PhilHealth Enhanced Benefits for Neonatal Sepsis, Bronchial  Asthma and Konsulta Package;

PhilHealth Enhanced Benefits for Neonatal Sepsis, Bronchial  Asthma and Konsulta Package

Good afternoon! I would like to thank you all for attending today’s PhilHealth  Kapihan with Media. In our previous press conferences, we usually mention PhilHealth’s plans to  enhance the benefit packages. True to this commitment, we are pleased to inform you that we have just enhanced two more health benefits in order to alleviate the  burden of members on these burdensome conditions.

Effective May 1 of this year, the benefit package for neonatal sepsis is now  P25,793 from P11,700 or an increase of 120%. We have also increased our coverage for bronchial asthma in acute exacerbation  from P9,000 to P22,488, a jump of 150%. 

Another good news, these new packages are effective immediately. Based on  the implementing guidelines of the two benefit packages which we issued  through PhilHealth Circular Nos. 2024-0008 and 2024-0009, all admissions due  to neonatal sepsis and bronchial asthma in acute exacerbation starting May 1,  2024, are already entitled to these new rates.

You might be wondering why we have enhanced our coverage for neonatal  sepsis and bronchial asthma. According to the World Health Organization, neonatal sepsis is responsible for 3  out of 10 neonatal deaths in the world. It is also among the leading causes of  neonatal deaths in the country. In 2023, more than 57,000 cases were paid by  PhilHealth in the amount of P733.86 million. Neonatal sepsis is defined as a serious medical condition that affects babies  younger than 28 days old.

On the other hand, asthma remains to be a high-burden disease in the  Philippines despite the medical advancements in the treatment of this condition.  The majority of Filipinos with asthma do not have adequate control over their  condition, which results in confinement. Based on PhilHealth data for 2023,  asthma ranks eighth in the top medical confinements we have paid for with more  than P717 million for more than 90,000 confinement cases. 

In addition, PhilHealth identified these two cases – neonatal sepsis and bronchial  asthma – as priority conditions in rationalizing select All Case Rates packages to  improve financial coverage as we transition our payment mechanism to  Diagnostic Related Groups or DRG, as mandated in the Universal Health Care  Law.

The good news does not stop here. I am also happy to announce that the  enhanced Konsulta Package was already effective last May 16, 2024. Previously  we were covering 13 laboratory and diagnostic tests, now we are expanding it to  15 which now includes mammogram and ultrasound of upper abdomen, pelvic and breast. With these enhancements, the annual capitation, or the amount we  pay our Konsulta Package Providers per patient is now P1,700 for both public  and private from the previous P550 per patient. This is also our response to the  call of our partner Konsulta Package Providers to increase the capitation.

I thank Speaker Ferdinand Martin Romualdez, Cong. Erwin Tulfo for staunchly  supporting these developments as well as to the Board of Directors, headed by  Secretary of Health Ted Herbosa for approving all these benefit enhancements. Later, resource persons from the Benefits Development and Research  Department and Project Management Team for Primary Care will give in depth  discussions on these enhanced packages.

Dear media partners, PhilHealth has started implementing important  enhancements in benefits in 2023, such as the expansion as well as the  institutionalization of 156 hemodialysis sessions for patients with Chronic Kidney  Disease Stage 5, increase in coverage for ischemic and hemorrhagic stroke and  high-risk pneumonia, and the launch of the groundbreaking Outpatient Mental  Health Package. 

This year, the 30-percent increase in the All Case Rates took effect, and just last  March, PhilHealth Z Benefits for breast cancer had a 1,400% leap from P100,000  to P1.4 million.  

With all these benefit developments implemented in the last 11 months,  PhilHealth is surely a bearer of hope to Filipinos who seek treatment for their  various medical conditions. Ngayon, masasabi natin na mas nararamdaman na  ng mga Kababayan natin ang kanilang benepisyong PhilHealth dahil malaking  bahagi ng kanilang gastusing medikal ay sagot na ng PhilHealth.

Your PhilHealth continues to bring positive changes in how the government cares  for the people through various social services. We are committed to further  unburdening our Kababayans by providing responsive financial coverage under  our thrust “Pinalawak at mga Bagong Benepisyo para sa Mamamayang  Filipino”. 

