PhilHealth to reduce premiums, expand coverage

MANILA, Philippines — Although deprived of subsidy under the 2025 approved budget program, the state-run Philippine Health Insurance Corp. (PhilHealth) has assured lawmakers that it would still be able to reduce premium contribution and expand its coverage next year for overall better health care benefits for members.

PhilHealth president and chief executive officer Emmanuel Ledesma Jr. relayed the assurance to House Assistant Majority Leader Jil Bongalon of party-list Ako Bicol at last week’s hearing by the House committee on good government and public accountability on the national health insurance system.

Ledesma said it is the intention of PhilHealth leadership to recommend a decrease in contributions, pursuant to a pending Senate measure aiming to reduce the rate from five percent to 3.25 percent.

“We are fully supporting that reduction. And that is a very huge reduction. I actually made a commitment to sit down with my team in PhilHealth to recommend for a decrease in the premium contributions,” he told the House panel.

Ledesma explained nevertheless that premium rates are set by law and that PhilHealth does not unilaterally decide on adjustments.

“All of these are already set. And then just for the information of this honorable body, it’s currently at five percent this year. That’s the latest increase,” he said.

At the same time, Ledesma assured lawmakers that PhilHealth remains committed to increasing program benefits. “Our commitment is to increase the program benefits, which hopefully will take effect by next month (January 2025).”

PhilHealth’s surplus funds, which stand at P150 billion, and reserve funds exceeding P200 billion, remain a key concern for the House, led by Speaker Martin Romualdez, who vowed to initiate marathon hearings next year on PhilHealth’s fund management.

The PhilHealth chief said they would also be expanding members’ hospitalization coverage by 50 percent, in response to lawmakers’ concerns that the state health insurer must better utilize its substantial reserve funds for the direct benefit of members.

The House panel, led by Manila Rep. Joel Chua, stressed the importance of balancing financial sustainability with tangible benefits for PhilHealth members.

Ledesma’s commitment to both reducing contribution rates and expanding health care benefits was welcomed by lawmakers, who vowed to monitor PhilHealth’s progress.

There will be more hearings on the PhilHealth issue when Congress resumes session on Jan. 13 next year.

Bongalon stressed that PhilHealth’s mandate includes decreasing contribution rates once reserve funds exceed the ceiling needed to meet expenditures. “That is your mandate. So, can you commit that you will not be focused on benefit expansion alone? Can you decrease contribution?”

The Bicolano legislator, a lawyer by profession, also questioned PhilHealth’s allocation of government subsidies, noting that funds intended for indirect contributors appear to have been diverted to investments.

“Same with the 2024 General Appropriation Act. The budget of PhilHealth was P60 billion, P40 billion of which are for indirect contributors. So, that is the reason why we could not understand why all of these funds go to investments,” Bongalon said.