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All The Medical Benefits You Could Lose If PhilHealth Runs Out Of Funds

Here's what you need to know.
PHOTO: Getty Images/EyeEm
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In August 2020, the Presidential Anti-Corruption Commission (PACC) found a "systemic" flaw in Philippine Health Insurance Corp (PhilHealth), allowing for fraud and corruption to happen. In a briefing, PACC Commissioner Greco Belgica said that corrupt officials have allegedly made false insurance claims on top of overpricing COVID-19 tests. President Rodrigo Duterte has ordered an investigation, relying on a task force composed of the Department of Justice, Office of the Ombudsman, Office of the Executive Secretary, Office of the Special Assistant to the President, Civil Service Commission, Commission on Audit, and Presidential Anti-Corruption Commission.

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According to whistleblower Thorrson Montes Keith, who used to be PhilHealth's own anti-fraud official, up to P15 billion in funds were pocketedWith increasing payouts due to the pandemic and decreasing contributions, operating losses could reach P90 billion this year and P140 billion in 2021 should the pandemic drag on, said data protection officer Nerissa Santiago. At this rate there will be "no more reserve funds" by the end of next year, she said. 

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What does this "mafia-led corruption" mean for members who contribute to PhilHealth? Where exactly does your money go? Here's what you need to know. 

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In 1995, the government formed PhilHealth to help with Filipinos' medical needs. The contributions of its members keep it running. Most employers require their employees to become members—and if you check your payslips regularly, you already know that a portion of your salary goes to PhilHealth. 

Members get different kinds of benefits, which are divided into four categories

  • Inpatient - If you're admitted to a Health Care Institution (HCI) that's considered one of PhilHealth's partners, you'll only have to pay a certain amount (professional fees) of your total bill.
  • Outpatient - These are procedures—like radiotherapy, hemodialysis, outpatient blood transfusion—that don't require hospitalization. 
  • Z Benefits - This category covers treatments for breast cancer, prostate cancer, leukemia, and other "diseases perceived to be economically and medically catastrophic.
  • SDG Related - Outpatient malaria, HIV/AIDS, and animal bite treatment packages fall under this category. 
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In accordance with the Universal Health Care Law of 2019, PhilHealth released a new contribution schedule for Direct Contributors: These are members "who are gainfully employed and bound by an employer-employee relationship," which includes kasambahays, self-earning individuals, practicing professionals, and Overseas Filipino Workers (OFWs). 

The premium rate was at 2.75 percent of the monthly basic salary with an adjusted ceiling of P50,000, but as of 2020, the rate increased to three percent "henceforth adjusted to increments of 0.5 percent every year until it reaches the five percent limit in 2025 as provided for by law." During this five-year period, the income floor is at P10,000, with the salary ceiling increasing by P10,000 every year until it reaches P100,000 in 2025. If this sounds too confusing, PhilHealth has a table that breaks it all down for you

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