DOH, PhilHealth eye expanded benefits for middle-income workers

The Philippine Health Insurance Corporation (PhilHealth) is exploring ways to provide enhanced benefits for middle-income workers who directly contribute to the insurance fund, officials said on Saturday.

In a radio broadcast, Health Secretary Teodoro Herbosa acknowledged that current PhilHealth programs mainly focus on sponsored members—those who cannot pay and whose contributions are covered by the State.

He said President Ferdinand Marcos Jr. has instructed the agency to review and expand benefits for direct contributors.

“For many years, ang tinututukan natin yung ating indirect o sponsored programs [na] wala silang binabayaran pero may benepisyo sila ng PhilHealth [dahil] estado nagbabayad ng premium nila,” Herbosa said.

(For many years, our focus has been on indirect or sponsored programs where beneficiaries do not pay but still receive PhilHealth coverage because the State pays their premiums.)

“Sa ating bagong programa, sabi niya pagandahin natin ang serbisyo para sa ating mga middle class,” he added.

(Under the new program, the President told us to improve services for the middle class.)

Herbosa said Executive Secretary Ralph Recto has recommended several enhancements for middle-income contributors, including better hospital accommodations and additional packages under the Zero-Balance Billing scheme.

“Baka pwedeng two in a room lang or may aircon, para yung mga direct member naman mas maganda yung benefit,” he said.

(Maybe two patients per room or with air conditioning, so that direct members will enjoy better benefits.)

He also highlighted another suggestion from Recto, which he said he would forward to the PhilHealth benefits committee:

“Mayroon pa siyang isang [suggestion] na gustong-gusto ko at ipapasok ko sa benefits committee, na pag yung hospital ay nagiimplement ng zero-balance, gusto niyang madagdagan ang package ng PhilHealth,” he said.

(He also had another suggestion that I really liked and will forward to the benefits committee. If a hospital implements zero-balance billing, he wants PhilHealth to provide additional packages.)

He said it was logical to encourage local government-run hospitals to adopt zero-balance billing.

“Ipapaaral ko sa aming mga actuarials yung kaya ng PhilHealth,” he added.

(I will ask our actuarial team to study whether PhilHealth can handle this.)

The recommendations follow Recto’s call for both the DOH and PhilHealth to implement expanded benefits and packages for middle-class workers, who pay taxes and contributions but currently have limited access to PhilHealth perks.

PhilHealth Senior Vice President and Health Finance Policy Sector head Dr. Israel Pargas confirmed that the agency received instructions from the President and Executive Secretary Recto to expand benefits for middle-income workers.

He also affirmed PhilHealth’s mandate to “provide additional programs to direct contributors where applicable.”—MCG, GMA Integrated News