PhilHealth implements 50% hike in around 9,000 benefit packages 

The Philippine Health Insurance Corporation (PhilHealth) has implemented a 50% increase in around 9,000 health packages despite a zero government subsidy for 2025. 

The increase will cover hospital admissions starting January 1, 2025. 

“Ito po ay will be composed of around 9,000 case rate packages na in-increase natin ng 50%...starting January 1 admissions,” said Israel Pargas, PhilHealth Senior Vice President for Health and Finance Policy Sector, in Bagong Pilipinas Ngayon press briefing. 

(A 50% increase will cover around 9,000 case rate packages…starting January 1 admissions.) 

According to PhilHealth Circular No. 2024-0037, the hike was made “to increase support value, decrease out-of-pocket payment (OOP), increase financial risk protection, and ensure the effective delivery of high-quality health services.” 

“Furthermore, it effectively reinforces case-based payments and adjusts case rates to align with health inflation, demonstrating a strong commitment to improving healthcare affordability and access,” the circular signed by PhilHealth president and CEO Emmanuel Ledesma Jr. on December 23, 2024 added. 

One of the packages with increased benefits includes the treatment of low-risk pneumonia, which the state health insurers will now cover up to P29,250 from the previous P19,500. 

Meanwhile, more than 50% will be hiked in PhilHealth’s coverage of kidney transplants and angioplasty for heart attacks. 

“Iyong pong kidney transplantation package na dati po ay P600,000, ngayon po ay aabot siya ng P800,000 to P2 million benefits package po,” said Pargas. 

(The benefit package for kidney transplantation used to be P600,000, but its coverage is now P800,000 to P2 million.) 

“...Iyong tinatawag na angioplasty na around P30,000 benefit ang ating package, ngayon po ay aabot na siya sa P530,000,” he added. 

(The benefit package for angioplasty was around P30,000 before, but it now reaches P530,000.)  

But excluded from the 50% adjustment are the following packages: 

• Benefits packages that are being rationalized such as acute stroke (ischemic, hemorrhagic); pneumonia (high risk); neonatal sepsis; bronchial asthma in acute exacerbation; severe dengue; ischemic heart disease - acute myocardial infarction; Covid-19 
• Benefit packages that are being re-costed and are scheduled for adjustment (example:       breast cancer) 
• Newly approved benefits packages starting 2023 (example: outpatient package for mental health) 
• Cases that are identified to have high risk for moral hazard and/or adverse incentives (example: cataract procedure, hemodialysis)
• Benefits packages that are paid through other provider payment mechanisms (example: Konsulta) 

Further, PhilHealth has implemented benefits for outpatients or those who do not need to be confined starting this year. 

“Iyon pong mga pasyente na nadadala sa emergency room pero hindi naa-admit, wala po silang mga benepisyo before. Pero ngayon po, we came out already with an emergency care package…hindi kinakailangang ma-confine iko-cover at babayaran na rin po natin siya,” said Pargas. 

(Those patients who are rushed to the hospital, but do not need to be admitted, they didn’t have benefits before. But now, we came out already with an emergency care package wherein they don’t need to be confined for us to cover their treatment.) 

On February 14 last year, the state health insurer implemented up to 30% increase in all its benefit case packages to lessen the out-of-pocket expenses of Filipinos availing of health care services using PhilHealth.

Senate finance committee chairperson Grace Poe previously said PhilHealth would receive zero subsidy under the proposed 2025 national budget, saying the state insurer still has P600 billion in reserve funds which it can use.

For his part, President Ferdinand "Bongbong" Marcos Jr. had said PhilHealth has enough funds to continue delivering services despite the proposed zero subsidy.—LDF, GMA Integrated News