PhilHealth approves higher capitation rate to Konsulta providers

The PhilHealth Local Health Insurance Office (LHIO) Caloocan (Photo from PhilHealth website)

MANILA, Philippines — The Philippine Health Insurance Corporation (Philhealth) is set to pay its Konsulta health package providers P1,700 per patient seen per year starting June 2024, the Department of Health (DOH) said on Thursday.

In a statement, the DOH said that its Board of Directors has approved an increase in Konsulta’s capitation fee which means that the health package’s providers will be able to provide more services to Filipinos without having to wait for reimbursements.

“Private Konsulta package providers (KPPs) will also be allowed to collect a co-payment of up to P900, while patients seen in public KPPs will not be charged extra,” the health department added.

READ: PhilHealth to give free mammograms, ultrasound to women starting July

The implementation of this increased capitation fee is targeted to be implemented in June 2024 or earlier, depending on the completion of operational details such as information technology systems enhancements, it further said.

According to the DOH, PhilHealth Konsulta is a “primary care benefit package that provides capitation payments for free annual check-ups, selected diagnostics, and medicines.”

In a previous circular, the state health insurance provider said that PhilHealth Konsulta is available for all Filipinos, but they need to be registered with a Konsulta provider, such as health centers, clinics, and hospitals accredited by Philhealth.

Konsulta covers check-ups, health screening and assessments, laboratory tests, and medication according to the health risks, age, and needs of the patient, the circular continued.

Meanwhile, the state health insurance provider’s board of directors also approved the addition of mammography and ultrasound screening services to its health benefits package.

READ: PhilHealth open to proposed expanded coverage in private hospitals 

“It is the pleasure of the Board to now bring up primary care benefits with mammogram and ultrasound services not just in sandbox sites, but nationwide,” Health Secretary Teodoro Herbosa said in DOH’s statement.

Philhealth will be able to provide free screening services starting in July of this year.