PhilHealth to implement new premium rate in 2014

MANILA, Philippines - Starting Jan. 1 next year, the Philippine Health Insurance Corp. (PhilHealth) will implement the new premium rate of P2,400 for individually paying members (IPMs) with a monthly income of P25,000 and below.

IPMs pertain to self-employed and voluntary members, including those under the Kalusugang Sigurado at Abot-Kaya sa PhilHealth Insurance program and the group enrollment scheme.

IPMs can choose from three payment schemes: P600 per quarter, P1,200 semi-annually or P2,400 per annum.

PhilHealth president and chief executive officer Alexander Padilla said that IPMs with an income of more than P25,000 shall continue to pay P3,600 in annual premium.

“Individually paying members and their dependents shall be entitled to in-patient hospital care including all case rate packages and catastrophic illnesses in the Case Type Z Benefit Package, out-patient coverage and other special benefit packages under the National Health Insurance Program (NHIP),” he added.

In July 2012, PhilHealth attempted to raise the rate from P1,200 to P2,400 to increase the “financial risk protection” of its members and their dependents.

The agency said this was “an essential element to enable the NHIP to realize the vision of universal health care for all Filipinos.”

The move, however, was met by strong resistance from various labor groups, prompting PhilHealth to defer it and set the annual premium rate at P1,800 for 2013 as part of the transition.

Padilla noted that PhilHealth is expecting total benefit payments of at least P62.98 billion this year, up by 34 percent from the P47 billion in 2012.

“The corporation releases some P1.2 billion per week for benefit payments. For the period of January-June of this year alone, PhilHealth already reimbursed a total of P26 billion, which is already 30 percent higher from the P20 billion disbursed during the same period in 2012,” he added.

The increase is attributed to the continuing enhancement of PhilHealth benefits, which substantially cover hospital expenses of members and their dependents.

These benefits, Padilla said, also ensure “totality of care and attainment of better health outcomes, especially on its low-risk and end-stage renal package worth P600,000, P 210,000 for childhood leukemia and P100,000 each for early stage breast cancer, and low to intermediate risk prostate cancer.”

This year, PhilHealth introduced catastrophic packages for coronary artery bypass at P550,000; surgery for tetralogy of fallot for P320,000; surgery for ventricular septal defect for P250,000; cervical cancer chemo-radiation with cobalt and brachytherapy (low dose) for P120,000, and cervical cancer with linear accelerator and brachytherapy (high dose) for P175,000.

“Improved subsidies to various medical cases and expanded coverage also pushed benefit payments upward. This also means that more and more beneficiaries are availing themselves of the benefits at the time they need them most,” Padilla said.

The expansion of service facilities has also contributed to the increase in benefit payments. Nine out of 10 hospitals licensed by the Department of Health are now PhilHealth accredited.

“We will continue to enhance our benefit package to be more relevant to the millions of members not only here but also abroad,” Padilla said.