PhilHealth, private insurers team up to expand primary care coverage

The Philippine Health Insurance Corp. and major health maintenance organizations and private health insurers have partnered to expand primary care coverage and reduce out-of-pocket expenses for Filipinos.

PhilHealth and participating insurers signed a memorandum of understanding establishing the PhilHealth YAKAP-HMO/PHI Benefit Complementation initiative in support of the Universal Health Care law.

Under the arrangement, PhilHealth will serve as the first layer of coverage for primary care services through its Yaman ng Kalusugan Program, or YAKAP. HMOs and private insurers will then provide additional benefits for expenses beyond PhilHealth coverage.

“With PhilHealth YAKAP as the first layer of protection, our private partners can focus their benefits on what lies beyond the program package. That way, every Filipino gets more care for every peso,” PhilHealth Acting President and CEO Dr. Beverly Lorraine Ho said.

Finance Secretary Frederick Go, who sits on the PhilHealth board, said the partnership aims to provide a more integrated health financing system.

“Together, we can establish a system that builds a healthier, more productive Philippines–where quality healthcare empowers every Filipino to drive the nation forward,” Go said.

Private insurers may cover expenses exceeding PhilHealth benefit limits or services outside primary care packages, including specialized procedures, branded medicines and hospital room upgrades.

YAKAP covers consultations, 13 laboratory tests, selected outpatient medicines under the GAMOT package and six outpatient cancer screening tests.

PhilHealth said other specialized outpatient benefits may also cover animal bite treatment, maternal care, tuberculosis treatment, HIV/AIDS management and mental health services, where applicable.

The agency said integrating YAKAP with private insurance policies is intended to avoid duplicate payments and reduce expenses shouldered directly by patients.

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., iCare, Manulife Philippines and InLife Benefits Insurance Co. Inc.

PhilHealth urged members to register for YAKAP through the eGovPH app, the PhilHealth Member Portal or a PhilHealth office.