Manila: The Philippine Health Insurance Corporation (PhilHealth) has unveiled a substantial expansion of its benefit coverage, with its projected budget for benefit payments surging to approximately PHP378 billion to PHP400 billion this year. This development follows the return of PHP60 billion in funds to the state insurer, aligning with the directive from President Ferdinand R. Marcos Jr.
According to Philippines News Agency, PhilHealth President and Chief Executive Officer Dr. Edwin Mercado, in an interview on Bagong Pilipinas Ngayon, stated that the budget for benefits has nearly tripled from PHP119 billion in 2023 to the current projection, demonstrating a significant increase in the resources allocated for its members. This budgetary improvement has enabled the introduction of an enhanced maternity care package effective April 30. The package now covers increased prenatal visits, comprehensive monitoring, and postnatal care.
The coverage for medical procedures, including normal delivery, cesarean sections, and dilation and curettage, has been increased by 150 percent. Mercado emphasized the agency's commitment to primary healthcare programs like the Yaman ng Kalusugan Program (YAKAP), which aims to provide easier access to primary care. Currently, 95 percent of towns in the Philippines have operational YAKAP clinics, with 4,130 accredited nationwide, 25 percent of which are private providers.
Another notable program is the Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT), which functions as an "e-wallet" worth PHP20,000 for outpatient medicines. To access this benefit, members must consult a YAKAP-accredited doctor, ensuring quality diagnosis and medicine alignment.
Mercado addressed concerns regarding bureaucracy, noting that the "claims turnaround time" has been reduced from an average of 40 days to 15 to 16 days. PhilHealth is also training hospital billing clerks to minimize errors in e-claims, which often lead to delays or rejections.
With the rainy season approaching, PhilHealth is finalizing expanded coverage for leptospirosis, animal bites, and cancer. The agency is working on expanding the "No Balance Billing" policy beyond Department of Health hospitals to local government units and private hospitals. Negotiations are underway with private hospitals to dedicate 10 percent of their bed capacity for basic accommodation under this scheme.
To ensure transparency, PhilHealth has launched a portal to publish financial statements, claim payments, and circulars. Mercado highlighted ongoing engagement with civil society organizations to communicate how funds are allocated and utilized. He urged members to register and select their YAKAP providers via the eGov app or local branches.
In collaboration with the Philippine Statistics Authority, PhilHealth plans to co-locate biometrics registration in its offices to verify patients and prevent fraud.
