PhilHealth contribution increase to fund expanded primary package

MANILA, Philippines — The increase in contribution of Philippine Health Insurance Corp. members starting next year will be used in the expansion of the agency’s primary care benefit package, a PhilHealth official said yesterday.

“Among the things that will be prioritized given the adjustments in contributions is the ‘Konsulta Benefit Package.’ This is based on our benefit plan for 2023,” PhilHealth corporate communications senior manager Rey Balena said during the Laging Handa public briefing.

“Konsulta is our expanded primary care benefit package wherein each and every Filipino should be assigned an accredited Konsulta provider that will check and take care of our health needs through consultation,” he said.

“Health risk screening will be conducted as well as laboratory tests and provision of medicines under the Konsulta package. We can access these procedures for free as long as we are assigned a Konsulta provider,” Balena added.

He likewise bared that for next year, they will double the target population coverage for Konsulta saying that “half of the population should already be assigned Konsulta providers and that this is one of the things… the contributions will be used for.”

Balena stressed that the contributions are being used to sustain the current level of several benefit packages being enjoyed by members.

“Whatever benefits we have now, these will just continue, and that under the Universal Health Care, it is guaranteed that these benefits will expand and further improve,” he said, adding that adjustments will be made through 2024 to 2025.

Balena said that they are also preparing the outpatient therapeutic care for severe acute malnutrition and its rollout will be next year. “We will also have the outpatient package for mental health next year. This is included in the benefit plan of PhilHealth. The members’ contribution will help a lot to finance this particular health benefit,” he said.

Balena said that many are in need of this given that right now, several have been dealing with mental health issues.

“We are still in the middle of the pandemic and the COVID-19 benefit package is still included in the benefit plan in support to the government’s campaign to address COVID-19,” he added.

At the same time, Balena said that the increase in premium will also be used by PhilHealth in the gradual transition to this “diagnostic related group” or DRG.

“Under the DRG, payment by PhilHealth to patients will now be rationalized. It will now depend on their health status or risk profile, so we can expect that the benefits through DRG will all the more be felt by members whatever is their health status,” he explained.

Come January 2023, PhilHealth’s membership contribution will increase to 4.5 percent from 4 percent. This means that members earning P10,000 monthly will see their P400 contribution increase to P450.

Balena said the increase in premium rate from the current 4 percent to 4.5 percent is mainly due to it being mandated by the law. “This is mandated by the Universal Health Care Law so that every Filipino will be given adequate access to medical services and financial protection,” he said.