Let me end with a very motivating story that Mr. Antonio Owen S. Maramag,  Senior Vice President and Chief Marketing Officer of the Development Bank of  the Philippines, recently shared during our Annual Investment Forum. This was  about his mother who was able to avail of her PhilHealth benefits. Mr. Maramag  said, “PhilHealth provides peace of mind to the patients and their families who  are already worried about their loved one’s ailment and the added burden of bills”.  He added that “the thought that PhilHealth is there to pay or subsidize for the  important procedures and charges is reassuring – yung may maaasahan ka na  tulong sa mga bayarin na hindi ka na hihingi pa.”

In addition, I also would like share with you another message, this time from Mr.  Carlos “Cholo” Baviera, former Vice President of Aliw Broadcasting Company  and now a PhilHealth Lifetime Member, on how PhilHealth was able to assist him  not only on his hemodialysis expenses. 

According to Sir Cholo, PhilHealth shoulders 80-90% of hemodialysis patients  expenses which is a big factor especially to him, being a senior citizen and a  retiree. What I appreciate most is his call to fellow Filipinos to support PhilHealth.  He said “We have to support PhilHealth, all the way. ‘Yan ang nagustuhan ko sa  PhilHealth. Totoo po na hindi sila pang pa-pogi lang”.

I sincerely thank Mr. Maramag and Mr. Baviera for sharing their experience with  us. These kinds of messages serve as an inspiration to all of us to strive even  more and do even better for our countrymen. Again, thank you dear partners in media for joining us today. Muli, ang aking  panawagan sa inyong lahat na tulungan ninyo kaming ihatid ang magandang  balitang ito sa ating mga Kababayan. Maraming salamat po.

PhilHealth increases benefits for  neonatal sepsis and bronchial asthma

Effective May 1, 2024, the Philippine Health Insurance Corporation  (PhilHealth) is implementing another  round of enhancements in two of its  existing benefit packages, this time for  neonatal sepsis and bronchial asthma which have been increased heftily by more  than 100%. 

PhilHealth Circulars 2024-0008 and 0009,  the implementing guidelines of these two  case rate packages, prescribe that all  patients admitted on May 1, 2024 onwards  may avail themselves of the increased  benefits in accredited health facilities. 

According to PhilHealth President and CEO  Emmanuel R. Ledesma Jr. “the PhilHealth  Board has approved the increase in  package rate for neonatal sepsis to  P25,793 from P11,700 and bronchial  asthma in acute exacerbation to P22,488  from P9,000. The increase translates to 120% and 150%, respectively”. 

Neonatal sepsis and other infectious  conditions are among as the leading causes  of neonatal deaths in the Philippines. In  2023, PhilHealth paid P733.86 million for  more than 57,000 cases for the said  condition. 

On the other hand, asthma remains to be a  high-burden ailment in the Philippines  despite medical advancements. The  majority of Filipinos with asthma do not  have adequate control over their  conditions, resulting to confinements.  Based on PhilHealth data for 2023, asthma  ranks eight among the top medical  confinements paid by the state insurer,  where P717 M have been paid for, for more  than 90,000 cases of asthma.

PhilHealth identified neonatal sepsis and  bronchial asthma as priority conditions in  rationalizing its All Case Rates packages to  further improve financial coverage and  lower, if not eradicate the patients out-of

pocket expenses.  Ledesma explained that “PhilHealth is  continuously improving its benefit  packages in line with our thrust Pinalawak  at mga Bagong Benepisyo para sa  Mamamayang Filipino. We are hoping  that these enhancements bring positive  impact in the behavior of the Filipinos in  seeking medical attention. Sa mga  nangangailangang magpagamot, huwag  na pong magdalawang isip dahil  nakaalalay ang PhilHealth sa kanilang  gastusing medikal PhilHealth also reminded the members  that the adjusted case rates may be availed  of in Levels 1 to 3 accredited public and  private health facilities nationwide.  Meanwhile, the previous rates of P11,700  for neonatal sepsis and P9,000 for  bronchial asthma will be applied to patients  admitted in accredited primary care  facilities.

laboratory tests, hospital admission due to  worsening of asthma will be avoided”, Ledesma added.  The PhilHealth Chief also urged all  members to register to their preferred to  Konsulta Package Provider to avail  themselves of free consultations, health  screening and assessment, as well as any of  the 21 essential drugs and medicines and 13  laboratory tests as will be required by their  primary care physician. ###