PhilHealth, HMOs, insurers team up to complement coverage for shared members

Filipinos with private insurance could see more of their medical costs covered as the Philippine Health Insurance Corp. (PhilHealth), major health maintenance organizations (HMOs), and private insurers have inked a memorandum of understanding (MOU) to coordinate benefits for primary care services.

Under the MOU, PhilHealth will serve as the initial source of coverage for primary care services through its Yaman ng Kalusugan Program (YAKAP), while private insurers will complement by providing additional benefits.

The YAKAP program covers consultations, 13 laboratory tests, select outpatient medicines under the GAMOT package, and outpatient services for six cancer screening tests. Its primary care program also includes specialized outpatient benefits such as animal bite treatment, maternal care, tuberculosis DOTs, HIV/AIDS management, and mental health services, as applicable.

The private insurers will act as secondary payers, covering costs that exceed PhilHealth benefit limits or fall outside primary care coverage, including specialized procedures, branded medications, or hospital room upgrades.

Among the private insurer partners are Asalus Corp. (Intellicare), Avega Managed Care Inc., Cooperative Health Management Federation, Health Plan Philippines Inc., inLife Benefits Insurance Company Inc., Insular Health Care Inc. (iCare), Maxicare Healthcare Corp., the Manufacturers Life Insurance Co. (Phils.), Medicard Philippines Inc., Medicare Plus Inc., Pacific Cross Health Care Inc., PhilhealthCare Inc., and the United Coconut Planters Life Assurance Corp.

“With PhilHealth YAKAP as the first layer of protection, our private partners can focus on their benefits on what lies beyond the program package. That way every Filipino gets more care for every peso,” PhilHealth acting president and chief executive officer Beverly Lorraine Ho said in an emailed statement.

PhilHealth noted, however, that members and policyholders will have to register for YAKAP through the eGovPH app, the PhilHealth Member Portal, or PhilHealth offices. The agency is also inviting other HMOs and private health insurers to join the network.

PhilHealth is a tax-exempt government corporation attached to the Department of Health (DOH) mandated to administer the National Health Insurance Program, which provides health care services to all Philippine citizens.

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—RF, GMA News