PhilHealth pact eyes cheaper private health plans

State health insurer PhilHealth and private health maintenance organizations signed an agreement Thursday to integrate coverage frameworks, a move expected to lower private insurance premiums as PhilHealth expands its outpatient services.

Under the memorandum of understanding on benefit complementation, PhilHealth will act as the primary payer for medical services. Private insurers and HMOs will cover remaining costs or expenses beyond the state insurer’s limits.

PhilHealth acting president and CEO Dr. Beverly Lorraine C. Ho said the setup will eliminate duplicative coverage for the estimated 7 to 10 percent of Filipinos enrolled in both PhilHealth and private health plans.

The partnership comes as PhilHealth expands its coverage to include emergency services, cancer screenings, and outpatient prescription drugs — areas historically covered by private insurers.

“Now that we have it, as we become the first payer, some adjustments need to happen,” said Atty. Ermar U. Benitez, officer-in-charge of the Insurance Commission.

Christian S. Argos, president and CEO of Maxicare and chairman of the Philippine Association of Health Maintenance Organization Companies, said private insurers can now reallocate coverage toward specialized services, such as mental health care, vaccinations, and critical illness benefits.

Argos added that having PhilHealth absorb the baseline costs for outpatient services could lead to more affordable HMO policies.

“If we can create outpatient products with PhilHealth as the first payer, then more people can actually buy an HMO product because it will be cheaper,” Argos said.