DESPITE the absence of government subsidy for next year, 2025, the Philippine Health Insurance Corporation (PhilHealth) is guaranteeing that medical benefits of all its members will remain, and even be further improved.
PhilHealth president Emmanuel Ledesma said the agency is highly capable of managing the national health insurance program given its strong financial position.
“PhilHealth will continue to pay for the health benefits of all Filipinos, with or without government subsidy. It is our goal to finance the best care and benefits available,” said Ledesma in a statement issued late Monday.
“Rest assured: All PhilHealth benefits will continue to be paid, and will even be improved. We remain dedicated to enhancing our benefits packages and reducing out-of-pocket expenses so that every patient feels the security of their health insurance,” he added.
Ledesma, at a House briefing yesterday, said PhilHealth is working to have members’ premium contribution rates reduced to 3.25 percent from 5 percent while also expanding hospitalization coverage by 50 percent despite having zero subsidy under the 2025 national budget which was approved by lawmakers at the bicameral level last week.
The subsidy is being used to cover the premiums of indirect contributors such as the poor, senior citizens, and unemployed.
Ledesma said PhilHealth’s intention to recommend a decrease in contributions aligns with a pending Senate bill seeking to reduce the rate to 3.25 percent from 5 percent.
“I actually made a commitment to sit down with my team in PhilHealth to recommend for a decrease in the premium contributions,” Ledesma said at the briefing with the House Committee on Good Government, during which lawmakers asked PhilHealth to better use its substantial reserve funds for the benefit of its members.
“We are fully supporting that reduction. And that is a very huge reduction po,” he added.
Rep. Jil Bongalon (PL, Ako Bicol) said that while PhilHealth has vowed to expand hospitalization coverage by 50 percent, the state insurer has yet to fulfill the “second mandate” which is to lower premium contributions given the agency’s surplus funds.
“That’s your mandate). So can we commit, can you commit that you will not only focus on the benefit expansion but can you commit also that you’ll decrease premium contribution?” he said in mixed Filipino and English.
Ledesma said premium rates are set by law and that PhilHealth does not unilaterally decide on increases. He also assured lawmakers that PhilHealth remains committed to increasing program benefits, which, he said, could take effect next month.
PhilHealth’s surplus funds, which stand at P150 billion, and reserve funds exceeding P200 billion, remain a key concern of lawmakers, who stressed the importance of balancing financial sustainability with tangible benefits for members.
RESERVE, SURPLUS FUNDS
Ledesma, in the Monday statement, said PhilHealth has P281 billion in reserve funds and P150 billion in surplus funds, while its investment portfolio is at P489 billion.
“Our financial position is strong and sufficient to sustain our operations,” he said.
He defended lawmakers for their decision to strip the agency of the subsidy allocation.
“The decision of the bicameral conference committee reflects its wisdom. The bicam understands PhilHealth’s capacity to continue managing the national health insurance program given its surplus funds,” he said.
Nevertheless, he said, the agency is looking forward to being provided subsidy by the national government after 2025.
“We shall do better to provide reasons for the provision of government subsidies, which are vital to ensuring long-term improvements,” he said.
ADEQUATE RESOURCES
Finance Secretary Ralph Recto said PhilHealth has adequate resources to meet its obligations and even improve benefit packages for 2025 despite the zero subsidy.
“I think what Congress did (zero subsidy) is their prerogative. They have the power of the purse, I understand the reasons why they did that,” Recto told reporters at the Department of Finance yesterday.
“They have adequate reserves and they have a huge surplus, which they can use for 2025, and yet they will have P280 billion at least of reserves,” he added.
Aside from the P281 billion in reserves and P150 billion in surplus funds as of October, its investment portfolio as of November has reached P489 billion.
“My understanding is, there’s a board meeting about a few days ago and they increased the benefit package by 50 percent. The operating budget of PhilHealth next year is roughly P250 billion,” Recto said.
“I leave that to Congress if they want to reduce PhilHealth contributions but my take is to improve the benefit packages and reduce out-of-pocket expenses,” he added.
PhilHealth said it will continue to pay for the health benefits of all Filipinos, with or without government subsidy.
P284B BUDGET
The PhilHealth Board of Directors has approved the Corporate Operating Budget (COB) for fiscal year 2025 amounting to P284 billion.
In a statement released by the Department of Health yesterday, Health Secretary Teodoro Herbosa, also and PhilHealth board chairman, said the budget “already factors in the zero government premium subsidy for indirect contributors for 2025, as decided by the bicameral conference committee.”
“The total amount is even 10 percent higher than the previous year’s P259 billion COB,” he added.
Within the 2025 COB is the amount of P271 billion programmed for benefit expenses, and is higher by 11 percent compared to 2024 COB.
Herbosa said the budget takes into account increases in benefit case rates, Z benefits, PhilHealth Konsulta, and hemodialysis sessions, as well as funds for emergency care, outpatient mental health, severe acute malnutrition, and other outpatient packages.
“PhilHealth has a lot of money, well over the reserve fund ceiling allowed by law. This surplus is a result of underspending for benefits through the years,” he said.
“The Board approved higher benefits and a budget for 2025 that recognizes the need for PhilHealth to spend more so that families will spend less,” added Herbosa. – With Wendell Vigilia and Angela Lorraine Celis
