 2023, the PhilHealth Board approved the expansion of its coverage of hemodialysis from 90 to 156 sessions per year. This has increased the annual benefit coverage of patients with Chronic Kidney Disease Stage 5 to P405,600 from P234,000. In 2023, PhilHealth paid a total amount of P17.43 billion for hemodialysis claims alone.

Significant increase in coverage

PhilHealth also significantly increased its coverage for certain conditions that are included among high burden diseases in terms of finances and effect on the quality of life of patients.

It increased the benefits packages for acute ischemic stroke from P28,000 to P76,000; and acute hemorrhagic stroke from P38,000 to P80,000. Ledesma said these two packages alone have increased by 200  percent.

“Para naman sa mga may high-risk pneumonia, halos na-triple po ang benepisyo mula P32,000 to P90,100 (For high-risk pneumonia patients, the benefits have almost tripled, from P32,000 to P90,100”)” adding that PhilHealth even improved its Z Benefits Packages for colorectal cancer and on selected orthopedic implants.

In October last year, it launched the Outpatient Mental Health Package which provides outpatient coverage for general and specialty mental health services for P9,000 and P16,000 per patient annually, respectively. 

The agency is partnering with the National Center for Mental Health for the initial implementation of the package and is currently contracting more providers at the grassroots level to make this even more accessible to more than three million Filipinos with mental health conditions.  

PhilHealth was able to implement the benefits enhancements despite the suspension of the scheduled adjustment in contribution rate in 2023 from 4 percent to 4.5 percent.

“Our commitment to continuously provide Filipinos with responsive benefit packages remains, as guided by our thrust of “Pinalawak at mga Bagong Benepisyo para sa Mamamayang Filipino (Expanded and New Benefits for Filipino Citizens),” he added.