Legarda proposes measure to reward loyal PhilHealth members with better benefits

Senator Loren Legarda has filed a bill seeking to recognize and reward long-term PhilHealth contributors through the proposed PhilHealth Member Recognition Program (PMRP), a points-based system aimed at providing additional benefits to members with consistent premium payments.

Under the bill, members will receive retroactive recognition for up to 10 years of past contributions or from the start of their membership, whichever is shorter. Accumulated points can be redeemed for additional healthcare benefits, coverage of out-of-pocket expenses, improved accommodations, preventive care services, and non-medical health-related support.

“Many of our workers, from factory employees to small business owners, have faithfully contributed to PhilHealth for years, hoping for comprehensive support during times of need. Yet, they often feel that their contributions don’t translate into meaningful benefits,” Legarda said. “This bill seeks to right that wrong by acknowledging their loyalty and ensuring they feel valued within the system.”

The bill also proposes loyalty bonuses for members with five, ten, or twenty years of uninterrupted contributions. Members can transfer accumulated points to family members for emergencies, offering more flexibility in benefit utilization.

The PMRP aims to keep PhilHealth relevant and responsive to its members by encouraging the adoption of emerging trends and reimagining its approach.

The bill also seeks to address one of the most common criticisms of PhilHealth: the perception that contributors receive little in return for their years of financial support. Many members have complained that despite regular payments, their benefits barely cover medical expenses, often leaving them with significant out-of-pocket costs.

Employers striving to support their employees are often compelled to secure private medical insurance to fill the gaps left by PhilHealth. Furthermore, many direct contributors, particularly employees or those on minimum wage, are forced to turn to other government programs, relying on the discretion and goodwill of those responsible for approving their applications.

Preventive healthcare and digital integration

Another key feature of the bill is its focus on preventive healthcare. Members can earn additional points by availing themselves of preventive services such as vaccinations, annual check-ups, and health screenings. This approach also benefits PhilHealth, as maximizing preventive healthcare helps reduce the occurrence of emergency situations and costly medical procedures, ultimately lowering expenses for both the program and its members.

To ensure transparency and ease of use, the bill mandates the creation of a digital platform where members can track their points, redeem benefits, and nominate beneficiaries for transferable points.

Safeguarding sustainability

The bill also includes strict safeguards to ensure the program’s sustainability. Redemption caps, point expiration policies, and periodic actuarial reviews will be implemented to prevent financial strain on the National Health Insurance Fund (NHIF).

“Financial sustainability is a priority. We’ve designed the PMRP to strike a balance between rewarding loyalty and maintaining the stability of the fund,” Legarda emphasized.

“We owe it to our long-term members to make them feel their contributions matter. This is not just about insurance; it’s about fairness, recognition, and building trust in a system meant to serve all Filipinos,” Legarda concluded.

After the implementation of the program, PhilHealth will conduct a comprehensive review to assess its financial impact, particularly its sustainability and strain on the National Health Insurance Fund (NHIF). This evaluation will include a study of whether the program can be expanded to include indirect contributors, such as indigents and sponsored members, without compromising the corporation's financial health.

“We just need data based on actual implementation to determine if the program can be extended to include indirect contributors in the future,” Legarda stated.

Legarda’s proposed bill not only seeks to reward loyalty but also aims to rebuild trust and ensure a more equitable and sustainable health insurance system for all Filipinos.