PhilHealth launches new, expanded benefit packages for 2025

By Ma. Teresa Montemayor, Philippine News Agency

Starting Jan. 1, PhilHealth has increased the case rates of 9,000 packages by 50 percent. (PNA file photo by Joan Bondoc)

MANILA – The Philippine Health Insurance Corporation (PhilHealth) on Friday launched additional and expanded health benefit packages that its members could avail of starting this year.

According to PhilHealth president and Chief Executive Officer Emmanuel Ledesma Jr., required policy instruments or circulars have already been created and published for these new benefits: ischemic heart disease-acute myocardial infarction, Z Package for peritoneal dialysis, Z Package for kidney transplantation, preventive oral health services, outpatient emergency care benefit, and 50-percent adjustment in case rates packages.

“Our goal is to alleviate financial strain on the Filipino patient and ensure timely access to life-saving services from hospitalization, diagnostic tests and procedures like angioplasty, stenting, and medication,” he said during the state-insurer’s first stakeholders meeting for the year.

The ischemic heart disease-acute myocardial infarction consists of four different packages: the percutaneous coronary intervention (PCI) or coronary angioplasty increase from PHP30,000 to PHP524,000; fibrinolysis increase from PHP30,290 to PHP133,500; emergency medical services with coordinated referral and interfacility transfer at PHP21,900; and cardiac rehabilitation after PCI at PHP66,140.

“We also want to encourage the availment of peritonial dialysis (PD) as a first line modality treatment for end stage renal disease. We want to push this option apart from hemodialysis, not just the autonomy and flexibility for members in choosing the treatment modality but also to promote the quality of life and mobility of the patients,” Ledesma said.

He also said Z Package for PD now covers continuous ambulatory peritoneal dialysis (CAPD) for adults. These benefits have been set at PHP389,640 and PHP510,140 depending on the PD solutions a patient requires per day. These packages increased by up to 89 percent from the previous PHP270,000 per year.

For pediatric patients, CAPD and automated peritoneal dialysis are now offered. These are set at PHP510,000 and PHP765,210, while coverage for APD ranges from PHP763,000 to PHP1.2 million, according to the PhilHealth chief.

Concerned members may also avail of exit site infection and peritonitis prevention care from any of the 51 accredited PD providers nationwide.

The state insurer has also included living organ donor transplantation in its Z Package for kidney transplantation. This increased the previous coverage of PHP600,000 to over PHP1 million. Meanwhile, deceased organ donor transplantation is set at PHP2.14 million.

The preventive oral health services are now part of the primary care services. These include mouth examination or oral screenings, dental pes milaxis (cleaning), fluoride varnish application, pit and fissure sealants, Class V restoration procedures (limited to two teeth per year), and emergency tooth extractions (when necessary and performed in accredited health facilities).

The outpatient emergency care benefit, meanwhile, will cover the cost of urgent care that does not require hospitalization of at least 24 hours.

“These will include treatment for life-threatening medical emergencies,” Ledesma said.

“Ngayon po, sagot po ng PhilHealth ang sinumang itatakbo sa ER ng mga ospital (Now, PhilHealth will cover for anyone who will be sent to the ER of hospitals),” he added.

The two main components of this package are the facility-based emergency and pre-hospital emergency benefits which cover essential care in accredited hospital emergency departments and emergency transport services.

Starting Jan. 1, PhilHealth has increased the case rates of 9,000 packages by 50 percent.

Ledesma assured members that the new and expanded benefit packages will not result in premium hike this year or in the coming years.