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Philhealth to adjust premium contributions in formal sector

Philippine Health Insurance Corporation (PhilHealth) held a consultation with stakeholders in Cagayan de Oro City on its proposed premium adjustment for CY 2019.

In an interview with Dr. Francisco Soria Jr., vice president for Member Management Group, he said there will be no increase in the rate but instead increase in the salary cut from P40,000 to P100,000.

He explained, current rate is at 2.75 percent of the employee’s salary as premium. That will remain at 2.75 percent in 2019. However, the salary cut will be adjusted from P40,000 to P100,000 which will affect those with salary of more than P40,000.

Only less than 10 percent of the members will be affected by this adjustment. According to Soria, with the adjustment, they will release the expanded primary care benefit for the formal sector.

This will be new for the employed sector, he added.

“We have gone all over the country orienting the providers of the expanded primary care benefit at the same time we have to adjust our system also because submission of reports to PhilHealth from the providers is online,” he said.

Included in the Expanded Primary Care benefit are free of charge health screening and assessment/consultation, basic services within the package based on age, sex and risk: CBC, urinalysis, fecalysis, chest xay, pap smear test or VIA, lipid profile and fasting blood glucose.

Further, this would also include outpatient drugs and medicines such as in hypertension, diabetes and other infections.

He said, outpatient care is a big gap in the benefits by PhilHealth which includes outpatient drugs/medicines. Medicines are now included in the expanded primary care to be implemented this year.

The demand for health care in the country is expanding. Soria said now we have triple burden of disease: infections, long term illnesses and globalization like diseases. The problem is that we have limited pool of resources.

PhilHealth has to step in, he said, to improve its benefits but at the same time ensure that its fund is sustainable.  So while we are expanding the benefits, there has to be some adjustment in the premium, he added.

This is needed, he explained, in response to the demand to expand the health care services covered by PhilHealth.

This can be availed once every year, however, for confinement, he reminds the new rule of 9/12 which will take effect by October 1, 2018.

Members must complete payment of premium contribution of at least a total of nine months within the immediate 12-month period prior to the first day of confinement.

Soria said, they have to expand the benefits aggressively to address the needs of the population. (PIA10)


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