THE Philippine Health Insurance Corporation (PhilHealth) is reminding all government agencies (GAs), government-owned and -controlled corporations (GOCCs), and government financial institutions (GFIs) intending to secure the services of private health management organizations (HMOs) that their benefits should not duplicate that of the state-run health insurer’s.
“The Commission on Audit has permitted the purchase of healthcare service coverage from private HMOs provided that the programs or benefits covered therein are not yet covered or provided by the PhilHealth,” said the state insurer’s president, Emmanuel Ledesma, in Advisory No. 2024-022.
Ledesma said GAs, GOCCs, or GFIs should make sure that supplemental coverage “are not paid for by the benefits already covered through PhilHealth.”
“(This may) constitute double compensation and irregular disbursement of public funds,” he added.
He asked the government agencies to have private HMOs to certify that their benefit packages will not duplicate those of PhilHealth.
PhilHealth said its coverage includes payment for basic and essential health services for select inpatient and outpatient services; primary care services and select diagnostic and commodities; and select catastrophic cases.
Excluded from PhilHealth coverage are hospital amenities; expanded choice of specialists and health facility; specialist outpatient care; most outpatient drugs; non-Philippine National Formulary drugs; commodities, devices, and procedures without HTA; outpatient emergency services; select rehabilitative and palliative care; and annual physical examination.
