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PhilHealth launches new, expanded benefits


PhilHealth launched a set of new and expanded benefit packages that Filipinos can avail this year.

The Philippine Health Insurance Corp. (PhilHealth) on Friday launched a set of new and expanded benefit packages that Filipinos can avail this year.

At the PhilHealth stakeholders’ meeting in Pasig City, PhilHealth president and CEO Emmanuel Ledesma Jr. said that the state health insurer came out and published the necessary policy instruments or circulars for its new and enhanced packages.

The newly introduced and expanded packages are as follows:

  • Ischemic Heart Disease-Acute Myocardial Infarction consists of four different packages: Percutaneous Coronary Intervention (PCI) or coronary angioplasty at P524,000 from P30,300, increased by over 1,600%, Fibrinolysis at P133,500 from P30,290 or a 900% increase, Emergency Medical Services with Coordinated Referral and Interfacility Transfer at P21,900, and Cardiac Rehabilitation after PCI at P66,140.

 

  • Z Package for Peritoneal Dialysis (PD) now covers Continuous Ambulatory Peritoneal Dialysis (CAPD) for adults while CAPD and Automated Peritoneal Dialysis for pediatric patients. For adults, PD Z Benefits have been set at P389,640 and P510,140 depending on the required PD solutions a patient requires per day. The packages increased by up to 89% from the previous P270,000 per year. Meanwhile, PD Z Benefits for pediatric patients under the CAPD are set at P510,000 and P765,210 while coverage for APD ranges from P763,000 to P1.2 million. PhilHealth also pays for exit site infection and peritonitis prevention care. These can be availed at any of the 51 accredited PD providers nationwide.

 

  • Z Package for Kidney Transplantation now covers Living Organ Donor Transplantation, increasing the previous coverage of P600,000 to over P1 million, or a substantial increase of 74%. Deceased Organ Donor Transplantation is set at P2.14 million.

 

  • Preventive Oral Health Services as part of primary care services —a historic first to be included in the country's national health insurance under its Konsultasyong Sulit at Tama or Konsulta package. Includes mandatory services such as mouth examination or oral screenings, dental pes milaxis (cleaning), and fluoride varnish application. Coverage also extends to pit and fissure sealants and Class V restoration procedures (limited to two teeth per year) and emergency tooth extractions, when necessary and performed in accredited health facilities.

 

  • Outpatient Emergency Care Benefit which provides comprehensive coverage for emergency services, focusing on two main components: Facility-Based Emergency and Pre-hospital Emergency benefits. These cover essential care in accredited hospital Emergency Departments (EDs) and emergency transport services for cases that do not result in hospital admission and may be availed of in OECB accredited facilities.

 

  • 50% Adjustment in Case Rates Packages applies to almost 9,000 benefit packages for all admissions starting January 1, 2025. This is the second wave of increase following the first made on February 14, 2024. It effectively doubled the old rates which did not move since these were introduced in 2014.

No increase in contributions

Ledesma said that these enhanced benefits will not entail an increase in contributions rate for 2025 and beyond.

Despite getting zero government subsidy for fiscal year 2025, the PhilHealth chief gave an assurance that the state health insurer has enough funds to finance its benefits packages.

President Ferdinand "Bongbong" Marcos Jr. had said PhilHealth has enough funds to continue delivering services despite the proposed zero subsidy.

Finance Secretary Ralph Recto also maintained Monday that the operating budget of state insurer PhilHealth is enough.

Health Secretary Ted Herbosa earlier said the state insurer still has a P150-billion surplus from its 2024 budget that could pay for the subsidy of indirect members.

The DOH, PhilHealth's supervising agency, earlier affirmed that services would remain uninterrupted.

Ledesma, meanwhile, appealed to PhilHealth’s 12,600 partner health facilities nationwide to strictly adhere to the no copayment policy as mandated in Section 9 of the Universal Health Care Act and in relevant PhilHealth Circulars.

"To ensure that every member truly experiences the benefits of PhilHealth, I call on our partner healthcare providers: Let us strictly implement the ‘No Co-Payment’ policy. Our members should not be charged additional fees beyond what PhilHealth covers for the standards of care and services included in our benefit packages,” he said.

The PhilHealth chief added that the state health insurer is set to release new packages for prescription glasses designed for children 0-15 years old; outpatient rehabilitation services and assistive mobility devices that will include access to wheelchairs, walkers, crutches, and canes; and expanded rates for cataract extraction.

--VAL, GMA Integrated News