PHILHEALTH KICKS OFF NEW YEAR WITH NEW AND EXPANDED BENEFITS

The Philippine Health Insurance Corporation (PhilHealth) announced today in simple ceremony held in Pasig City the latest set of its newly-introduced and enhanced benefit packages, the guidelines of which have been released and published in December 2024.

“Last year, we committed to expanding further our coverage for the top 10 most burdensome diseases to help ease the financial hardship that these conditions bring to members and their families. We have successfully delivered on this promise,” said PhilHealth President and CEO Emmanuel R. Ledesma, Jr. in his New Year’s message to the public.

The new and enhanced benefit packages are as follows:

1. Ischemic Heart Disease–Acute Myocardial Infarction consisting of four different packages: (1) Percutaneous Coronary Intervention (PCI) or coronary angioplasty at P524,000 from P30,300, increased by over 1,600%; (2) Fibrinolysis at P133,500 from P30,290 or 900% increase; (3) Emergency Medical Services with Coordinated Referral and Interfacility Transfer at P21,900; and (4) Cardiac Rehabilitation after PCI at P66,140. Took effect on December 21, 2024.

2. Z Package for Peritoneal Dialysis (PD) which now covers Continuous Ambulatory Peritoneal Dialysis (CAPD) for adults while CAPD and Automated Peritoneal Dialysis for pediatric patients.

For adults, PD Z Benefits have been set at P389,640 and P510,140 depending on the required PD solutions a patient requires per day. The packages increased by up to 89% from the previous P270,000/year. Meanwhile, PD Z Benefits for pediatric patients under the CAPD are set at P510,000 and P765,210 while coverage for APD ranges from 763,000 to P1.2 million. PhilHealth also pays for exit site infection and peritonitis prevention care. These can be availed at any of the 51 accredited PD providers nationwide. Took effect on January 1, 2025.

3. Z Package for Kidney Transplantation which covers Living Organ Donor Transplantation, increasing the previous coverage of P600,000 to over Php1 million, or a substantial increase of 74%. On the other hand, Deceased Organ Donor Transplantation is set at Php2,14 million. Took effect on January 1, 2025.

4. Preventive Oral Health Services as part of primary care services – a historic first to be included in the country’s national health insurance under its Konsultasyong Sulit at Tama or Konsulta package. Includes mandatory services such as mouth examination or oral screenings, dental prophylaxis (cleaning), and fluoride varnish application. Coverage also extends to pit and fissure sealants and Class V restoration procedures (limited to two teeth per year) and emergency tooth extractions, when necessary and performed in accredited health facilities. Takes effect on December 28, 2024.

5. Outpatient Emergency Care Benefit (OECB) which provides comprehensive coverage for emergency services, focusing on two main components: Facility-Based Emergency and Pre-hospital Emergency benefits. These cover essential care in accredited hospital Emergency Departments (EDs) and emergency transport services for cases that do not result in hospital admission and may be availed of in OECB accredited facilities. The PhilHealth Circular takes effect on January 11, 2025, the implementing timelines of which will be issued through a separate PhilHealth advisory.

6. 50% Adjustment in Case Rates Packages – applies to almost 9,000 benefit packages for all admissions starting January 1, 2025. This second wave of increase (the first was made on February 14, 2024) effectively doubled the old rates which did not move since these were introduced in 2014.

Ledesma stressed that these enhanced benefits will not entail an increase in contributions rate for CY 2025 and beyond.

To make the benefits truly felt by the patients, the PhilHealth Chief issued an appeal to its 12,600-strong partner health facilities nationwide to strictly adhere to the no co-payment policy as mandated in Section 9 of the Universal Health Care Act and in relevant PhilHealth Circulars.

“To ensure that every member truly experiences the benefits of PhilHealth, I call on our partner healthcare providers: Let us strictly implement the “No Co-Payment” policy. Our members should not be charged additional fees beyond what PhilHealth covers for the standards of care and services included in our benefit packages”, the PhilHealth Chief emphasized.

To ensure the cooperation and support of partner hospitals and healthcare professionals, Ledesma led on January 8 a brief meeting with leaders of various national associations of hospitals and healthcare professionals and citizens’ groups to renew and strengthen ties and mutual cooperation, particularly in the faithful observance of no co-payment policy for patients admitted in hospital wards.

The said event was actively participated in by the Philippine Medical Association (PMA), Philippine Hospital Association (PHA), Integrated Midwives Association of the Philippines (IMAP), Integrated Philippine Association of Optometrists, Inc. (IPAO), Dialysis Coalition of the Philippines, Inc. (DCPI), Philippine Alliance of Patient Organizations (PAPO) and CitizenWatch Philippines.

Ledesma also urged members stay informed about their PhilHealth benefits, utilize them as needed, cast away their insecurities and not to delay decision when it comes to seeking needed medical treatments. “I encourage each of you to take full advantage of these benefits, stay informed, and trust that PhilHealth is here to serve you at every step”, he said.

The PhilHealth Chief added that PhilHealth is set to release new packages for prescription glasses designed for children 0-15 years old; outpatient rehabilitation services and assistive mobility devices that will include access to wheelchairs, walkers, crutches, and canes; and expanded rates for cataract extraction.

For questions and further details on these enhanced benefit packages, members can call the following 24/7 touch points: (02) 866-225-88 or at mobile numbers 0998-857-2957, 0968-865-4670, 0917-1275987 or 0917-1109812