PhilHealth approves P284-B budget for 2025, hikes benefits case rates

FILE: BUSINESS UNUSUAL. Philippine Health Insurance Corp. transactions go through the manual process, like in this branch in Mother Ignacia Avenue, Quezon City, on Tuesday (Sept. 26, 2023), four days after its system was attacked by the Medusa ransomware. The cyberhackers are reportedly demanding USD300,000 or about PHP17 million to decrypt the files, but the state health insurer said it won’t pay. (PNA photo by Joan Bondoc)

By Ma. Teresa Montemayor, Philippine News Agency

MANILA – The Philippine Health Insurance Corporation (PhilHealth) Board of Directors has approved the PHP284 billion corporate operating budget (COB) for fiscal year 2025, the Department of Health (DOH) said Tuesday.

The total amount is 10 percent higher than the previous year’s PHP259 billion.

The corporate operating budget is PhilHealth’s version of a General Appropriations Act for the national government or a General Appropriations Ordinance for local government units.

The PHP284 billion budget takes into consideration the zero-government premium subsidy for indirect contributors for 2025.

It also includes computations by PhilHealth management of a PHP150 billion surplus as of Oct. 31.

The PhilHealth Board also approved a second round of increases in selected case rates by 50 percent in addition to an emergency care benefit, glasses and optometric services for children, open heart surgery benefits, and pediatric cataract extractions.

“PhilHealth has a lot of money, well over the reserve fund ceiling allowed by law. This surplus is a result of underspending for benefits through the years, which is why Filipino families pay high out of pocket,” DOH Secretary Teodoro Herbosa said.

“The Board approved higher benefits and a budget for 2025 that recognizes the need for PhilHealth to spend more so that families will spend less,” he added.

Herbosa chairs the PhilHealth Board which has four other ex-officio members that include the Secretaries of the Departments of Finance, Budget and Management, Social Welfare and Development, and Labor. It also has three expert panel members and four sectoral members.

It is separate and distinct from PhilHealth’s executive officers led by president and chief executive officer Emmanuel Ledesma Jr. and executive vice president and chief operating officer Eli Diño Santos.

About PHP271 billion of the 2025 COB is programmed for benefit expenses. This is 11 percent higher compared to fiscal year 2024.

This increase takes into account Board-approved increases in case rates, Z benefits, PhilHealth Konsulta at PHP1,700 and PHP2,100 capitation per person, and 156 hemodialysis sessions at PHP6,350 per session.

It also includes funds for emergency care, outpatient mental health, severe acute malnutrition, and many other standalone outpatient packages.

As for administrative expenses, the Board approved an increase of 3 percent only — from PHP12.1 billion in 2024 to PHP12.5 billion in 2025.

Only PHP259 million was classified for capital expenditures, which is 91 percent less than the approved PHP2.9 billion equivalent in 2024.

The Board observed that the management has used only 8 percent of its COB 2024 for the purchase of information and communications technology (ICT) and other capital expenditures.

While the Board did not grant a new ICT budget for 2025, it has extended the validity of the COB 2024 for ICT projects in the amount of PHP989 million to ensure that digitalization is prioritized.