The Philippine Health Insurance Corporation (PhilHealth) officially announced on Friday, Jan. 12, the implementation of a “five percent” premium rate increase for the year 2024.
“For us to be able to sustain these benefit enhancements, PhilHealth needs to continue strengthening its fund. Kailangan natin ng pondo para matugunan ang ating mga nasimulang magagandang pagbabago sa mga benepisyo ng PhilHealth (We need funds to address the positive changes we have initiated in the benefits of PhilHealth),” said PhilHealth President and CEO Emmanuel R. Ledesma, Jr., during the press conference at PhilHealth Head Office.
PhilHealth confirmed that the increase was effective since Jan. 1.
He also noted that the premium rate adjustment is mandated by Section 10 of Republic Act 11223, also known as the Universal Health Care (UHC) Act, and the law requires PhilHealth to carry out the last adjustment of premium contribution, setting the "five percent" contribution rate and an income ceiling of P100,000 for the year.
Ledesma emphasized that, as a key implementer of the UHC Law, PhilHealth must implement the mandated changes to fulfill its duty to the Filipino people.
He highlighted that the law also stipulates that any increase in the contribution rate should correspond to an increase in benefits.
“Nitong nakalipas na mga linggo, bagamat nasa batas ang pagpapatupad ng premium adjustment, ay minabuti ng PhilHealth na makipag-ugnayan sa iba't-ibang partners at stakeholders upang magkatuwang na ipatupad ang kahuli-hulihang contribution adjustment ayon sa UHC Law, at para siguruhing magtutuloy-tuloy ang mga pinagbuting benepisyo ng mga miyembro (In the past weeks, although the implementation of premium adjustment is mandated by law, PhilHealth has opted to coordinate with various partners and stakeholders to collaboratively carry out the final contribution adjustment according to the UHC Law, ensuring the continuous delivery of improved benefits to its members),” the PhilHealth Chief emphasized.
Meanwhile, addressing concerns about the financial position of PhilHealth, Ledesma reassured that the institution's financial status remains “robust.”
He committed to funding the proposed rationalization and expansion of benefits, aiming to alleviate the financial burden on the Filipino people during medical emergencies and reduce out-of-pocket expenses for members.
PhilHealth Konsulta Package
On the other hand, Ledesma further discussed the “PhilHealth Konsulta Package,” emphasizing the government's focus on strengthening primary care in the country.
He revealed a budget allocation of P30 billion for the Konsulta Package in 2024 to provide essential healthcare services to every Filipino.
“Ang PhilHealth ay patuloy na tataya sa kalusugan ng bawat Filipino, kung kaya pinapalakas at pinagbubuti pa natin ang PhilHealth Konsulta Package (PhilHealth continues to invest in the health of every Filipino, thus reinforcing and improving the PhilHealth Consultation Package),” he explained.
Moreover, in the realm of outpatient care, PhilHealth has published guidelines for the implementation of PhilHealth GAMOT (Outpatient Drug Benefit), expanding coverage to include 53 outpatient medications, from infections to maintenance medications for non-communicable diseases.
Claim payment
Meanwhile, regarding claims payments, Ledesma acknowledged the importance of prompt payments to healthcare providers.
“As of Dec. 31, 2023, PhilHealth paid a total of P45.1 billion to our partner health facilities, both private and government, between August and December of 2023, despite the cybersecurity incident in September,” Ledesma explained.
Despite the impact on stakeholders' receivables in September and October, PhilHealth demonstrated resilience by disbursing payments exceeding 12 billion pesos in August and over 10 billion pesos in November, surpassing the commitment to settle obligations with partner facilities within 90 days, as stated by the PhilHealth Chief.
He called for cooperation from partner health facilities in submitting accurate claims to avoid denials, stating that PhilHealth is open to communication and reconciliation of claims records.
Moreover, PhilHealth also unveiled plans for initiatives to address claims processing bottlenecks, including the implementation of the claims system override support (SOS) and the development of cloud-based application systems for online claims filing.
In a strategic move for the future, Ledesma announced the organization's plan to implement automated e-claims submission and processing through a cloud-based application system by 2025, marking a significant long-term solution for enhanced efficiency.
“With all these developments, you can expect more from your PhilHealth. We need everyone's support to make all these things happen. Let us help each other, dear friends, to progressively realize UHC,” he said.
Ledesma urged support from all stakeholders, stating that PhilHealth remains committed to enhancing and expanding benefit packages, in line with the UHC Law's mandate to provide equitable access to quality and affordable healthcare for every Filipino.