PhilHealth allots P21B for expanded hemodialysis coverage

The Philippine Health Insurance Corporation (PhilHealth) has allotted P21 billion to expand its coverage for patients undergoing hemodialysis to 156 sessions.

“Ngayong taon, simula ngayong araw, June 22, 2023, pinalawak na ng PhilHealth ang coverage para sa mga pasyenteng naghe-hemodialysis. Ito po ay 156 sessions na, so ito po ay batay sa PhilHealth Circular 2023-0009,” said PhilHealth Corporate Affairs Group Acting Vice President Rey Baleña at the televised public briefing on Thursday.

(This year, starting today, June 22, 2023, PhilHealth has expanded the coverage for hemodialysis patients. This is 156 sessions and is based on PhilHealth Circular 2023-0009.)

He said PhilHealth pays P2,600 per session or P234,000 for 90 sessions yearly. With this enhancement, PhilHealth now covers up to P405,600 for patients with chronic kidney disease stage 5 (CKD5).

With the help of its partner agencies, the Philippine Amusement and Gaming Corporation (PAGCOR) and the Philippine Charity Sweepstakes Office (PCSO), PhilHealth allotted P21 billion for the benefit enhancement.

“Under General Appropriations for 2023, may P21 billion na nanggaling sa PCSO na ita-transfer sa PhilHealth para sa pagpapabuti sa coverage ng hemodialysis at ito na po yung 156 sessions,” he said.

(Under General Appropriations for 2023, there is P21 billion that came from the PCSO grant that will be transferred to PhilHealth for improving the coverage of hemodialysis, and this is the 156 sessions.)

“Hindi na po mangangamba yung ating mga kababayan lalo na po yung kapos sa budget dahil covered na po ng PhilHeath yung kanilang standard dialysis requirement para po sa buong taon,” said Baleña.

(Our countrymen will no longer be scared, especially those short on budget, because PhilHeath has covered their standard dialysis requirement for the whole year.)

The patient, however, must be listed under the PhilHealth dialysis database, and the dialysis must be recommended by a licensed doctor.

Asked if the patients could carry over the unclaimed sessions for the following year, Baleña said: “Hindi po, itinakda po sa ating polisiya na ito po ay para sa taunang hemodialysis session at hindi po lalagpas sa 156 sessions ang sasagutin ng PhilHealth.”

(No, it is stated in our policy that this is for the annual hemodialysis session, and PhilHealth will not pay for more than 156 sessions.)

“‘Yung mga hindi po nagamit na hemodialysis sessions sa taong ito, hindi pwedeng icarry over sa susunod na taon,” he added.

(Those who have unused hemodialysis sessions from this year cannot be carried over to the following year.)

This benefit only covers CKD5 patients. However, if a non-CKD5 patient needs emergency dialysis, it will be charged on the regular 45 days allowance.

Moreover, Baleña also mentioned that this was just among the benefit enhancement under the PhilHealth initiative to give financial protection to the Filipinos.

Other improvements for Z benefits, for causes like acute lymphocytic leukemia, early breast cancer, prostate cancer, and kidney transplant, among others, are still being studied by the agency. — RSJ, GMA Integrated News