PhilHealth increases dialysis coverage to P1 million per year

The Philippine Health Insurance Corporation (PhilHealth) has implemented a second increase in its benefit package for hemodialysis this year, raising it from P4,000 per session in July to P6,350 per session in October.

This adjustment brings the total financial package to nearly P1 million per patient per year.

Effective 7 October, PhilHealth members and their qualified dependents with chronic kidney disease stage 5 (CKD5) can now avail of the adjusted package for hemodialysis at any accredited dialysis facility near them.

PhilHealth president and CEO Emmanuel R. Ledesma, Jr. stressed that this increase demonstrates the agency's commitment to listening to its members and ensuring that benefit packages adequately address their needs.

Despite the 1 July increase in reimbursement rate, PhilHealth received reports of patients still paying significant amounts for their dialysis sessions. The agency aims to eliminate co-payments for the minimum set of dialysis services.

Ledesma acknowledged the swift action of the PhilHealth Board, led by Health Secretary Ted Herbosa, in approving the increase to P6,350 per session without additional charges to patients. He also cited the cooperation of nephrologists and participating dialysis centers in making the no co-payment arrangement possible.

With the increase to P6,350 per session, a CKD5 patient is now entitled to a maximum of P990,600 in financial protection per year, from the previous P624,000/year at P4,000/session.

The PhilHealth Circular No. 2024-0023 clearly specifies the essential services required and should be provided to CKD5 patients, including anti-coagulation medications, anemia management drugs, laboratory tests, supplies, and administrative fees. These services should be accessible at all times in accredited public and private hemodialysis facilities.

Patients requiring additional or premium services beyond the minimum standard of care will be subject to co-payment, with a cap of P450 for professional fees. Dialysis facilities are required to fully explain any co-payments to patients.

This life-saving service has brought new hope to dialysis patients like Roseanne Lappay of Tabacalera, Pateros.

Ledesma assures all PhilHealth members, both in the Philippines and abroad, that PhilHealth is committed to fulfilling its promises. He encourages all Filipinos to seek medical treatment without fear, as PhilHealth will cover their expenses.