ILIGAN CITY (PIA) — The Philippine Health Insurance Corporation (PhilHealth) has significant enhancements in its benefit packages and policies to ensure broader healthcare coverage of Filipinos.
This has been announced by PhilHealth-10 Regional Vice President Delio A. Aseron II during a press conference in Iligan City.
These packages aim to make medical services more accessible and affordable for members and their dependents.
Since September 2024, PhilHealth has added 13 new and improved benefits to help Filipinos with medical costs. Hemodialysis coverage increased, allowing up to 156 sessions a year. The Konsulta Package now includes free treatment for tuberculosis, malaria, HIV/AIDS, and animal bites. Support for severe dengue and COVID-19 hospitalization also increased.
For major illnesses, kidney transplant coverage is now up to P2 million, heart attack treatment up to P523,853, and cataract surgery up to P187,100 per eye. Peritoneal dialysis (Z benefit package) is now promoted as a better option for kidney patients.
More services are now covered, including emergency room visits, dental checkups, rehabilitation devices like wheelchairs, and free eyeglasses for children aged 0 to 15 years old.
PhilHealth also increased its financial support by 50 percent for common treatments, such as pneumonia coverage from P15,000 to P29,250, caesarean delivery from P19,000 to P37,050, and cholecystectomy or gallbladder surgery from P31,000 to P60,450.
Moreover, PhilHealth has made its policies simpler and more helpful for members as it removed the Single Period of Confinement Policy to give patients more flexible and better coverage. Solo parents and their children now have extended benefits, while foster children are also recognized as dependents to ensure that they get the healthcare they need. To make hospital care more affordable, the No Co-Pay Policy is strictly enforced for patients in basic ward accommodations so they will not have to pay extra fees.
Starting in 2025, PhilHealth will introduce new packages, including Diagnosis Related Groups and a Comprehensive Outpatient Benefit Package. More serious conditions will also be covered, such as heart valve surgery, prostate and cervical cancer, and open-heart surgeries. Chemotherapy coverage for lung, liver, ovarian, and prostate cancer will also be adjusted. Additionally, children with disabilities will receive better healthcare support.
Moreover, Aseron said communication and coordination between PhilHealth and healthcare facilities have now improved through the Financial Management and Reporting Enhancement Program.
“It takes two to tango. Again, kung may kailangang i-improve ang PhilHealth, may kailangang ding i-improve ang partner hospitals. Dapat maayos ang kanilang pag-file ng claims; dapat maayos ang sistema at pag-transmit. Marami kaming inaayos. Malaking bagay ang digitalization, at malaking bagay din ang pagkakaroon ng open line of communication,” he said.
(It takes two to tango. Again, if there are improvements needed in PhilHealth, the partner hospitals also need to make improvements. Their claims filing must be properly done, and and their system and transmission must be efficient. We are addressing many issues. Digitalization is a big help, and having an open line of communication is also essential.)
According to him, since November last year, 108 healthcare facilities have finalized agreements with PhilHealth that make it easier to track and settle outstanding balances.
Strengthening fund sustainability through contributions and awareness
From January to December 2024, PhilHealth recorded 965,411 members in Iligan City and Lanao del Norte, comprising 575,390 primary members and 390,021 dependents. The total collection for the period amounted to over P548.69 million.
Currently, Iligan City and Lanao del Norte have 22 accredited hospitals and ambulatory clinics, alongside 67 outpatient facilities, including 40 Konsulta facilities.
Local Health Insurance Office-Iligan and Lanao del Norte Chief Christine Mae Garcia-Magno urged members to contribute their premiums if they have the capacity to ensure PhilHealth remains strong and sustainable.
“Before we can even prepare PhilHealth, we all have to work together to prepare PhilHealth. Kasi at the end of the day, ang daganan nato kay PhilHealth. Balikan nato ang prinsipyo sa balaod sa social solidarity o bayanihan. PhilHealth is a shared responsibility. Kinahanglan magtinabangay ta sa pagpaling-on sa pondo, magtinabangay ta aron mahimong mas mabinantayon para masiguro nga lig-on ang pondo. Magtinabangay ta sa pagbayad sa premium kung naa ta’y kapasidad,” she said.
(Before we can even prepare PhilHealth, we all have to work together to prepare PhilHealth. Because at the end of the day, we all rely on PhilHealth. Let’s go back to the principle of the law on social solidarity or bayanihan. PhilHealth is a shared responsibility. We need to help each other in strengthening the fund and work together to be more vigilant in ensuring that the fund remains strong. We must also support each other in paying premiums if we have the capacity.)
Moreover, she also emphasized the power of information in maximizing PhilHealth benefits. With tools like the member portal and the online case rate search application, members can easily check coverage amounts and avoid unnecessary hassle during hospital admissions. By staying informed, Filipinos can make the most of their healthcare benefits, she said. (LELA/PIA-10/Lanao del Norte)
