PhilHealth eyes 30-percent increase in benefit packages

MANILA, Philippines — Another 30-percent increase in the coverage rates of benefit packages could be implemented in November by the Philippine Health Insurance Corp. (PhilHealth).

“Our commitment for this is November 2024. Final guidelines and mechanics in the form of a circular will be released for this,” said PhilHealth corporate affairs vice president Rey Baleña.

In February, the state health insurer implemented a 30-percent increase in the coverage rates of most of its benefit packages.

Baleña clarified that high-risk illnesses will be exempted from this increase.

“These packages (not covered) are for conditions that are high-burden diseases and in the top claims. Packages for stroke, high-risk pneumonia, etc. will be increased by more than 100 or even 200 percent,” he said.

The adjustment in benefit packages aims to eliminate out-of-pocket expenses, PhilHealth said.

“The 30-percent increase in case rates will restore substantial coverage affected by health inflation,” said PhilHealth president and chief executive officer Emmanuel Ledesma Jr.

Confinement rule

Meanwhile, the Benefits Committee of the PhilHealth board of directors yesterday recommended a new policy that would remove the single period of confinement rule.

This rule means that “admissions and re-admissions due to the same illness or procedure within a 90-calendar day period shall only be compensated with one case rate benefit,” based on PhilHealth Circular No. 0035, s. 2013.

Around 26,750 claims in 2023 were denied due to this rule.