PhilHealth commits enhanced benefits

State health insurer Philippine Health Insurance Corporation (PhilHealth) has committed to continue expanding its benefit packages following a series of enhancements introduced last year.

PhilHealth president and CEO Emmanuel R. Ledesma Jr. reaffirmed the agency’s top priority.

“It cannot be denied that members are beginning to experience significant improvements in PhilHealth benefits. We started with dialysis by fully covering all sessions for the year and increasing the payment per session,” Ledesma reported.

PhilHealth’s coverage for dialysis has increased from 90 to 156 sessions, and payment per session has been raised by 51 percent from P2,600 to P4,000.

“This means patients can now enjoy up to P624,000 in annual coverage from the previous P405,600. Additionally, the benefit has been institutionalized and subject to ‘no balance billing’ which means patients no longer have to pay on top of the increased package rate,” he said.

“We hear the concerns of our kababayans about the high cost of medical treatment. We see and feel this in our interviews with patients. We are expediting the improvement of benefits. We started with chronic illnesses because treatments for breast cancer, pneumonia, stroke, asthma and others can be financially draining,” explained the PhilHealth chief.

“We ask for a little understanding from our kababayans because the expansion of services goes through a thorough process of study, not only to ensure it is done properly but also to launch it in a way that will benefit the majority. Our team is working tirelessly to ensure that patients feel the care of our national health insurance system,” he added.

The health insurance agency has doubled coverage for hemorrhagic stroke (P80,000 from P38,000), ischemic stroke (P76,000 from P28,000), bronchial asthma (P22,488 from P9,000) and neonatal sepsis (P25,793 from P11,700), among others.

Coverage under its Z Benefit Package for breast cancer has likewise been significantly increased from P100,000 to up to P1.4 million. It also added ultrasound and mammograms to the Konsulta Package to promote early detection of breast cancer among women. These additions are on top of the existing 13 laboratory tests and 21 medicines already available from over 2,000 Konsulta providers across the country that can be availed of free-of-charge once recommended by the provider.

In February, PhilHealth also raised the case rates packages by 30 percent. Another round of 30 percent increase is set before the end of 2024. Private Hospitals Association of the Philippines president Jose Rene de Grano confirmed during a recent meeting that, “there was an increase by 30 percent and I think another 30 percent,” he said.

Members can also expect an increase in benefits for chemotherapy covering lung, liver, cervical, and prostate cancers, along with emergency care, open-heart surgeries, ischemic heart disease, cataract extractions, peritoneal dialysis, post-kidney transplant care, and severe dengue treatment also this year.