PhilHealth Increases Dialysis Coverage to PHP1 Million

In just three months, state health insurer PhilHealth has implemented two successive increases in its benefit package for hemodialysis, from PHP4,000 in July to PHP6,350 per session starting in October, raising the total financial package to nearly PHP1 million per patient annually.

Through PhilHealth Circular No. 2024-0023, which took effect on October 7, members and their qualified dependents with chronic kidney disease stage 5 (CKD5) can now avail of the adjusted hemodialysis package from accredited dialysis facilities.

“This is clear proof that PhilHealth is not only listening to our members but also taking concrete steps to ensure our benefit packages adequately respond to patient needs, which is a core objective of the Universal Health Care Law,” said Emmanuel R. Ledesma Jr., PhilHealth President and CEO.

Ledesma noted that despite the increase in the reimbursement rate to PHP4,000 per session on July 1, patients were still reporting significant out-of-pocket expenses for their dialysis treatments.

“Our goal is to eliminate co-payments for patients availing of the minimum set of services for dialysis. This is to ensure that our members truly feel the benefits of their PhilHealth coverage,” Ledesma explained, crediting the swift approval of the increase to PHP6,350 per session to the leadership of Health Secretary Ted Herbosa.

Ledesma also acknowledged the cooperation of nephrologists and dialysis centers in making the no co-payment arrangement possible.

With the new rate of PHP6,350 per session, a CKD5 patient is now entitled to a maximum of PHP990,600 in financial protection per year, up from the previous PHP624,000 annually at PHP4,000 per session.

The circular also outlines the essential services that must be provided to CKD5 patients.

These include anti-coagulation medications, drugs for anemia management, laboratory tests, supplies such as dialyzers and hemodialysis solutions, and administrative fees covering dialysis machines, facility use, utilities, and staff time.

All services must be available at accredited public and private hemodialysis facilities.

Patients requiring additional or premium services beyond the minimum standard of care outlined in the circular may be subject to co-payment.

A cap of PHP450 is set for professional fees if additional services such as telemedicine or immediate interventions during sessions are needed.

Dialysis centers are required to fully explain any co-payment to patients.

This life-saving service has brought new hope to dialysis patients like Roseanne Lappay of Tabacalera, Pateros, who welcomed the development. “PhilHealth’s increased dialysis package is great news for us dialysis patients.”

Ledesma assured all PhilHealth members, both in the Philippines and abroad, “When we make a promise at PhilHealth, we deliver. I encourage all Filipinos to seek treatment without fear because PhilHealth has got you covered.”