MANILA -- The Philippine Health Insurance Corporation (PhilHealth) has partnered with major health maintenance organizations (HMOs) and private health insurers (PHIs) to ensure health services reach the public and avoid double billing or confusing overlapping benefits.
A memorandum of understanding was signed by PhilHealth with major HMOs and PHIs on benefit complementation, which is expected to make primary care or outpatient services more affordable and accessible.
It also aims to push for a seamless benefit availment for Filipinos.
PhilHealth President and CEO Beverly Lorraine Ho said, "We want to make sure that benefits are complementary. Meaning we don’t duplicate each other’s benefit and also that we’re able to give better coverage… In the end, panalo yung pasyente o yung member.”
Philippine Association of Health Maintenance Organization Companies Chairman Christian Argos said they are already doing this with inpatient services or hospitalization.
Now, they want to expand to primary care which is a bulk of the health services availed by Filipinos.
“Kung meron sa inyo na-ospital, diba lalabas sa bill ninyo, nakalagay na doon less PhilHealth, less HMO. Tapos napakaliit na lang ng out of pocket natin. So we want to extend that to outpatient as well," said Argos, who is also the president of Maxicare.
Under the agreement, PhilHealth YAKAP pays first the covered benefits like general practitioner consults, 13 laboratory tests, some medicines under PhilHealth's GAMOT program, 6 cancer screening tests, other services like animal bite care, maternal care, TB-DOTS, HIV/AIDS treatment, and mental health services.
The HMOs and PHIs then will cover other medical services not covered by PhilHealth.
Ho said, “PhilHealth Yakap will serve as the first layer of protection for consultations, some laboratory tests, medicines, and cancer screening. We hope that our partner private insurers and HMOs will then build on that foundation and can cover what we currently don’t cover- specialist consultations, perhaps certain vaccines, additional diagnostics.”
Because of this new arrangement, Argos said they can expand their existing services or packages to even include the benefits of the parents.
They can also create new packages that are more affordable.
The Insurance Commission of the Philippines ma recommend to HMOs to bring down the premium fee, but it also says that benefits may also be expanded.
“It gives HMOs an opportunity not just to adjust premium, but to add something- broader benefits, higher limit, better diagnostics, more preventive healthcare,” said IC OIC Ermar Benitez.