Marcos orders PhilHealth to expand coverage for members

MANILA, Philippines — President Ferdinand “Bongbong” Marcos Jr. on Wednesday directed the Philippine Health Insurance Corp. (PhilHealth) to expand its coverage for its members.

Marcos issued the order during a meeting with PhilHealth officials in Malacañang on Wednesday, according to the Presidential Communications Office (PCO).

During the meeting, the PCO said PhilHealth officials led by acting president and CEO Emmanuel Ledesma Jr.,  spelled out its short-term plan for the six months of 2023, such as:

-increasing the hemodialysis coverage from 90 to 156 sessions

-repealing the pay-whichever-is-lower corporate policy in payment claims

– increasing the case rate of the top four packages covering 25% of filed claims.

The PCO said PhilHealth, with its widened coverage, will increase dialysis support to three times a week for outpatients, equivalent to full weekly coverage annually.

Also part of the state health insurer’s short-term plan is the introduction of the PhilHealth mobile app and short message service (SMS) confirmations, as well as the implementation of new benefits packages.

The PCO said PhilHealth, under its new packages, is looking to introduce the outpatient mental health benefits package, the outpatient package for severe acute malnutrition for children below five years old, and its improved Konsulta package.

PhilHealth also plans to rationalize the Covid-19 in-patient packages, reverse transcription polymerase chain reaction (RT-PCR), and rapid antigen tests as well as isolation packages.

Malacañang, meanwhile said that for its mid-term plan to be introduced in 2024, PhilHealth will carry out general amnesty for employers and government agencies with missed premium payments, which will cover businesses, employers, and individuals, especially small and medium enterprises that cannot afford to pay the 3% interest on missed premium payments.

The health insurer also plans to impose penalties on erring doctors and hospitals instead of revoking their accreditation, amend the Universal Healthcare Law (UHC) and increase the case rates of the top 10 packages with the highest claims filed.

The PCO said an anti-fraud system will also be introduced and a reorganization of PhilHealth will also be implemented to ensure proper manpower complement, especially for claims processing and frontline services.

For its long-term plans, PhilHealth will be pursuing digitalization and the construction of PhilHealth-owned buildings and facilities.

READ: PhilHealth to tweak aid for mental health, malnutrition, others due to rate hike delay

je