PhilHealth: Increased benefits rates to take effect Feb. 14

The Philippine Health Insurance Corporation (PhilHealth) on Saturday said the increase in the coverage rates of most of its benefit packages will take effect on February 14, 2024.

To recall, in November last year, PhilHealth announced that the rates of its benefits packages would increase up to 30% to lessen the out-of-pocket expenses for Filipinos availing of health care services using PhilHealth.

Interviewed on dzBB, PhilHealth spokesperson Rey Baleña said the state health insurer issued Circular No. 2024-001 which contains the case rates or benefit packages subject to increase or adjustment.

Under the circular, which shall take effect on February 14, PhilHealth adopted an inflation adjustment factor of 30% for existing case rates to account for price changes over the past decade.

“‘Yan ang layunin ng ating adjustment sa benefit packages, ang mapababa o mabura na ang balanseng binabayaran sa pagpapaospital,” Baleña said.

The PhilHealth official, however, said not all case rate packages would increase since these were already adjusted in the last five years.

“Pangunahin diyan ‘yung dialysis… Kung matatandaan, last year ang ginawa natin sa dialysis ay hindi lang 30% adjustment... Ang ginawa ng PhilHealth Board, 'yung pangangailangan ng isang pasyente for dialysis sessions sa buong isang taon ay sinagot na ng PhilHealth,” Baleña said.

“Ang ginawa natin sa dialysis, lahat ay kinover na natin... Hindi na maaantala ang pagpapa-dialysis ng pasyente sa buong taon,” he said.

Likewise, Baleña said that high-risk pneumonia was exempted from the 30% adjustment.

“Iba ang naging approach natin sa high-risk pneumonia dahil isa 'yan sa mga condition na talagang high burden sa patients. From P32,000, naging P90,100 'yan effective last year. Hindi lang 30% ang naging increase diyan,” he said.

For stroke, the PhilHealth official said the benefit coverage was increased by more than 150% last year.

“Dati 'yung [coverage] for ischemic stroke ay nasa P28,000, naging P76,000. 'Yung hemorrhagic, dating P38,000 naging P80,000,” Baleña said.

He added that PhilHealth was also looking into rationalizing the case rates for six conditions.

“Hindi lang 30% ang itataas... three last year, six this year so nine na conditions,” Baleña said.

“Beyond these nine conditions naira-rationalize natin... the rest will be subjected to 30% [increase],” he said.

Nevertheless, he said that the bulk of the case rates or benefit packages would be increased by 30%.

PhilHealth increased the premium or member’s contribution to 5% from 4% this year.

Health Secretary Ted Herbosa appealed for the suspension of the enforcement of the increase.

President Ferdinand Marcos Jr., however, had yet to decide on the appeal as he wanted to see an increase in services following the implementation of the premium hike. — DVM, GMA Integrated News