By Ma. Teresa Montemayor | Philippine News Agency
The Philippine Health Insurance Corporation (PhilHealth) on Tuesday announced a significant expansion of its benefit coverage, with its projected budget for benefit payments nearly tripling to around P378 billion to P400 billion this year.
This follows the return of P60 billion in funds to the state insurer, in line with the directive of President Ferdinand R. Marcos Jr.
PhilHealth President and Chief Executive Officer Dr. Edwin Mercado said in a Bagong Pilipinas Ngayon interview, “To give you a perspective, noong 2023, ito ay P119 billion lamang, so in a span of three years ay almost nag-triple iyong amount ng ating benepisyong inilalaan para sa ating mga miyembro.”
With such budget improvement, Mercado said the newly launched maternity care package, effective April 30, increased prenatal visits from four to eight. The package now includes comprehensive monitoring such as ultrasounds, vaccines, vitamins, and postnatal care.
Coverage for procedures—including normal delivery, cesarean sections, and dilation and curettage (raspa)—has increased by 150%.
He added the agency is also pushing its primary healthcare programs like the Yaman ng Kalusugan Program (YAKAP) that aims to provide easy access to primary care.
PhilHealth has accredited 4,130 clinics nationwide, 25% of which are private providers. Currently, 95% of towns in the Philippines have functional YAKAP clinics.
Another program is the Guaranteed and Accessible Medications for Outpatient Treatment or GAMOT, which acts as an “e-wallet” worth P20,000 for outpatient medicines.
Members must consult a YAKAP-accredited doctor to access this benefit to ensure quality diagnosis and medicine alignment.
Progressive reforms
Addressing concerns about bureaucracy, Mercado said the “claims turnaround time” has been reduced to 15 to 16 days, down from the previous average of 40 days.
He added that PhilHealth is currently training hospital billing clerks to minimize errors in e-claims, which often cause delays or rejections due to incomplete data.
In anticipation of the rainy season, PhilHealth is finalizing expanded coverage for:
- Leptospirosis – Coverage will span from prophylactic doxycycline at YAKAP clinics to hospitalization, dialysis, and respirator support for severe cases.
- Animal Bites – Expansion of rabies treatment to include “Category 2” bites (scratches without bleeding), moving beyond the current “Category 3” (open wounds) coverage.
- Cancer – A new “benefit roadmap” is being finalized for various types of cancer with currently low support values.
PhilHealth is also working to expand the “No Balance Billing” policy. While already established in Department of Health hospitals through a combination of PhilHealth and the Medical Assistance to Indigent and Financially Incapacitated Patients program, the goal is to bring this to local government units and private hospitals.
Mercado disclosed that PhilHealth is negotiating with private hospitals to dedicate 10% of their bed capacity for basic accommodation under a “No Balance Billing” scheme.
To ensure accountability, PhilHealth maintains a transparency portal where financial statements, claim payments, and circulars are published.
He said, “At kami naman po ay nakikipag-usap din po sa maraming civil society organizations para din po maipahatid at para rin po, in the spirit of transparency, maipaliwanag po ang ating pong pinaggagastusan at pinaggagamitan nitong ating pondo.”
Mercado urged all members to register and choose their YAKAP providers via the eGov app or at local branches.
He also announced a collaboration with the Philippine Statistics Authority to co-locate biometrics registration in PhilHealth offices to verify patients and prevent fraud. (PNA)
