PhilHealth to employers: Premium adjustment is necessary

In response to public reactions on the adjustment in premium contribution rates starting this month, the Philippine Health Insurance Corporation (PhilHealth) reiterated that the latest adjustment affects only the members in the Formal Sector, and that the adjustment in premium rate is long overdue.

“The adjustment will enable the corporation to strengthen its current financial position so that it can boost the social health insurance benefit packages and frontline services that are currently accorded to the country’s workforce and their qualified dependents,” sai d PhilHealth Interim/ OIC President and CEO Dr. Celestina Ma. Jude de la Serna.

Primarily, de la Serna said that the premium rate adjustment is needed to enable PhilHealth to continue providing benefit packages that respond to what its members need. For the last three (3) years, PhilHealth has introduced benefit packages without raising the premium contribution rate.

Ver y soon, PhilHealth is extending the availability of the Primary Care Benefit (PCB) 1 Package to employed members. The package includes primary care consultations, risk profiling for hypertension and diabetes, periodical breast examination, among others.

This package was earlier pilot-tested among teaching and non-teaching personnel of the Department of Education, thus, its roll-out to the rest of the Formal Sector is welcome news.

Among the latest packages were the medical detoxification package worth P10,000, Z benefit package for small and pre-term babies worth as much as P135,000, the upgrading of coverage for Acute Lymphocytic Leukemia from P210,000 to P500,000, among other s.

Also up for implementation soon are four (4) Z benefit packages for children with disabilities, covering hearing impairment, visual impairment, mobility and developmental disabilities.

While studies are being conducted to determine the appropriate amount of coverage for hearing and visual impairment, children with developmental disabilities are entitled to PhilHealth benefits ranging from P3,626 to P5,276; and claims for mobility impairment starts at P13,110.

De la Serna added that the adjustment is timely as PhilHealth puts into effect programs that improved its service standards. For instance, the All Case Rates provider payment mechanism empowered members to immediately know how much PhilHealth pays for each and every compensable medical condition or surgical procedure.

The list of medical conditions and the corresponding fixed, pre-determined amount can now be viewed through a mobile application or through the PhilHealth website. (PhilHealth)