PhilHealth commemorates its 28th year anniversary with the theme “Pinalawak at mga Bagong Benepisyo para sa Mamayang Filipino,” in line with the country’s observance of National Health Insurance Month.

“This year’s anniversary theme is  a manifestation of our commitment to continuously expand and make the PhilHealth benefits more relevant and responsive to the medical needs of the Filipino”, Emmanuel R. Ledesma, Jr., PhilHealth President and Chief Executive Officer said in a press statement.

Emmanuel R. Ledesma Jr., PhilHealth President & CEO

Foremost among the enhancements of benefits outlined by Ledesma was the expanded coverage for outpatient hemodialysis from 90 to 156 sessions based on standards for adequate dialysis which requires three 4-hour sessions every week for chronic kidney disease (CKD) stage 5 patients.  

In addition, PhilHealth is also providing P270,000 in financial support to patients who are on peritoneal dialysis (PD-First) and P600,000 for renal patients qualified under our Z Benefits for Kidney Transplantation.

“PhilHealth is also moving towards rationalizing select inpatient case rates.  Initially, we are looking at moderate and high risk pneumonia and acute stroke, both ischemic and hemorrhagic, among those that will be rationalized,” Ledesma disclosed. “Patients can expect an improvement in the extent by which PhilHealth will pay for these conditions for these are the most common cases availed of by patients in recent years.”

Also in the pipeline are enhancements in select Z benefit packages for patients who have health conditions requiring prolonged hospitalization and expensive treatments such as  orthopedic implants; kidney transplants; breast, cervical and prostate cancers; and open heart surgeries for children, specifically Ventricular Septal Defect and Tetralogy of Fallot.

On top of all these, Ledesma also reiterated PhilHealth’s commitment to introduce the following programs this year : outpatient benefit package for mental health in addition to existing inpatient coverage for mental health conditions, to improve health outcomes, quality of life, and productivity of our kababayans with mental health issues; outpatient package for severe acute malnutrition (SAM) for children below 5 years old in support of the Kalusugan at Nutrisyon ng Mag-Nanay Law that provides for the management of severe acute malnutrition; and rationalization of current COVID-19 benefit packages, specifically for the inpatient packages, RT-PCR and Rapid Antigen Test and isolation packages. 

But perhaps most welcome for all stakeholders was that effective January 2023, the premium increase mandated under RA 11223 (Universal Health Care Law) has been suspended. However, PhilHealth will continue implementation of its “Immediate Eligibility” policy which guarantees the availability of PhilHealth benefits by members who have premium contribution deficiencies, and the implementation of several new benefits despite the premium increase suspension.

Meanwhile, in a press conference held in Cagayan de Oro on February 15, Delio A. Aseron II , Regional Vice PresidentPhilHealth Region 10, reiterated how PhilHealth has devoted and continues to devote significant efforts to develop much responsive benefit and health care packages and services for PhilHealth members and their dependents.

He cited how Konsultasyong Sulit at Tama (or Konsulta), focuses on the preventive aspect of health care by reducing or averting hospital confinements through accredited health care institutions that would provide essential/primary health services to members and their dependents. With reduced hospital confinements PhilHealth can utilize more of its funds for the development of better benefit packages for all Filipinos.

Ledesma similarly stressed how Philhealth will continue to strengthen its PhilHealth Konsulta Package to make essential services such as consultations, health screening and assessment, laboratory tests, and drugs and medicines available to all Filipinos anywhere in the country.

“Last year, we started a nationwide drive so that Filipinos are informed about this package, for them to register with the Konsulta provider of their choice, and avail of this benefit. As of January 31 of this year, there are already 1,512 accredited Konsulta Providers nationwide,” Ledesma noted.

Meanwhile in Region 10, PRO-X and its Local Health Insurance Offices have launched the Short Message Service (SMS) Blast Project to provide sufficient and timely information to members about their availment of PhilHealth benefits and the amount paid to health care providers.

“With this information, members will be aware of the time payment was made and how much was paid to the health care institution every time they avail of PhilHealth benefits,” Aseron said.

Not the least, Ledesma assured PhilHealth is and remains to be in a strong position to implement these benefit enhancements.

“As of September 2022, we recorded our highest net income at P46 billion. Our total assets stood at P394 billion which is 13% higher than our December 2021 figures.  Also, PhilHealth’s investment portfolio stands at P355 billion which consists of 83% long-term investments in government bonds and corporate bonds; and the remaining 17% are short-term investments. PhilHealth’s reserve fund also rose to P224 billion from P151 billion in September 2021, or a 48% growth due to the consistent positive results of operations,” Ledesma noted. 

“PhilHealth’s finances remain robust and strong. And to make it more sustainable in many years to come, we appeal to our members, employers, healthcare providers, and to our government partners for their continuous support to the Program,” he added.


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