The Philippine Health Insurance Corporation announced Tuesday that its projected budget for member benefits is expected to nearly triple this year, reaching between 378 billion and 400 billion pesos, as the state insurer moves to expand coverage across maternity care, outpatient medicines, and critical illnesses.
The figure marks a dramatic rise from the 119 billion pesos allocated in 2023, according to PhilHealth President and Chief Executive Officer Dr. Edwin Mercado, who attributed the growth in part to the return of 60 billion pesos in funds to the agency following a directive from President Ferdinand R. Marcos Jr.
“In a span of three years, the amount of benefits we assign for our members almost tripled,” Mercado said in a nationally televised interview.
Maternity and Delivery Coverage Expanded
Among the most significant changes is a revamped maternity care package that took effect April 30. The new package doubles prenatal visits from four to eight and adds comprehensive monitoring including ultrasounds, vaccines, vitamins, and postnatal care. Coverage for normal deliveries, cesarean sections, and dilation and curettage procedures has increased by 150 percent.
Primary Care Push
Mercado highlighted two flagship programs aimed at broadening access to basic health services. The Yaman ng Kalusugan Program, or YAKAP, has accredited 4,130 clinics nationwide — 25 percent of them private — with functional facilities now present in 95 percent of towns across the country.
A separate outpatient drug benefit program called GAMOT provides members with the equivalent of a 20,000-peso electronic wallet for outpatient medicines. Members must consult a YAKAP-accredited physician to access the benefit.
Faster Claims Processing
Mercado said PhilHealth has cut its average claims turnaround time from 40 days to between 15 and 16 days. The agency is also training hospital billing staff to reduce errors in electronic claims submissions, which he identified as a leading cause of delays and rejections.
Rainy Season Preparedness
Looking ahead to the wet season, PhilHealth is finalizing expanded coverage for leptospirosis — from preventive treatment at clinics through to dialysis and respirator support for severe cases — as well as for animal bites, extending rabies treatment to minor scratches that do not break the skin. A new benefit roadmap covering multiple cancer types with currently limited support is also being developed.
‘No Balance Billing’ Goal
The agency is working to extend its “No Balance Billing” policy beyond Department of Health hospitals to local government facilities and private hospitals. Mercado said PhilHealth is negotiating with private hospitals to reserve 10 percent of bed capacity for basic accommodation under the scheme.
Transparency and Fraud Prevention
To bolster accountability, PhilHealth maintains a public transparency portal and is actively engaging civil society organizations to explain how funds are being used. The agency is also partnering with the Philippine Statistics Authority to co-locate biometrics registration in PhilHealth offices as a safeguard against fraud.
Mercado urged members to register and select their YAKAP provider through the eGov mobile application or at their nearest PhilHealth branch.
