Marcos orders PhilHealth to increase dialysis coverage to 156 sessions

President Ferdinand “Bongbong” Marcos Jr. ordered the Philippine Health Insurance Corp. (PhilHealth) to expand its coverage to provide more benefits to its members, according to the Presidential Communications Office (PCO) on Wednesday.

Marcos met PhilHealth officials led by its acting president and CEO Emmanuel Ledesma Jr.,  to discuss its short-term plan in the first six months of 2023 during a meeting at Malacañang Palace, the PCO said.

The plan includes increasing the hemodialysis coverage from 90 to 156 sessions, repealing the pay-whichever-is-lower corporate policy in payment claims and increasing the case rate of the top four packages covering 25% of filed claims.

PhilHealth said it will increase dialysis support to three times a week for outpatients, equivalent to full weekly coverage annually with its widened coverage.

It said that it will also include the introduction of the PhilHealth mobile app and short message service (SMS) confirmations, as well as implementation of new benefit packages.

Under its new packages, the state health insurer said it is also looking to introduce the outpatient mental health benefit package, outpatient package for severe acute malnutrition for children below five-years-old, and strengthen its Konsulta package.

PhilHealth said it also plans to rationalize the COVID-19 in-patient packages, reverse transcription polymerase chain reaction (RT-PCR), and rapid antigen tests as well as isolation packages.

It said that it will carry out general amnesty for employers and government agencies with missed premium payments, which will cover businesses, employers and individuals, especially small and medium enterprises that cannot afford to pay the three percent interest on missed premium payments for its mid-term plan to be introduced in 2024.

The state health insurer said it plans to impose penalties on erring doctors and hospitals instead of revoking their accreditation, amend the Universal Healthcare Law (UHC), and increase the case rates of top 10 packages with the highest claims filed.

“An anti-fraud system will also be introduced and a reorganization of PhilHealth will also be implemented to ensure proper manpower complement, especially for claims processing and frontline services,” it said.

“For its long-term plans, PhilHealth will be pursuing digitalization and the construction of PhilHealth-owned buildings and facilities,” it added.

PhilHealth earlier said it has paid a total of P66.3 billion worth of claims for COVID-19 patients.

The state health insurer covers the hospitalizations of COVID-19 patients depending on the severity of pneumonia, from P43,997 to P786,384.—LDF, GMA Integrated News