More benefits, wider coverage for PhilHealth members in 2024

State health insurance chief Emmanuel R. Ledesma Jr. assures President Ferdinand R. Marcos Jr. that members and their beneficiaries can expect better and more responsive health benefits packages that they can avail of at any accredited health facility nationwide.

“Nasimulan na po natin ang pagpapabuti ng ating mga benepisyo sa nakaraang taon, at magpapatuloy po ito ngayong 2024. Marami kaming nakalatag na enhancements na siguradong mararamdaman ng mga miyembro dahil sa mas mababang bayarin sa ospital, kung hindi man wala nang babayaran pa,” he declared.

The PhilHealth chief’s pronouncement came on the heels of President 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”.

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,” said Ledesma.

Coverage for breast cancer under its Z Benefits Package also jumped from P100,000 to P1.4 million or an increase of 1,300 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.

PhilHealth also significantly increased its coverage for certain conditions that are included among the high burden disease 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”, 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," he added.

For 2024, members have more to expect from PhilHealth. “We will rationalize case rates for bronchial asthma and bacterial sepsis in newborns and COVID-19 inpatient benefits,” said Ledesma. He further said that guidelines for outpatient therapeutic care benefits package for severe acute malnutrition in children aged 5 years old and below and services for physical medicine and rehabilitation will also be expected this year.

Another benefit to look forward to is the enhancement of peritoneal dialysis under the Z Benefits Package.

“This is where the importance of adjusting our contribution rates comes into play. It will generate funds necessary for us to complete our benefit plans, and more importantly to sustain the reforms in the benefit packages,” he stressed.

For 2024, the Agency has allotted some P243 billion to pay for these benefits, P30 billion of which is earmarked for its PhilHealth Konsultasyong Sulit at Tama or Konsulta package. The Konsulta will be further expanded to include treatment for TB, animal bite, malaria and HIV/AIDS. This is in addition to expanding coverage for medicines from the current 21 to 53 through PhilHealth's Guaranteed and Accessible Medications for Outpatient Treatment or GAMOT.

"We are set to expand access points for these medicines by engaging pharmaceutical service entities to make these essential medicines within reach by our Kababayans needing them," Ledesma vowed.