IN response to public reactions on the adjustment in premium contribution rates starting this month, the Philippine Health Insurance Corporation (PhilHealth) today 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,” said PhilHealth Interim/OIC President and CEO Dr. Celestina Ma. Jude P. 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.
Very 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 P10,000.00, Z benefit package for small and pre-term babies worth as much as P135,000.00, the upgrading of coverage for Acute Lymphocytic Leukemia from P210,000.00 to P500,000.00, among others.
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 P3,626.00 to P5,276.00; and claims for mobility impairment starts at P13,110.00.
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.
The government-owned and controlled corporation is also fast moving into electronic transactions, with the implementation of the eClaims that will enable its accredited health care institutions to submit their claim documents electronically for improved efficiency.
Among employers, PhilHealth has also instituted its Electronic Premium Remittance System (EPRS) which facilitates payment of premium contributions of the Formal Sector, and which guarantees real-time posting in PhilHealth’s database.
“These efforts are just the beginning. Once the effects of the adjustment are felt, placing the Corporation on solid ground, studies will be set into motion aimed at putting together enhanced coverage that will meet the dynamic requirements of Universal Health Care (UHC),” de la Serna said.
The PhilHealth Chief stressed that the adjustment is but one of the strategies approved by the PhilHealth Board of Directors to ensure the long-term sustainability of the National Health Insurance Program (NHIP). “This is a mere prelude to a better PhilHealth which closes the gap between quality health care and financial-risk protection. Eventually, this gap will be bridged, but not by PhilHealth alone. It will take the trust, understanding, and support of our members and stakeholders to realize the true essence of UHC,” she said. (END)
(Reference: Dr. Israel Francis A. Pargas, Head Executive Assistant and Concurrent OIC-Vice President for Corporate Affairs Group, Tel. 0917-8089399)