PhilHealth underscores importance of social insurance

CEBU CITY, Cebu (PIA) — The Philippine Health Insurance Corporation (PhilHealth) in Region 7 highlighted the importance of social insurance among Filipinos amid reports of low insurance penetration in the country.

Leonard Castañeda, chief insurance officer of PhilHealth, said that according to surveys, Filipinos have the least number of insured individuals.

“We are all aware that most Filipinos would prefer to buy gadgets over paying monthly insurance dues,” said Castañeda during the 2nd General Assembly of the Association of Government Information Officers in Region 7 in Cebu City.

He explained that insurance provides financial protection or a safety net in case something bad happens.

“One strategy that we have chosen to pursue in the Philippines is social health insurance. It is a compulsory scheme requiring contributions from the employee and the employers, both with government subsidies,” he said.

Leonard Castañeda, chief insurance officer of Philhealth 7, explaining the importance of social insurance during the 2nd General Assembly of the Association of Government Information Officers in Region 7 in Cebu City. (PIA7)

Castañeda explained that having social health insurance is risk pooling, reflects solidarity, shared responsibility, and the concept of being selfless.

“The basic concept is if the risk is shared, the need will be alleviated. There is solidarity, there is sharing,” he explained.

Risk pooling is the practice of sharing all risks among a group of insurance companies. Insurance companies come together to form a common pool as protection against catastrophic events, usually natural disasters.

Castañeda said that “we have to have a wide pool in order to address the needs of the people.”

Data from the Insurance Commission show that the Philippines’ insurance penetration is only at 1.68 percent — the ratio of premiums to gross domestic product — at the end of the third quarter of 2023.

Image from Philhealth 7
Need to increase premium rates

Laarni Joy Allanic, PhilHealth 7 head of collection section, said that for 18 years from 1999 to 2017, Philhealth premium rates stayed at 2.5 percent.

Allanic said there was no adjustment in the premium rates even during the COVID-19 pandemic.

In fact, the agency continued to expand their benefits to their members and beneficiaries, which included the COVID-19 testing.

In its PhilHealth Circular No. 2019-0009 published on Nov. 23, 2019, the premium rate for Direct Contributors was adjusted to 2.75 percent of their monthly basic salary with an adjusted ceiling of P50,000.

In 2020, PhilHealth increased the rate to 3 percent with a supposed adjustment increment of 0.5 percent every year until it reaches the 5 percent limit in 2025 as provided for by law.

“However, COVID 19 happened in 2020 so the 3.5 percent for 2021 increase did not happen. It was suspended,” said Allanic.

In 2022, there was an adjustment of 4 percent by June, but the increase for 2023 was not implemented because the lifting of the health emergency was done in July 2023.

“So for 2024 and 2025, it will be at 5 percent,” she added.

Allanic emphasized that contributing members and their beneficiaries can avail of the Philhealth benefits including their spouse, children, even illegitimate or foster children for as long as they were recognized by the contributing member.

According to PhilHealth, the resumption of the legislated premium schedule is necessary to sustain, enhance and expand benefits, ensure coverage of qualified dependents without additional premiums, and to fund provisions of the Universal Health Care Law providing automatic membership and immediate eligibility.

Image from Philhealth 7 Facebook page
Benefit package

Medical Specialist of Philhealth Benefits Administration Section, Dr. Reginald L. Mangubat, shared that the benefit package, including certain surgeries, has been updated and enhanced.

“As expected, the reception of the increase in premium has been widely criticized, but because of the signing of the Universal Health Care law, we need this increase for funding and for the expansion of the benefits,” said Mangubat.

There are enhanced benefit packages for hemodialysis, cataract surgeries, general mental health facilities, acute stroke, high risk pneumonia, including adjustments on medical case rates, and surgical case rates.

Hemodialysis sessions increased from 45 to 90 sessions per year in 2015 to 156 sessions per year in 2023.

Effective November 2023, accredited Philhealth ophthalmologists can now perform cataract surgeries, from 50 surgeries per month to 200 surgeries per month.

For ischemic stroke, the benefit was increased from P28,000 to P76,000, while for hemorrhagic stroke, it was increased from P38,000 to P80,000.

In high-risk pneumonia cases, coverage has now increased from P32,000 to P90,100.

“As you can see, Philhealth has increased the benefits for the most common illnesses and the majority of the case rates have a 30 percent increase effective Feb. 14, 2023,” Mangubat added. (MYP/PIA7 Cebu)

In other News
Skip to content