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Increase in contribution rate means more benefits for members - PhilHealth 

PhilHealth President and Chief Executive Officer (CEO) Emmanuel R. Ledesma Jr. explains the importance of adjusting contribution rates in terms of expanding the coverage of health benefits for Filipinos. (Photo Courtesy: PhilHealth)

QUEZON CITY, (PIA) -- The Philippine Health Insurance Corporation (PhilHealth) reiterated its commitment to provide more responsive health benefit packages for members nationwide following the increase in premium contribution rate from 4 percent to 5 percent this 2024. 

“Our commitment to continuously provide Filipinos with responsive benefit packages remains, as guided by our thrust of “Pinalawak at mga Bagong Benepisyo para sa Mamamayang Filipino," said PhilHealth President and Chief Executive Officer (CEO) Emmanuel R. Ledesma Jr. 

Ledesma earlier announced that the 30 percent increase in most case rate packages of PhilHealth had already been implemented last February 14, 2024. This will help restore substantial coverage that is affected by health inflation. 

Under the Z Benefits Package, the coverage for breast cancer increased from P100,000 to P1.4 million. 

Meanwhile, in 2023, the coverage of hemodialysis also expanded from 90 sessions to 156 sessions per year. This paved the way for the increased annual benefit coverage of patients with chronic kidney disease (stage 5) from P234,000 to P405,600. 

PhilHealth similarly increased coverage for high burden diseases such as acute ischemic stroke (P28,000 to P76,000) and acute hemorrhagic stroke (P38,000 to P80,000). Other increases in coverage include the benefit packages for high-risk pneumonia from P32,000 to P90,100. 

In October 2023, the corporation successfully launched the Outpatient Mental Health Package to cater to more than 3 million Filipinos who are suffering from different mental health conditions. This package provides coverage for general and specialty mental health outpatient services amounting to P9,000 and P16,000 per patient annually. 

For 2024, PhilHealth is expected to rationalize case rates for bronchial asthma and bacterial sepsis in the inpatient benefits of newborns and COVID-19 patients. 

Members can also look forward to the enhancement of peritoneal dialysis under the Z benefits package. 

The guidelines for the outpatient therapeutic benefits package will also be released this year. This will cater to children aged 5 years old and below who have severe acute malnutrition. 

“This is where the importance of adjusting our contribution rates comes into play. It will generate funds necessary for us to complete our benefit plans, and more importantly to sustain the reforms in the benefit packages,” Ledesma highlighted. 

It can be recalled that the scheduled adjustment in contribution rate from 4 percent to 4.5 percent was suspended in 2023. However, this did not halt the corporation from implementing necessary enhancements to the benefit packages for members. 

In February 2024, PhilHealth released P257 million funding to strengthen the implementation of the Konsultasyong Sulit at Tama (Konsulta) program or primary care benefit package. This will be allocated for the first tranche of capitation payments to Primary Care Provider Networks (PCPNs). 

In total, P30 billion has been earmarked for the rollout of the Konsulta program out of the P243 billion budget allocation of PhilHealth for the coverage of benefits packages this 2024. 

The coverage of the said program will further expand to the treatment of tuberculosis, animal bite, malaria, and HIV (human immunodeficiency virus)/AIDS. This adds to the expansion of coverage and access points of Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT) of PhilHealth. (PhilHealth/PIA-NCR) 

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Janna Marie Pineda

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