Philippine Health Insurance Corporation office in Quezon City. Maria Tan, ABS-CBN News/File

MANILA — The Philippine Health Insurance Corp. needs more accredited medical facilities as it seeks to expand its health coverage to millions of Filipinos.

In a televised briefing, PhilHeatlh National Capital Region Office Vice President Dr. Bernadette Lico said among the new services covered are preventive oral health services, outpatient emergency care benefits, and pediatric optometric services.

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“Sa oral care package, 1,000 per year po 'yan, ang kaya bayarin ng PhilHealth dun sa clinic, na kung saan kaya mag-provide ng two visits. Meron tayong assessment, may cleaning, like 'yung prophylaxis, may fluoride varnishing, and pag meron din emergency na pasta. Pero kapag private dental clinic po siya, may out-of-pocket po. Kapag government na dental clinic po, wala po dapat na out-of-pocket,” she said.

(For the oral care package, Philhealth can cover up to P1,000 per year or up to two visits. These include assessments, oral prophylaxis, fluoride varnishing, and even emergency filling. No out-of-pocket expenses if they visit government facilities. But if they visit private dental clinics, there will be out-of-pocket expenses.)

Lico said out-of-pocket expenses for oral care can range anywhere between P600 to P1,500.

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Aside from medical facilities, PhilHealth is also looking at facilities of local government units given that they also have a pool of rural health centers.

“Ina-identify po namin kung sino may may capability sa certain packages na i-fi-fi-fit namin para dun sa mga RHUs.”

(We are identifying which LGUs have the capability for certain packages)

The accreditation process will start on February 14. 

Aside from new services, PhilHealth also bared its enhanced benefit package for hemodialysis from P2,600 for 156 sessions per year to P6,350 for 156 sessions per year. 

Konsulta, considered the bread and butter of Universal Health Care, has also seen a 133% increase from P900 to P2,100.

However, the number of Konsulta-accredited facilities, Lico admits, is not enough. She explains that one facility can serve up to 20,000 individuals. This means that with NCR’s 17 million population, around 850 facilities are needed for the region. Data from PhilHealth show the number of accredited Konsulta facilities at 468.

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The PhilHealth official is also encouraging school clinics with proper facilities to have themselves accredited as long as they fulfill the requirements.

“Magpa-accredit din po 'yung clinic nila, kasi may clinic naman po sila. Ang gagawin lang nila, kasi wala po silang laboratory, saka wala silang pharmacy, makikipag-partner lang po sila sa laboratory na licensed ng DOH, tapos laboratory na licensed ng DOH, tapos pharmacy na licensed ng FDA,” Lico explained.

(Since they have clinics, they can have them accredited. What they need to do since they don’t have a laboratory and a pharmacy, is to partner with a DOH-licensed laboratory and an FDA-licensed pharmacy.)

PhilHealth has so far accredited one school-based clinic in Quezon City as a Konsulta facility.

Despite the lack of government subsidy coupled with continued efforts to expand and enhance benefits packages for its members, PhilHealth assured the public it will continue to operate given its steady source of funds from paying members.

“Hindi mababawasan ang benefits, actually tataas pa. Hindi naman mauubos ang pondo. Hindi tayo natatakot na mauubusan para sabihin namin na magsasarado ang Philhealth, hindi po. This 2025, papalawakin pa natin ang benefits. Marami pa kaming idadagdag at itataas po ngayong taon,” Lico said.

(We will not cut on benefits but rather increase them. Funds will not run out and we do not fear funds running out. It is wrong to say and even believe that Phihealth will stop operating. This 2025, we will continue to enhance benefits.)

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