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Thursday, June 20, 2024

PBBM orders PhilHealth to broaden services and benefits to its members

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President Ferdinand Marcos Jr. on Wednesday ordered the Philippine Health Insurance Corp. (PhilHealth) to provide more benefits for its members.

In a meeting with the President at Malacañang, PhilHealth officials led by its acting president and chief executive officer Emmanuel Ledesma Jr., enunciated their short-term plan and long-term plans for the agency.

For the short-term program which basically covers the first six months of 2023, PhilHealth looks forward to increasing the hemodialysis coverage from 90 to 156 sessions, in effect doing away with the whichever-is-lower policy in settling claims and increasing the case rate of the top four packages covering 25 percent of filed claims.

The broadened dialysis coverage involves increased dialysis support to three times a week for outpatients, equivalent to full weekly coverage on yearly basis.

PhilHealth’s short-term plan also calls for the introduction of mobile app and short message service (SMS) confirmations, as well as implementation of new benefit packages.

Under its new packages, PhilHealth considers unwrapping outpatient mental health benefit package, outpatient package for severe acute malnutrition for children below five years, old and strengthen its Konsulta program.

PhilHealth also plans to streamline its COVID-19 in-patient benefits, reverse transcription polymerase chain reaction (RT-PCR), and rapid antigen tests, as well as isolation schemes.

For its mid-term plan to be introduced in 2024, 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 percent interest on missed premium payments.

The health insurer also plans to impose penalties on erring doctors and hospitals instead of revoking their accreditation, amend the Universal Healthcare Law (UHC) 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.

For its long-term plans, PhilHealth will be pursuing digitalization and the construction of PhilHealth-owned buildings and facilities.

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