Increase covers 9,000 case rate packages to stem health inflation

The Philippine Health Insurance Corp. increased almost all of its benefit packages by 50 percent despite getting zero subsidy from the government this year.

According to PhilHealth Circular No. 2024-0037, the increase, which took effect January 1, was approved “to increase support value, decrease out-of-pocket payment (OOP), increase financial risk protection, and ensure the effective delivery of high-quality health services.”

“This (circular) covers around 9,000 case rate packages that we have increased by 50 percent,” PhilHealth senior vice president Israel Pargas said.

PhilHealth said the package hike “effectively reinforces case-based payments and adjusts case rates to align with health inflation, demonstrating a strong commitment to improving healthcare affordability and access.”

Among the medical cases covered by the adjustments are urinary tract infection (UTI), acute gastroenteritis, and influenza.

However, excluded from the 50-percent adjustment are the following: acute stroke, high risk pneumonia, severe dengue, and COVID-19 as these are being rationalized separately.

Z Benefits packages for catastrophic illnesses such as cancer that are being re-costed and are scheduled for adjustment are likewise excluded from the case rate package increase.

Last month, the PhilHealth Board of Directors approved the state health insurer’s P284 billion corporate operating budget (COB) for 2025, about 10 percent higher than the P259 billion in 2024.

The P284 billion budget takes into consideration the zero-government premium subsidy for indirect contributors for this year.

It also includes computations by PhilHealth management of a P150 billion surplus as of Oct. 31.

“PhilHealth has a lot of money, well over the reserve fund ceiling allowed by law. This surplus is a result of underspending for benefits through the years, which is why Filipino families pay high out of pocket,” Health Secretary Teodoro Herbosa earlier said.

“The Board approved higher benefits and a budget for 2025 that recognizes the need for PhilHealth to spend more so that families will spend less,” he added.

In 2022, around 25 percent of Filipinos reported that they avoided seeking medical care due to financial concerns, according to a survey by the Philippine Statistics Authority.

About P271 billion of the 2025 COB is programmed for benefit expenses – 11 percent higher compared to fiscal year 2024.

As for administrative expenses, the Board approved an increase of 3 percent only – from P12.1 billion in 2024 to P12.5 billion in 2025.

The President earlier retained the zero subsidy allocation for PhilHealth for 2025 as approved by both houses of Congress.

“We will ensure that PhilHealth benefits will continue and even expand (despite the zero subsidy),” Mr. Marcos said.

PhilHealth has approximately P280 billion in reserve funds, a P150 billion surplus, and over P400 billion in investments.