Philippine Health Insurance Corp. (PhilHealth) is celebrating a significant milestone as it marks its 29th anniversary alongside the National Health Insurance Month, themed "Damang dama ko ang benepisyo" (I strongly feel the benefits). On its 29th birthday, falling on Valentine's Day, PhilHealth is giving Filipinos a special gift: expanded financial coverage for hospitalization expenses and broader health coverage and benefits.
PhilHealth Members' Day
PhilHealth is partnering with SM Store to honor its members on its 29th anniversary. Through the PhilHealth Members' Day, the state health insurer is offering a one-day shopping discount promo for members who shop at any SM Store branch nationwide today.
PhilHealth members and SM Store shoppers must show their PhilHealth ID and SMAC or SM Advantage to avail of a P300 discount on every minimum single-receipt purchase worth P3,000.
Expansion of Coverage, Benefits
To better serve Filipinos' needs, PhilHealth announced the expansion of coverage and benefits for its members on April 26, 2023.
PhilHealth acting President and CEO Emmanuel Ledesma Jr. mentioned that this expansion initially focused on outpatient hemodialysis sessions. This increase raises the sessions from 90 to 156, ensuring support for three hemodialysis sessions per week throughout the year.
This adjustment addresses the needs of patients with stage 5 chronic kidney disease, who require three 4-hour dialysis sessions each week.
As part of its enhancements, PhilHealth introduced the PhilHealth mobile app and text message confirmations, aiming to streamline Philippine healthcare through technology.
"We are planning to rationalize select inpatient case rates, including moderate and high-risk pneumonia and acute ischemic and hemorrhagic cases, as these are the most common cases availed in recent years," said Ledesma in an article published by The Manila Times on April 26, 2023.
Following this statement, PhilHealth increased coverage for ischemic stroke from P28,000 to P76,000 and for hemorrhagic stroke from P38,000 to P80,000.
This year, PhilHealth aims to expand Z benefits for breast cancer, offering coverage of up to P1 million per patient per year for targeted therapy.
In an effort to address rising medical costs and improve benefit value, PhilHealth is adjusting its case rates starting today. In line with the Universal Health Care (UHC) Law, PhilHealth has also been enhancing its PhilHeath Konsultasyong Sulit Tama (Konsulta) package over the past few years, aiming to provide basic health and medical services to Filipinos.
Through the PhilHealth Konsulta package, Filipinos have access to a comprehensive outpatient benefit covering free checkups, health screening, select laboratory and diagnostic exams, X-rays, and medications at any accredited PhilHealth Konsulta provider.
This package includes laboratory and diagnostic tests such as complete blood count, urinalysis, fecalysis, sputum microscopy, pap smear, lipid profile, and more.
The Konsulta package promotes equal access to quality and affordable healthcare, preventing chronic illnesses through early detection and providing health insurance and medicines nationwide.
All PhilHealth members can register and enjoy the benefits of the Konsulta package through PhilHealth's member portal at www.philhealth.gov.ph or at any PhilHealth local insurance office.
Launch of Outpatient Mental Health Benefits Package
PhilHealth's benefits expansion includes the launch of an outpatient mental health package and outpatient therapeutic care package for severe acute malnutrition in children under 5 years old.
PhilHealth partnered with the National Center for Mental Health to implement the mental health benefits package, following the launch of the Philippine Council for Mental Health Strategic Framework for 2024 to 2028 on Oct. 12, 2023.
This initiative aligns with the Mental Health Act (Republic Act 11036), mandating enhanced delivery of integrated mental health services for Filipinos with mental disorders.
As the primary healthcare provider in the country, PhilHealth aims to provide members and their dependents with responsive benefits that ensure financial risk protection during their healing from anxiety and depression.
PhilHealth's mental health benefits for outpatient services include consultations, diagnostic follow-up, psychoeducation, and psychosocial support at accredited mental health outpatient facilities.
There are two packages available: general mental health services with a reimbursement rate of P9,000 per patient per year and specialty mental health services with a reimbursement rate of P16,000 per patient.
Psychiatric services are available for individuals aged 10 years and older, while neurological services have no age restriction.
With this comprehensive mental health package, PhilHealth expands its coverage to include a broader range of mental health conditions, surpassing the previous limit for conditions such as dementia, bipolar disorders, schizophrenia, and anxiety disorders.
PhilHealth urges mental health facilities nationwide to undergo accreditation to ensure essential mental health services are readily available across the country.
The state health insurer also expands mental health services nationwide, increasing awareness in both urban and rural areas to combat discrimination and stigma.
Cybersecurity Efforts
PhilHealth faced challenges last year, including a major cyberattack incident from the ransomware called Medusa, affecting some servers and local workstations and raising concerns about data privacy.
The information security incident occurred on Sept. 22, 2023. PhilHealth later announced that the ransomware attack did not affect servers containing members' private information, including the membership database, claims, contributions, and accreditation information.
However, the agency temporarily shut down its online systems and shifted to manual operations for investigation and security measures. PhilHealth later revealed that some data records were compromised, and affected individuals were promptly notified.
PhilHealth urged the public to take safety measures by checking their membership and contribution records on the PhilHealth member portal, being cautious of phishing emails and texts, and strengthening passwords, especially for financial accounts.
PhilHealth reported the incident to the Department of Information and Communications Technology, the National Privacy Commission, and law enforcement agencies for resolution and to apprehend the perpetrators.
A week after the hacking incident, PhilHealth resumed online operations and assured members of data safety and secure benefit entitlement.
To assist members in protecting their privacy, the National Privacy Commission introduced a database search portal, "Na-leak ba ang PhilHealth data ko?" (Was my PhilHealth data leaked?), allowing members to verify if their Phil