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 PHP378 billion to PHP400 billion this year. This follows the return of PHP60 billion in funds to the state insurer, in line with the directive of President Ferdinand R. Marcos Jr.
Budget Growth Highlights
PhilHealth President and Chief Executive Officer Dr. Edwin Mercado said that in 2023, the budget was only PHP119 billion. 'In a span of three years, the amount of benefits we assign for our members almost tripled,' he said in a Bagong Pilipinas Ngayon interview.
New Maternity Care Package
With the budget improvement, 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 — has increased by 150 percent.
Primary Healthcare Programs
PhilHealth is also pushing its primary healthcare programs like the Yaman ng Kalusugan Program (YAKAP), which aims to provide easy access to primary care. The agency has accredited 4,130 clinics nationwide, 25 percent of which are private providers. Currently, 95 percent of towns in the Philippines have functional YAKAP clinics. Another program is the Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT), which acts as an e-wallet worth PHP20,000 for outpatient medicines. Members must consult a YAKAP-accredited doctor to access this benefit.
Improved Efficiency
Addressing concerns on bureaucracy, Mercado said the 'claims turnaround time' has been reduced to 15 to 16 days, down from the previous average of 40 days. PhilHealth is currently training hospital billing clerks to minimize errors in e-claims, which often cause delays or rejections due to incomplete data.
Expanded Coverage for Rainy Season
In anticipation of the rainy season, PhilHealth is finalizing expanded coverage for leptospirosis, animal bites, and cancer. Leptospirosis coverage will span from prophylactic doxycycline at YAKAP clinics to hospitalization, dialysis, and respirator support for severe cases. Rabies treatment will expand to include 'Category 2' bites (scratches without bleeding), moving beyond the current 'Category 3' (open wounds) coverage. A new benefit roadmap is being finalized for various types of cancer with currently low support values.
No Balance Billing Expansion
PhilHealth is also working to expand the 'No Balance Billing' policy. While already established in Department of Health hospitals, 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 percent of their bed capacity for basic accommodation under this scheme.
Transparency and Fraud Prevention
To ensure accountability, PhilHealth maintains a transparency portal where financial statements, claim payments, and circulars are published. 'We are also engaging with various civil society organizations to communicate and, in the spirit of transparency, explain how our funds are being allocated and utilized,' Mercado said. He 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.
