DOH eyes expands PhilHealth benefits for middle-income contributors

National

MIDDLE-INCOME Filipinos directly paying their Philippine Health Insurance Corp. (PhilHealth) contributions may soon receive expanded health care benefits, according to the Department of Health (DOH).

In a report by Philstar, Health Sec. Teodoro Herbosa said the DOH, in coordination with PhilHealth, is studying new initiatives aimed at improving services for direct contributors/members whose premiums come from salaries or business income while continuing support for government-sponsored members.

“For many years, our focus has been on indirect or sponsored members whose premiums are paid by the government,” Herbosa said during a live radio broadcast.

“Now, we are looking at enhancing services for the middle class.” Herbosa said President Ferdinand Marcos Jr. has emphasized the need to provide better and more meaningful benefits to direct contributors under the Universal Health Care (UHC) program.

Among the proposals being considered are upgraded hospital accommodations for direct contributors, including fewer patients per room and improved amenities such as air-conditioned facilities. “

Currently, all members receive basic accommodations,” Herbosa said. “We are discussing whether direct members can be given better options.”

The DOH is also evaluating the expansion of PhilHealth benefit packages for hospitals implementing the zero-balance billing (ZBB) program, which allows patients to settle hospital bills without out-of-pocket expenses.

“This will encourage more local government unit hospitals to adopt zero-balance billing,” Herbosa said, noting that PhilHealth payments to hospitals already reach up to P300 billion and may increase with additional benefit packages.

President Marcos previously announced that ZBB would be implemented in all 87 DOH-retained hospitals nationwide. PhilHealth spokesperson Dr. Israel Francis Pargas said the planned enhancements are in line with the UHC Act, which mandates additional benefits for direct contributors.

“Section 9 of the UHC Act directs PhilHealth to issue guidelines on additional program benefits for direct contributors,” Pargas said. “This directive ensures that middle-income earners receive full and adequate PhilHealth benefits.”

Pargas added that PhilHealth benefits remain available to all members, regardless of whether contributions are current, missed, or unpaid.(Georgia Olivar, USJ-R Comm Intern)