SOME 9,000 types of illnesses and medical procedures are set to have improved benefit packages from the Philippine Health Insurance Corporation (PhilHealth).
PhilHealth Spokesperson Dr. Israel Francis Pargas, said a large number of case rates are covered in the 50 percent rate adjustment implemented recently by the state-run health insurer.
“Last February 2024, we increased our benefit packages by 30 percent. Now, before the year ended, we had another round of increase at 50 percent,” said Pargas in a televised public briefing.
“This round of increase in benefit adjustment covers around 9,000 packages, starting with the January 1 admissions. Almost all of our packages are covered,” he added.
Under Circular No. 2024-0037, excluded from the latest adjustments are acute stroke (ischemic and hemorrhagic); pneumonia (high risk); neonatal sepsis; bronchial asthma in acute exacerbation; severe dengue; ischemic heart disease – acute myocardial infarction (IHD-AMI); and COVID-19.
Also excluded are Z Benefits packages that are being re-costed and are scheduled for adjustment; newly approved benefits packages starting 2023; cases that are identified to have a high risk for moral hazard and/or adverse incentives; and benefits packages that are paid through other provider payment mechanisms.
“These benefits have different increase rationalization applied to them,” Pargas explained.
“We have benefits that have different increases while the rest would be increased by 50 percent,” he added.
In a related development, Pargas said PhilHealth is preparing to implement its newly-formed emergency benefit care package.
“We came out with an emergency care package, wherein our members, who are brought to the emergency room because of an illness but did not require confinement, will be covered,” said the PhilHealth official.
“The emergency benefit care package is a new benefit for PhilHealth members,” added Pargas.
Earlier, health reform advocate Dr. Tony Leachon said PhilHealth should have an emergency room benefit package.
