THE Philippine Health Insurance Corporation (PhilHealth) has implemented a 50% increase in nearly all of its benefit packages, aiming to provide greater financial protection and improve healthcare affordability. This adjustment, detailed in Circular No. 2024-0037 signed by PhilHealth President Emmanuel Ledesma Jr., took effect on January 1, 2025, and applies to around 9,000 medical and procedural case rates.
Key Adjustments
Moderate-Risk Pneumonia: Coverage increased from ₱19,500 to ₱29,500, reflecting its status as the most claimed benefit package.
Acute Gastroenteritis: Coverage rose from ₱7,800 to ₱11,700, making it more accessible for beneficiaries.
The adjustments are designed to align with health inflation, reduce out-of-pocket expenses, and enhance access to quality healthcare services.
Exclusions from the Increase
Some benefit packages are not included in the 50% hike, such as:
Rationalized Packages: Including acute stroke, high-risk pneumonia, and severe dengue.
Catastrophic Illnesses: “Z benefit packages” like cancer treatments, which are under separate recosting efforts.
Newly Introduced Benefits: Outpatient mental health packages.
High-Risk Procedures: Cases with a high risk of moral hazard, such as cataract surgery and hemodialysis.
Other Payment Mechanisms: Benefits under Konsultasyong Sulit Tama (Konsulta).
The updated benefit packages can be accessed via PhilHealth’s Case Rates Search Portal or through its official channels.
Background and Challenges
This marks only the second across-the-board adjustment by PhilHealth since 2013, following a 30% increase in February 2024. The agency has faced criticism from health reform advocates for delays in implementing universal healthcare and addressing systemic inefficiencies.
Despite the hike, PhilHealth continues to operate without a government subsidy for 2025, raising questions about its ability to meet the growing healthcare demands of its members.