PhilHealth, HMOs team up to lower health care costs

The Philippine Health Insurance Corp. and 13 major health maintenance organizations and private health insurers have agreed to coordinate benefits to help reduce out-of-pocket health care expenses.

PhilHealth Acting President and CEO Dr. Beverly Ho and representatives of the participating insurers signed a memorandum of understanding on 1 October in Manila for the Yaman ng Kalusugan Program-HMO/PHI Benefit Complementation initiative.

Under the agreement, PhilHealth will serve as the first layer of coverage for primary care services through YAKAP, while HMOs and private insurers will provide additional benefits.

Private insurers may cover costs that exceed PhilHealth benefit limits or fall outside primary care coverage, including specialized procedures, branded medicines and hospital room upgrades.

“With PhilHealth YAKAP as the first layer of protection, our private partners can focus their benefits on what lies beyond the program package,” Ho said.

“That way, every Filipino gets more care for every peso,” she added.

YAKAP covers consultations, 13 laboratory tests, selected outpatient medicines and outpatient services for six cancer screening tests.

Participating insurers include Maxicare Healthcare Corp., MediCard Philippines Inc., PhilhealthCare Inc., Health Plan Philippines Inc., United Coconut Planters Life Assurance Corp., Intellicare, Medicare Plus Inc., Avega Managed Care Inc., Cooperative Health Management Federation, Pacific Cross Health Care Inc. and iCare.