PhilHealth Expands Heart Surgery Coverage to P1 Million

Effective March 1, 2025, the Philippine Health Insurance Corporation (PhilHealth) has significantly expanded its Z Benefits Package for open-heart surgeries and introduced a new package for heart valve repair and replacement. This move underscores PhilHealth’s commitment to providing financial protection for cardiovascular health.

Cardiovascular disease (CVD) remains the leading cause of mortality in the Philippines. Globally, 32% of deaths are attributed to CVDs, according to the World Health Organization. In response to this growing concern, PhilHealth has increased coverage for the following open-heart surgeries:

1. Coronary Artery Bypass Graft (CABG): Coverage now ranges from P660,000 to P960,000, up from P550,000.
2. Closure of Ventricular Septal Defect (VSD): Coverage increased to P614,000, from the previous P250,000.
3. Total Correction of Tetralogy of Fallot (TOF): Coverage now reaches P614,000, up from P320,000.

PhilHealth has also launched a new Z Benefits Package for Heart Valve Repair and Replacement, with coverage ranging from P642,000 to P810,000. Additionally, cardiac rehabilitation packages are available at P15,000 for adult cases and P6,500 for pediatric cases.

Patients with rheumatic fever or rheumatic heart disease undergoing these treatments may also enroll in the outpatient benefit package for secondary prevention, as outlined in PhilHealth Circular 2019-0005.

Qualified PhilHealth members and their dependents can avail of these benefits without co-payments when admitted to ward accommodations in PhilHealth-contracted facilities nationwide.

These initiatives align with President Ferdinand R. Marcos Jr.’s commitment to making healthcare services more accessible to all Filipinos. In his first State of the Nation Address, President Marcos emphasized the need to bring medical services closer to communities, stating, “We must bring medical services to the people and not wait for them to come to our hospitals and health care centers.”

As of December 2023, 131 specialty centers have been established nationwide to support these efforts.

“Kaisa ni Pangulong Ferdinand R. Marcos Jr. ang PhilHealth sa layuning mailapit ang mga benepisyo, lalo na ang mga specialty services sa mga Pilipino sa lahat ng rehiyon,” said PhilHealth President and CEO Dr. Edwin M. Mercado. “Ito ay naaayon sa layunin ng Department of Health na pagbutihin ang antas ng mga ospital sa buong bansa,” he added.

For more information on PhilHealth benefits and services, members may call the 24/7 hotline at (02) 866-225-88 or contact mobile numbers (Smart) 0998-857-2957, 0968-865-4670, or (Globe) 0917-127-5987, 0917-110-9812.