Health Secretary Teodoro J. Herbosa together with the Board of Directors of the Philippine Health Insurance Corporation (PhilHealth) approved the country’s first preventive oral healthcare benefit package which will be implemented by the second quarter of 2025.
“Universal health care must have oral health care, and the best way to make it sustainable and felt by all Filipinos is through primary care. The Board agreed on a preventive oral health benefit to be delivered by dentists working in PhilHealth Konsulta package providers, and also by stand-alone dentists based on referrals from the Konsulta providers,” Herbosa said in a statement released yesterday by the Department of Health.
The DOH said the next step will be for PhilHealth to write and publish the details in a Circular, which will then lead to the development or enhancement of IT systems that will be used to capture data and facilitate payments.
PhilHealth staff will also be training and orienting stakeholders prior to roll-out and implementation of the package next year.
The benefit package is designed to pay for annual routine preventive oral care services for every Filipino, such as mouth examination/oral screening, dental prophylaxis or cleaning, and fluoride varnish application.
The coverage also includes pit and fissure sealant and Class V procedures as needed for a maximum of two teeth.Emergency tooth extractions and dental consultations will also be part of the benefit package.
The PhilHealth Board approved the landmark expansion of primary care benefits to cover dental needs in line with the overall vision of “Ngiting 70-20” which aims that more Filipinos will reach the age of 70 with 20 permanent teeth still in place.
The PhilHealth Board approved a maximum payment of PHP 1,000 per patient per year for preventive oral health services, to be paid as follows: PHP 300 for the first visit, covering mouth examination/oral screening, oral prophylaxis (cleaning), and fluoride varnish application; another PHP 300 for a second visit at least four months apart from the first visit, for the same services; and PHP 200 per tooth (maximum of two teeth per year) for pit and fissure sealant or a Class V procedure.
There will be no co-payment allowed for public dentists, while private dentists will be allowed maximum co-payment charges per visit of PHP 1,500 for mouth examination and oral prophylaxis; PHP 600 for pit and fissure sealant or Class V procedure; and PHP 600 for emergency tooth extraction.
Applying fluoride varnish strengthens enamel or the outermost layer of teeth, to prevent new cavities from forming or to slow down or stop tooth decay from worsening. Pit and fissure sealants are procedures that protect from tooth decay by filling in grooves and pits of teeth where bacteria combined with leftover food or sugars can cause damage.
The Class V procedures on the other hand, remove decayed or damaged tooth tissue, and then replace the area with composite resin material.
