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PhilHealth Goes Full-Speed Towards UHCNovember 28, 2011

THE Philippine Health Insurance Corporation (PhilHealth) announced today that it is aggressively moving towards universal health care with the introduction of a new set of enhanced benefits designed to improve financial risk protection for all of its members.

PhilHealth President and CEO Dr. Eduardo P. Banzon said that PhilHealth will prioritize the roll-out of primary care benefits that will entitle members to basic, quality health care services through accredited public and even private health care providers nationwide.

"We envision a situation where each and every PhilHealth member is assigned to a primary care provider through which preventive and diagnostic services can be availed of at no cost to the member," Banzon said. "The primary care package will also include outpatient medicines such as anti-hypertensives, anti-diabetics, and antibiotics, which are among the more common medicines needed by our fellowmen."

He added that the agency is also working towards expanding the case rate for all diseases and procedures to further empower the members with the knowledge of how much PhilHealth covers for each and every medical condition. The case rate method of paying for benefits is similar to a 'pakyaw' system wherein all services are already included in the package.

It will also be used as an incentive to further improve access to quality care by eventually offering a higher percentage increase in base case rate for Centers of Excellence, health facilities in under-served areas, and providers implementing the No Balance Billing policy (or the "Sagot Ka ng PhilHealth" policy).

Banzon also emphasized that the NBB Policy, which is currently being implemented among Sponsored members including those identified in the National Household Targeting Survey for Poverty Reduction (NHTS-PR) admitted in government hospitals, will eventually be expanded to all cases and other member-types to enable members to experience true financial protection.

Also included in the enhanced benefits framework are the facilitation of other complementary and supplementary sources of health financing that will be on top of the basic benefit package, specifically covering catastrophic cases and additional health expenses of private and government sector workers.

"As we increase our rates for members, we will make sure that our stakeholders, particularly the employers, shall have time to prepare for this investment in UHC," Banzon said.

For the NHTS-identified poor, premiums will increase to P2,400 by January 1, 2012, primarily financed by the National Government as the enhanced benefits will be immediately provided to them. Members sponsored by local government units (LGUs) will pay a maximum of 50 percent of their premiums, while the rest will be covered by the LGUs. Premiums for this group, for individually paying members, and for OFWs will also increase to P2,400 by July 2012. However, these groups can avail of the old P1,200-peso annual rate for as long as these dues are fully paid for before July. "They can even be locked in to the P1,200 per year rate if they sign up for two years," Banzon said.

For the formal employed sector, premium rates will be pegged at three percent of the basic monthly salary by January 2013, with a maximum salary base of P50,000 to allow employers time for the necessary adjustments.

Banzon also assured members that availment processes at hospitals and other health facilities will be made easier. "With the expected electronic claims submission that will be mandated among Levels 3 and 4 hospitals, PhilHealth will ensure that not only will there be financial protection for our members, but they will always be delighted by our services," Banzon stressed. (END)

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