PhilHealth gets P21B subsidy, to launch new benefit packages

FILIPINOS can expect more benefits from the Philippine Health Insurance Corp. (PhilHealth) this year despite the deferment of the scheduled increase in the members’ monthly contribution.

This, as the state insurer banks on P21 billion in subsidies from the national government as well as its own strong financial position to fund them.

An outpatient benefit package for mental health and an outpatient package for severe acute malnutrition for children below five years old will be introduced this year, PhilHealth president and chief executive officer Emmanuel Ledesma Jr. announced at a press conference in Pasig City Wednesday, Feb. 15, 2023, a day after PhilHealth celebrated its 28th anniversary.

PhilHealth already provides inpatient coverage for mental health conditions. But with an estimated six million Filipinos living with depression and/or anxiety, the outpatient benefit package hopes to improve the quality of life and productivity of those suffering from mental health issues, he said in a statement.

Ledesma said dialysis patients can also expect an expansion of PhilHealth’s coverage for outpatient hemodialysis from 90 to 156 sessions this year.

In addition, the state insurer will enhance select benefit packages for patients requiring prolonged hospitalization and expensive treatments such as for orthopedic implants; kidney transplantation; breast, cervical and prostate cancers; and open heart surgeries for children, specifically Ventricular Septal Defect and Tetralogy of Fallot.

Helping to fund these enhancements are the Philippine Amusement and Gaming Corp. (Pagcor) and Philippine Charity Sweepstakes Office (PCSO), from which a total of P21 billion has been approved for transfer to PhilHealth under the 2023 General Appropriations Act, Ledesma said.

Under Republic Act (RA) 11223, or the Universal Health Care Act of 2019, 50 percent of the national government share from the income of Pagcor, as provided for in Presidential Decree 1869, as amended, as well as 40 percent of the PCSO’s charity fund, net of documentary stamp tax payments and its mandatory contributions as provided for in RA 1169, as amended, shall be transferred to PhilHealth.

Ledesma said PhilHealth also has its own financial capability to provide for its members.

“As of September 2022, we recorded our highest net income at P46 billion. Our total assets stood at P394 billion, which is 13 percent higher than our December 2021 figures,” he said.

Ledesma said the bulk of PhilHealth’s P355 billion investment portfolio, or 83 percent, was in long-term investments in government bonds and corporate bonds, while the rest was in short-term investments.

Healthy operations, he said, had also grown PhilHealth’s reserve fund to P224 billion from P151 billion in September 2021.

Last January, President Ferdinand Marcos Jr. directed PhilHealth to suspend the scheduled increases in the premium contribution rate to 4.5 percent from four percent, and monthly income ceiling to P90,000 from P80,000, to provide financial relief to Filipinos still suffering from the challenges brought by the Covid-19 pandemic.

RA 11223 mandates the increase in the premium rates from 2.75 percent in 2019 to three percent in 2020, 3.5 percent in 2021, four percent in 2022, 4.5 percent in 2023 and five percent in 2024.

Under the implementing rules of this law, the premium contributions of those earning below the income floor of P10,000 will be based on the income floor, while those earning above the income ceiling will pay premiums based on the income ceiling.

For any income from the income floor to the income ceiling, the premium contribution will be computed based on the basic monthly income.

For 2022, the income floor and ceiling were P10,000 and P80,000, respectively.

Under RA 11223, the income ceiling should be raised to P90,000 in 2023 and then to P100,000 in 2024.