The Philippine Health Insurance Corp. (PhilHealth) on Friday said it paid a total of P66.3 billion worth of claims for COVID-19 patients.
“From January 2020 to February pa lang of 2023, meron na po tayong kabuuang P66.3 billion na naibayad for COVID claims (From January 2020 to February 2023, we already paid a total of P66.3 billion for COVID-19 claims.),” PhilHealth acting vice president for corporate affairs Rey Baleña said at a Department of Health (DOH) forum.
Baleña the claims involved testing, community isolation, and hospitalization.
PhilHealth covers the hospitalizations of COVID-19 patients, depending on the severity of pneumonia, from P43,997 to P786,384, Baleña said.
PhilHealth also covers up to P22,449 for community isolation and up to P5,917 for home isolation, he said.
Baleña bared that PhilHealth had P224 billion reserve funds as of September 2022. It also had P394 billion in total assets, P355 billion investment portfolio, and P46 billion net income.
A study showed that the national average of financial coverage under PhilHealth is at 65.89 percent.
According to Baleña, it meant that for every P100 in medical expenses a patient incurs, the insurer covers around P66.
Indigent members usually receive 79.48 percent coverage, which is the highest coverage among membership sectors, he said.
This is followed by sponsored members with 78.80 percent, self-earning members with 68.40 percent, senior citizens with 57.91 percent, formal members from the private and government sectors with 55.53 percent, and lifetime members with 50.39 percent, he said.
The PhilHealth official also announced that they will start offering outpatient packages for mental health services this year, and they are set to release its guidelines soon.
Aside from mental health services, the state health insurer is also planning to improve other services from 2023 to 2025, according to Baleña.
He said they will increase the dialysis sessions from 90 to 156, rationalize inpatient services, and enhance select “Z benefits” such as orthopedic implants, kidney transplants, cancer treatments, and open heart surgeries for children, among others.
PhilHeallth also aims to improve outpatient therapeutic care for severe acute malnutrition for children below five years old, COVID-19 benefits package, and its consultation benefit package.