PhilHealth improves eye health packages

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THE Philippine Health Insurance Corporation (PhilHealth) has created a benefit package for kids aged 0 to 15 years.

In Circular No. 2025-0002, PhilHealth said it has approved the benefit package for optometric services covering assessments and prescription glasses for children 0 to 15 years old.

“While the current vision screening of the government is only focused on kindergarten pupils, other children with error of refraction and other eye problems need early intervention to improve their vision,” said PhilHealth.

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“Clear vision is vital in the child’s health development. Moreover, improving the child’s vision will have a positive effect on his/her social and emotional well-being, and literacy and learning,” it added.

Under the benefit package, PhilHealth will cover optometric services like vision assessment, including refraction; prescription eyeglasses, including frames and lenses; and follow-up check-ups for children 0 to 15 years of age.

“The PhilHealth Optometry Benefit Package rate is P2,500 per case, inclusive of facility and professional/consultation fees,” said PhilHealth.

It said vision screening and assessment will be based on current standards of care and clinical practice guidelines.

For those with errors of refraction and other eye conditions that can be corrected by prescription glasses, PhilHealth said they will be eligible for the benefits.

Another circular (No. 2025-0001) enhanced the benefit package for extracapsular cataract extraction with insertion of intraocular lens (IOL).

“PhilHealth identified cataract surgery, as one of the priority conditions for improving financial coverage and protection against catastrophic healthcare expenditure during illness,” said PhilHealth.

“PhilHealth has approved the adjusted rates for the reimbursement of cataract surgery as part of the all case rates rationalization,” it added.

From the current P16,000 benefit package, the adult cataract surgery will have a package rate of P20,000 to P80,900 while pediatric cataract surgery reimbursements may range from P135,000 to P187,100.

“The minimum standards of care recommendations from clinical practice guidelines, which are critically appraised and validated by current best practices in the local setting, are PhilHealth’s basis for service coverage and costing analyses,” said PhilHealth.

It noted the 2018 Philippine National Survey on Blindness and Eye Diseases showed that cataract is the major cause of visual impairment.

PhilHealth said surgery is the only treatment for cataract, with an artificial intraocular **lens replacing the damaged lens.

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