PhilHealth: President In Action: Acting President and CEO Dr. Edwin Mercado convenes the Technical Advisory Council to refine disease coverage selection process

by Info @Brand Zone | Mar. 14, 2025

Council Members consist of Dr. Tessa Tan-Torres Edejer, health economist who served as  the Coordinator of the Unit on Costs, Effectiveness, Expenditure and Priority Setting in the  Department of Health Financing and Governance (HGF), WHO in Geneva; Dr. Carlo Irwin  A. Panelo, health systems, policy and financing expert; Honesto A. Nuqui, Jr., actuary,  mathematician, and seasoned insurance executive; Dr. Michael L. Tee, university professor,  scientist, and chancellor; Dr. Valerie Gilbert T. Ulep, health economist and well-published  senior research fellow; Dr. Vivencio Jose Villaflor, a practicing surgeon and seasoned  hospital administrator; and Henry Aguda, information technology and digital transformation  expert.

.PhilHealth PR No. 2025-15 | March 13, 2025 | Reference:  Dr. Israel Francis A. Pargas

The PCEO Mercado convened the Technical Advisory Council (TAC) for its second meeting  on March 10, 2025. The session focused on improving actuarial assumptions and refining  the disease coverage selection process. 

During the meeting, experts discussed practical ways to strengthen actuarial projections that  will directly benefit PhilHealth members. The council emphasized the need for more detailed,  market-based assumptions that assess whether current healthcare providers can actually  deliver the covered services.  

"By improving our actuarial assumptions, we can better predict healthcare costs and  utilization patterns," explained the PCEO Mercado. "This means we can expand benefits in a  sustainable way while ensuring members can actually access the care we're promising." 

The TAC supported the President and CEO's direction to expand coverage for high-cost,  high-burden diseases to increase access to critical services. For members, this translates to  greater financial protection against catastrophic health expenses that previously caused  significant hardship for many Filipino families. 

"Going granular means understanding if our current healthcare infrastructure can deliver the  services we're covering, and developing strategies to create robust markets where they don't  exist. Ang ibig sabihin po nito, alam natin hindi lang kung nasaan ang mga doktor at iba pang  mga propesyonal, ngunit alam din natin kung ilang pasyente ang kaya nilang tingnan sa  isang araw nang hindi bumababa ang kalidad ng serbisyong pang-medikal," added the  PhilHealth President and CEO. "When we promise coverage for a condition, we want to  ensure our members can find qualified providers to deliver that care without excessive out of-pocket expenses or long travel times." 

Council members committed to developing a practical framework that will guide this  expansion while ensuring service delivery capability.

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Pinalawak na benepisyo para sa operasyon ng katarata ng PhilHealth

ni Fely Ng @Bulgarific | Mar. 8, 2025

Hello, Bulgarians! Simula Enero 30, 2025, ipinatupad ng Philippine Health Insurance Corporation (PhilHealth) ang pinalawak nitong benepisyo para sa operasyon sa katarata kasama ang paglalagay ng intraocular lens (IOL) para sa matatanda at bata.

Ito ay sang-ayon sa direktiba ni Pangulong Ferdinand R. Marcos, Jr. na palawakin pa ang mga serbisyong pangkalusugan ng PhilHealth.

Batay sa PhilHealth Circular 2025-0001 na inilathala noong Enero 15, 2025, ang benepisyo para sa operasyon sa katarata sa mga matatanda ay tumaas nang higit sa apat na beses at nagsisimula sa P20,200. 

Ang benepisyo ay depende sa uri ng lens, kung saan ang mga operasyon na gagamitan ng monofocal IOL o standard lens ay may halagang P28,300 bawat mata. Ang mga premium lens naman tulad ng monofocal toric IOL na nagbibigay ng malinaw na paningin sa isang partikular na distansya habang inaayos ang astigmatism ay sasagutin sa halagang P43,800 bawat mata. 

