Philippines: $18,046 PhilHealth annual coverage for certain patients
Higher contributions to PhilHealth revealed Friday, alongside expanded coverage
Manila: The Philippine Health Insurance Corporation (PhilHealth) announced on Friday its plan to increase benefit package rates, or monthly payments, starting in January 2024.
As part of the 2024 plan to expand coverage, PhilHealth aims to enhance “Z Benefits” for breast cancer, providing coverage for targeted therapy up to Php1 million ($18,046) per patient annually.
Increase in care rates
The state-owned insurer justified the rate increase as essential for its members to cope with the escalating costs of medical care.
Emmanuel Ledesma Jr., PhilHealth's President and CEO, expressed the insurers’s commitment to ensuring members feel the true value of their benefits, translating into meaningful financial risk protection.
For example, those earning Php10,000 per month are expected to add Php50 — from Php450 to Php500—in monthly premiums.
The official said this adjustment aims to alleviate the financial burden on members during hospitalisation and outpatient care, reducing out-of-pocket expenses.
Cost-sharing mechanism: What is it?
To mitigate adverse inflationary effects, PhilHealth plans to introduce a cost-sharing mechanism.
This mechanism will establish fixed co-payment rates for both health facilities and members, complementing PhilHealth's contributions. The strategy aims to enhance resource efficiency in health facilities while providing members with predictability regarding additional expenses beyond basic accommodations.
The PhilHealth official has emphasized the importance of controlling healthcare costs and discouraged irrational, or unnecessary, healthcare service use among facilities.
Ledesma mentioned that the upward adjustment in case rates aligns with the ongoing benefit expansion and rationalisation previously approved by the PhilHealth Board.
In 2021, there wre more than 4.3 million diabetics in the Philippines, according to the IDF Diabetes Atlas.
Dialysis coverage expanded
In 2023, PhilHealth expanded dialysis coverage for those facing chronic kidney diseases to 156 sessions–up from the previous 90 sessions, and rationalised rates for commonly availed conditions among Filipinos.
The organisation increased coverage for ischaemic stroke from PhpP28,000 to Php76,000 ($1,371.45 ) and haemorrhagic stroke from Php38,000 to Php80,000 ($1,444) through Circular 2023-0021.
PhilHealth is expected to release a circular soon, widening coverage for high-risk pneumonia from Php32,000 to Php90,100.
Looking ahead to 2024, PhilHealth plans to expand Z Benefits for breast cancer, covering targeted therapy up to Php1 million ($18,046) per patient per year.
Z Benefits encompass 20 catastrophic illnesses and health conditions requiring costly treatments and hospitalizations, reinforcing PhilHealth's commitment to providing comprehensive coverage for Filipinos.
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