I RECENTLY attended an educational series about social health insurance with government information officers, local media practitioners and representatives from the academe. Spearheaded by top ranking officials of Philhealth, the afternoon event updated us on the various programs being offered by the provider of health insurance. With their vision statement, “Bawat Pilipino, Miyembro, Bawat Miyembro, Protektado, Kalusugan Natin, Segurado”, I truly wish that no one in this country of over seven thousand islands would be afraid of being hospitalized for fear of not having money to pay their medical services.
The revitalized National Health Insurance Act of 2013 or Republic Act 10606 according to the speakers ensures coverage of the poor and marginalized in like manner as the formally insured.
The act in its Declaration of Principles and Policies declares that the State adopts an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost and to provide free medical care to paupers.
Further, the State shall provide comprehensive health care services to all Filipinos through a socialized health insurance program that will prioritize the health care needs of the underprivileged, sick, elderly, persons with disabilities (PWDs), women and children and provide free health care services to indigents.
As explained by the Philhealth officials, a qualified member is a person whose premiums have been regularly paid to the National Health Insurance Program who may be a paying member, a sponsored member, or a lifetime member. The legal dependents of a member are the parents who are sixty (60) years old or above whose monthly income is below an amount to be determined by the Corporation in accordance with the guiding principles set forth in Article I of this Act; and parents with permanent disability that render them totally dependent on the member for subsistence.
Philhealth Senior Manager Arsenio Torres who discussed the benefit packages for members explained that they are offering inpatient, outpatient, catastrophic or Z-benefits, primary care and other special benefits.
These cover medical, surgical or procedural cases brought to accredited health care providers such as hospitals, primary care facilities, infirmaries and dispensaries. The inpatient benefits according to Torres include facility fee, room and board, medicines, laboratory, diagnostic and professional fees.
Inpatient benefits include medical cases of Dengue Fever, High Risk Peneumonia, Asthma, Stroke and Hypertensive Emergency among others.
Under the Z-Benefits program, a patient with Acute Lymphocytic / Lymphoblastic Leukemia for the standard risk can be insured with the fixed amount of P210,000 Breast Cancer (stage 0 to IIIA) for P100,000 and Prostate Cancer (low to intermediate risk) for P100,000 A Philhealth member with End-state renal disease eligible for requiring kidney transplantation is assured with P600,000 and Coronary Artery Bypass Graft Surgery (standard risk) for P550,000, Surgery for Tetralogy of Fallot in Children for P320,000 and surgery for Ventricular Septal Defect in Children for P250,000.
Even members who suffered loss of limbs can be assured of Rehabilitation and Prosthesis Help.
For the loss of first right or left below the knee, a member patient can receive Orthopedic Implants worth P15,000 or P30,000 for both limbs. Patients needing Implants for Hip Arthroplasty and Implants Hip Prosthesis-cemented can have P103,400 worth of insurance.
As to the different types of membership, it was explained by the Philhealth officials that one can be a Lifetime Member if a person has reached the age of retirement under the law and has paid at least one hundred twenty (120) monthly premium contributions.
Workers with formal contracts and fixed terms of employment including workers in the government and private sector, whose premium contribution payments are equally shared by the employee and the employer are classified under the Formal Economy.
Workers who are not covered by formal contracts or agreements and whose premium contributions are self-paid or subsidized by another individual through a defined criteria set by the corporation are grouped in the Informal Economy.
Migrant Workers are the documented or undocumented Filipinos engaged in a remunerated activity in another country of which they are not citizens and the Sponsored Members are those whose contribution is being paid by another individual, government agency, or private entity according to the rules as may be prescribed by the Corporation.
As a mandatory coverage of the act, all citizens of the Philippines shall be covered by the National Health Insurance Program. In accordance with the principles of universality, the program shall be compulsory in all provinces, cities and municipalities nationwide to ensure that all members shall have access to quality and cost-effective health care services.