Samantala, ang multifocal IOL na tumutulong makakita ng malinaw sa malapit at malayo ay may halagang P66,900 bawat mata, habang ang multifocal toric IOL na nag-aayos ng astigmatism at nagbibigay ng malinaw na paningin sa iba’t ibang distansya ay sagot ng ahensya sa halagang P80,900 para sa kanang mata.

Samantala, ang coverage para sa operasyon ng katarata sa mga bata ay umaabot ng hanggang P135,000 bawat mata at P139,050 para sa parehong mata. Kung kasama ang intraocular lens, ang coverage ay nasa P179,000 bawat mata at P187,100 para sa parehong mata.

Dating nagbabayad ang ahensya ng P16,000 bawat mata para sa pagtanggal ng katarata sa matatanda at bata.

Nananawagan ang ahensya sa mga accredited healthcare facilities na panatilihing may sapat na supply ng Intraocular lenses, gamot sa mata, IV fluids, at iba pang mga kagamitan upang masigurong hindi na kailangang gumastos ng pasyente sa pagbili ng gamot sa labas ng pasilidad.

Sa buong 2024, ang PhilHealth ay nakapagbayad ng kabuuang P3.58 bilyon para sa 224,209 na operasyon sa katarata.

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Para sa anumang impormasyon, opinyon, isyu o maging imbitasyon, mag-e-mail sa bulgarific@gmail.com o sumulat kay Ms. Bulgarific at ipadala sa Bulgar Bldg., 538 Quezon Avenue, Quezon City.

New benefit in focus: PhilHealth Outpatient Mental Health Package to support “invisible” pains of Filipinos

by Info @Brand Zone | Mar. 5, 2025

PhilHealth PR No. 2025-11 March 4, 2025

PhilHealth is committed to holistically addressing the healthcare needs of every Filipino. 

“Nais naming ipaabot na kahit hindi nakikita ang inyong daing, may PhilHealth na magbibigay ng suporta at alaga sa inyo. Ito po ay alinsunod sa mga prayoridad ng ating Pangulong Marcos,” said Dr. Edwin M. Mercado, PhilHealth Acting President and CEO.

Through the PhilHealth's Outpatient Benefits Package for Mental Health [PhilHealth Circular 2023-0018], members and dependents aged 10 and above, can now access services encompassing initial assessments, follow-up consultations, diagnostic tests, and psychosocial support. It covers conditions such as depression, psychosis, epilepsy, child and adolescent mental and behavioral disorders, dementia, and self-harm or suicide risks, among others. 

As such, those requiring specialized care are provided with access to interventions from psychiatrists, neurologists, and psychologists. PhilHealth provides annual coverage of Php 9,000 for general mental health services and Php 16,000 for specialized care. 

Members can access these benefits at any accredited facility that provides general mental health services. These facilities include rural health units (RHUs), city or municipal health offices, level 1 and 2 hospitals, Department of Health (DOH) Medicine Access Program-mental health access sites, and stand alone mental health clinics. 

On the other hand, specialized mental health services can be accessed at accredited Level 2 and 3 hospitals with specialized staff, custodial care facilities, and national specialty centers identified by DOH. 

"We recognize the importance of accessible mental health services for every Filipino. Kaya naman, katuwang din natin ang Kagawaran ng Kalusugan sa patuloy pang pagpapalawig ng ating mga serbisyo para sa kalusugang pangkaisipan. We are calling for more providers to participate and make these services within reach of Filipinos with mental health struggles," added Dr. Mercado. 

Beyond the Mental Health package, PhilHealth encourages individuals experiencing suicidal thoughts or mental health distress to utilize readily available 24/7 crisis hotlines, including the National Center for Mental Health hotline at 0917-899 8727 or 989-8727, for immediate counseling. 

PhilHealth remains committed to strengthening the nation's mental health service infrastructure and ensuring that quality care is accessible to all Filipinos needing them. For more questions on the MH benefit package and other benefits, members can call the following 24/7 touch points: (02) 866-225-88; mobile numbers 0998-857-2957, 0968-865-4670, 0917-1275987 or 0917-1109812.### 

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