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Marcos to PhilHealth: Expand dialysis coverage, provide mental health benefit

Published Mar 9, 2023 02:50 am
President Ferdinand “Bongbong” Marcos Jr. has directed the Philippine Health Insurance Corp. (PhilHealth) to expand its coverage for its members, particularly to increase the hemodialysis coverage from 90 to 156 sessions and to provide mental health benefit package.  During a meeting with the President at Malacañang Palace on Wednesday, March 8, PhilHealth officials, led by acting President and Chief Executive Officer (CEO) Emmanuel Ledesma Jr., discussed its short-term plan for the first half of 2023.  This included increasing 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. The widened dialysis coverage will cover three times a week dialysis sessions for outpatients, which is equivalent to full weekly coverage annually. The state insurer’s short-term plan will also introduce the PhilHealth mobile app and short message service (SMS) confirmations, as well as new benefit packages—outpatient mental health benefit package and outpatient package for severe acute malnutrition for children below five years old. It also aims to strengthen its Konsulta package. According to a statement from Malacañang, PhilHealth also plans to “rationalize the Covid-19 in-patient packages, reverse transcription polymerase chain reaction (RT-PCR) and rapid antigen tests as well as isolation packages.” The officials also spelled out its mid-term plan, which will be introduced in 2024.  The mid-term plan included a general amnesty for employers and government agencies with missed premium payments. This will particularly benefit businesses, employers, and individuals, especially small and medium enterprises that cannot shoulder the 3 percent interest on missed premium payments. Instead of revoking the accreditation of erring doctors and hospitals, the state insurer will simply impose penalties, amend the Universal Healthcare Law (UHC), and increase the case rates of top 10 packages with the highest claims filed. PhilHealth also plans to introduce an anti-fraud system and reorganize the agency to improve claims processing and frontline services. Its long-term plans include digitalization and the construction of PhilHealth-owned buildings and facilities.

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