The Philippine Health Insurance Corporation (PhilHealth) announced today the latest expansion in its health benefits packages in keeping with its commitment to improve financial coverage and to further lower out-of-pocket of patients seeking treatment in health facilities nationwide.
In its meeting on November 29, the PhilHealth Board chaired by Health Secretary Teodoro Herbosa has approved the new packages for ten rare diseases, preventive oral health services under the Konsulta package, and assistive mobility devices for priority conditions affecting those in need of physical rehabilitation. The PhilHealth Board also approved enhancements of its packages for acute myocardial infarction (AMI) or heart attacks, peritoneal dialysis, and kidney transplants.
“We are pleased to unveil a total of six enhanced packages for in-patient care, Z Benefits and Konsulta. These expanded benefits reflect our dedication to providing accessible and affordable healthcare through better health insurance coverage”, PhilHealth President and Chief Executive Officer Emmanuel R. Ledesma, Jr., said during a press conference in Pasig City.
Ten new packages for rare diseases have been introduced, and these are for Maple Syrup Urine Disease, Methylmalonic Acidemia/ Propionic acidemia, Galactosemia, Phenylketonuria, Gaucher Disease, Pompe Disease, Fabry Disease, Hunter and Morquio Syndromes, Osteogenesis Imperfecta. Previously covered under inpatient care benefits, these packages are now called “Z Miracles” which are the latest addition to the Z Benefits. Rates for these packages have jumped by more than a thousand percent from their previous rate. “The successful implementation of this package will not only enhance patient care but also position the Philippines as a leader in rare disease policy and healthcare in Southeast Asia, demonstrating PhilHealth’s strong commitment to the health and well-being of Persons Living with Rare Diseases”, said Ledesma.
To aid in recovery and rehabilitation, PhilHealth also expands coverage for rehabilitation services, including assessment done by a physical therapist, occupational therapist, speech pathologist or psychologist, therapy sessions, laboratory, diagnostic tests and imaging, and assistive devices for mobility impairment such as wheelchairs, walkers, orthopedic canes, white canes, and crutches. All of these have been included in the standard services under the package for physical medicine and rehabilitation services and assistive mobility devices.
PhilHealth is also expanding its support to CKD 5 patients by enhancing the Z Benefits for Kidney Transplantation from P600,000 to benefit coverage of up to more than P 2M or a percentage rate increase of up to 258%. In addition, PhilHealth will be releasing new Comprehensive Care Services for post-kidney transplant patients under the Z Benefits for Post Kidney Transplantation Services. Adult patients are covered for procedures such as renal graft biopsy, and donor monitoring. During the first year of post KT, coverage for drugs and medicines will be at P506,000 while diagnostic and laboratory test is P85,000. For the second year onwards, the package for drugs and medicines will be at P496,000 while P45,000 for diagnostic tests. For pediatric post-kidney transplant patients, the package includes donor monitoring and post-transplant services.The package for the first year is P1.7 million, with P890,000 for the second year and beyond.
PhilHealth is again strengthening its support to dialysis patients by enhancing the Z Benefit Package for Peritoneal Dialysis for both adult and pediatric patients. This comprehensive coverage includes catheter insertion, Continuous Ambulatory Peritoneal Dialysis (CAPD), PD-related infection management, and both CAPD and Automated Peritoneal Dialysis (APD) for pediatric patients. For adults, the packages range from P29,200 to 585,500, while packages for pediatric patients range from P16,800 to P1,522.000.
Services included in this package are as follows: percutaneous coronary intervention from the previous P30,300 to P524,000 or 1,629 percent increase), fibrinolysis (from P30,290 to P133,500 or 909 percent increase), emergency medical services with coordinated interfacility transfer (from P21,900 to P5,200 or 321 percent increase), and cardiac rehabilitation at P66,140.
The PhilHealth Board also approved a package for preventive oral health services under the Konsulta package. Covered services include mouth examination/oral screening, dental prophylaxis or cleaning, and fluoride varnish application, fissure sealants, Class V procedures, emergency tooth extractions, and dental consultations.
The guidelines for the new set of enhanced benefits in the form of PhilHealth Circulars will soon be published in newspapers of general circulation.
The PhilHealth Chief also highlighted the agency’s significant progress in enhancing benefit packages since he assumed leadership in November 2022. “Over the past year, the nation has witnessed remarkable expansion and enhancements in our health benefit packages. Notable improvements include our increased coverage for catastrophic health conditions and high-burden diseases, and additional outpatient benefits for chronic illnesses. Of the top ten high-burden and mostly claimed health conditions that we have prioritized for rationalization, we have so far completed enhancements to seven packages”, he emphasized.
For further inquiries on benefits and services, members may call PhilHealth’s 24/7 hotline at (02) 866-225-88 or at mobile numbers (Smart) 0998-857-2957, 0968-865-4670, (Globe) 0917-1275987 or 0917-1109812.
