In light of the death of one of its beneficiaries, a former lawmaker called on the Philippine Health Insurance Corporation (PhilHealth) to revisit its policies that have caused more harm than good to its beneficiaries.

Bagong Henerasyon Partylist spokesperson Bernadette Herrera said that the unfortunate incident that happened to Marvin Sulit, a PhilHealth member, was a reminder of the constant struggle of many ordinary Filipinos in the country.

Sulit had died due to a brain hematoma last 5 June as his family was not able to afford an emergency surgery at Manila Doctors Hospital which was said to have cost around P4 million.

His wife, Maria Lourdes was subsequently left with around a P200,000 hospital bill as PhilHealth was not able to provide coverage because of its minimum confinement requirement.

Under the Health Corporation’s benefit conditions, a patient must be admitted to a hospital for at least 24 hours before they would qualify to receive the full inpatient benefits.

However, under PhilHealth Circular 2024-0033, an individual may still be eligible for Outpatient Emergency Care Benefit under emergency circumstances that lead to their death even before reaching the full day threshold.

“This is not an isolated incident. This is not a simple oversight. This is a systemic issue. The goal should not be to fix one case at a time after public outrage. The goal is to fix the policy so that the same injustice does not happen again,” Herrera said.

The former lawmaker stressed that some people manage to get around the issue through being familiar with a member of the corporation who can assist them with receiving the benefits they are entitled to.

Citing her personal experience, Herrera said that she had a family member who had a similar case with Marvin. She noted that the only way she was able to receive the Emergency Benefit Package was because of their access to PhilHealth Vice President Bernadette Lico.

In spite of the seemingly positive outcome of her case, she noted that such a luxury was in reach for everyone.

“How about people that do not know anyone at PhilHealth? How about families that don’t have a public platform, no media attention, and no one they could call? Government service should work whether you know someone or not,” she said.

Doubling down on her point, Herrera expressed that such policy revisions should not only come at a point when someone was already affected by the issue and publicized through reports.

She said that changes in the requirements of PhilHealth should happen as there are many more Filipinos facing the same issue or other pertinent concerns suffering on a daily basis.

“When one member of PhilHealth pays for their membership, receives medication, gets confined in the hospital, and in some instances die while their confined, is told that they are not qualified for the Emergency Benefit Package because they were confined for less than 24 hours, clearly something needs to change,” the partylist spokesperson expressed.

PhilHealth has since come out with a statement wherein it explained that it has already coordinated with both the family of the victim and the hospital that was involved in the issue.

The corporation assured that it was taking into consideration the full circumstances in order to improve its responsiveness to such problems.

“Please know that PhilHealth will always stand with our members, especially in their time of need,” the statement read.