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Government workers get additional benefits from PhilHealth March 8, 2019

Pargas responds to attendee's queries on supplemental benefits.

The Philippine Health Insurance Corporation (PhilHealth) through its Health Finance Policy Sector recently held consultative and orientation forum on the additional PhilHealth benefits for government workers at the Crowne Plaza Hotel in Quezon City.

Over 130 representatives from various National Government Agencies participated in the orientation forum on February 22, 2019 wherein PhilHealth officers discussed the Supplemental Benefits for the employees of the Executive Branch, and the enhanced Primary Care Benefits (ePCB) for all government employees in addition to their counterparts in the private sector, Senior Citizens and Lifetime Program members.

During the activity, Dr. Jonathan Michael H. Ele, Head of Supplemental Benefits Team explained that the General Appropriations Act of 2018 allocated P3.5 billion to cover the Supplemental Benefits for regular and casual employees of the Executive Branch. The added coverage was capped at P75,000 per employee and must be applied to hospital bills only after deduction of mandatory senior citizen discount, Health Maintenance Organization (HMOs) entitlements, and PhilHealth benefits, among others.

Dr. Ele explained the processes in availing of the PhilHealth Supplemental Benefits, key conditions and restrictions, deduction methods and claims filing.

Entitlement to the said benefits entails the following conditions: (1) qualifying contributions; (2) sufficient regularity of payment; and (3) use of Electronic Premium Remittance System (EPRS) in the remittance and reporting of the agency's PhilHealth contributions. The Supplemental Benefits shall cover only the principal member and cannot be extended to their qualified dependents.

On the other hand, the consultative forum held on March 4, 2019 scheduled for Government Owned and Controlled Corporations (GOCCs) focused on reviewing the PhilHealth Plus benefits and discussion of ePCB.

PhilHealth Medical Specialist Dr. Marvin Galvez from the Benefits Development and Research Department, said that PhilHealth Plus is a supplementary benefit on top of the basic benefit package aimed to lessen the out of pocket expenses of the member. He cited that its creation of PhilHealth Plus was based on Commission on Audit Resolution 2005-001 as regards the irregular use of public funds in the procurement of HMO by government agencies.

"The PhilHealth Plus shall be extended to all employees of the public and private segments. The added cost in premium required by this proposition is overshadowed by the additional social health benefits by a wide margin," said PhilHealth Acting President and CEO Dr. Roy B. Ferrer in his address to the attendees.

Ferrer discusses PhilHealth's effort to provide more benefits to its members.

Sharing his view on the proposed supplementary benefits, Lino Cala-or of the Philippine National Oil Company said, "maganda ang layunin ng PhilHealth Plus sana maisama sa mga benepisyong maaaring makuha dito ang immunization at ambulance services." Being a head of the family, he also asked if the new benefit can be extended to his dependents.

Dr. Lorna Tortona of the Manila International Airport Authority suggested a system for checking the members' remaining balance. "Sana may ma-develop na system na puedeng ma-check ang remaining balance ng mga miyembrong kumuha ng PhilHealth Plus benefits."

Philippine Amusement and Gaming Corporation representative, Dr. Marilyn Ramos suggested that regardless of the employment status, everyone must have PhilHealth Plus benefit. "Para sa akin dapat lahat ng kawani ng gobyerno mayroong PhilHealth Plus kahit ano man ang estado ng employment nito."

For her part, Zarah Jane E. Ignacio, member of the Primary Care Benefit Team, discussed the importance of ePCB as a means to improve the quality of life of PhilHealth members as well as of their dependents. She pointed out that proper diagnostics pave the way for early detection of illnesses, while the lifestyle modification services can help in the avoidance of medical conditions.

Ignacio enumerated the various services included in the ePCB such as health screening and assessment, diagnostic services, follow up consultations, and medicines. The ePCB benefits are dispensed by PhilHealth-accredited public and private hospitals, infirmaries, primary care facilities, ambulatory surgical clinics and medical outpatient clinics.

Dr. Israel Francis A. Pargas, now the Senior Vice President for Health Finance Policy Sector, expressed his gratitude to the participants of the two sessions for their active participation in the discussions. "Every suggestion is important to us and these will serve as guide for us to fully implement the latest benefit enhancements for every entitled member," said Pargas. END

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Government workers get additional benefits from PhilHealth