PhilHealth, HMOs in talks to avoid YAKAP benefit overlap

The Philippine Health Insurance Corporation (PhilHealth) said Tuesday that it is in talks with health maintenance organizations (HMOs) to eliminate redundancies and ensure that primary care services under its Yaman ng Kalusugan Program (YAKAP) complement private healthcare coverage.

“Sa ngayon po ang PhilHealth ay nakikipag-usap na sa mga HMOs para magkaroon tayo ng complementation ng mga benefits at maiiwasan po natin ‘yung mga redundant benefits," said Mae Villa, PhilHealth acting vice president for corporate affairs group, in “Bagong Pilipinas Ngayon.”

(Right now, PhilHealth is already in talks with HMOs so that we can have a complementation of benefits and avoid redundant benefits.)

"Dahil mayroon po tayong mga benepisyo na makukuha sa PhilHealth YAKAP kagaya ng mga konsultasyon, medicines, and laboratory tests, and even the cancer screening ay kasama na sa YAKAP,” she added.

(This is because we have benefits available under PhilHealth YAKAP, such as consultations, medicines, laboratory tests, and even cancer screening is already included in YAKAP.)

YAKAP is PhilHealth’s primary care package that provides members access to preventive health services such as consultations, laboratory tests, screening, and selected medicines to promote early detection and reduce the need for hospital confinement.

According to Villa, PhilHealth is now in talks with HMOs to make sure their benefits complement each other and avoid overlap, adding that the agency hopes to come out soon with a clear policy on the matter.

“Kung ang mga HMOs natin ay may ganitong benepisyo, mas maganda po sana na magkakaroon ng complementation ang HMO at PhilHealth na hindi magkakaroon ng redundancy," she said.

"Kaya pinaguusapan na po ito at very soon po, I hope makalabas na po kami ng kaukulang polisiya para dito,” Villa added.

(If our HMOs offer the same benefits, it would be better for HMO and PhilHealth to complement each other so there will be no redundancy. That is why this is currently being discussed, and very soon, I hope we can release the corresponding policy for this.)

YAKAP services are available to all PhilHealth members. Among the services offered are primary care checkups, laboratory tests, free medicines, and screening tests.

Under the program, 75 free medicines are available but may only be availed of upon a doctor’s prescription.

Members may also avail of free laboratory and diagnostic tests upon a doctor’s recommendation.

PhilHealth also said YAKAP has expanded to at least 12 public schools nationwide, providing healthcare services to both students and teachers.

“Sa listahan po natin ngayon mayroon po kaming 12 na DepEd schools all over the Philippines na mayroong YAKAP clinics na accredited sa loob mismo ng kanilang eskwelahan,” said Villa.

(In our current list, we have 12 Department of Education schools all over the Philippines that have accredited YAKAP clinics inside their school premises.)

“Inaalagaan na po agad ang ating mga learners at mga guro bago pa tayo magkasakit… Kung kailangan ng primary care for our learners and teachers, covered din tayo ng YAKAP benefits,” she added.

(Our learners and teachers are being taken care of even before they get sick… If primary care is needed for our learners and teachers, they are also covered by YAKAP benefits.)—MCG, GMA News