PhilHealth expands services

ZAMBOANGA CITY – The Philippine Health Insurance Corp. (PhilHealth) said it has expanded its coverage for all its active members after President Ferdinand Marcos Jr ordered the agency to roll out more services that will benefit some 69 million beneficiaries.

PhilHealth CEO Emmanuel Ledesma Jr. - who recently met with Marcos - said for the short-term plan, they have increased the hemodialysis coverage from 90 to 156 sessions, repealing the pay-whichever-is-lower corporate policy in payment claims and increasing the case rate of the top four packages covering 25 percent of filed claims.

With its widened dialysis coverage, he said PhilHealth 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, Ledesma said they also introduced the PhilHealth mobile app and short message service confirmations, as well as implementation of new benefit packages.

Under its new packages, PhilHealth is looking to introduce the outpatient mental health benefit package, outpatient package for severe acute malnutrition for children below five years old and strengthen its Konsulta package.

Ledesma said PhilHealth plans to rationalize the COVID-19 in-patient packages, reverse transcription polymerase chain reaction and rapid antigen tests, as well as isolation packages.

For its mid-term plan to be introduced in 2024, Ledesma said 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.

He said they also plan to impose penalties on erring doctors and hospitals instead of revoking their accreditation, amend the Universal Healthcare Law and increase the case rates of top 10 packages with the highest claims filed.

“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,” Ledesma said.

For its long-term plans, he said PhilHealth will be pursuing digitalization and the construction of PhilHealth-owned buildings and facilities. (Mindanao Examiner)