PhilHealth membership in W. Visayas reaches 93%

By Joseph Bernard A. Marzan

The Philippine Health Insurance Corporation (PhilHealth) in Western Visayas has achieved a milestone by registering 93.86 percent of the total eligible population in the region to its mandatory insurance program in the middle of the third quarter last year.

PhilHealth-WV revealed the data in a press conference on February 29 in celebration of the National Health Insurance Month.

The celebration is in line with Presidential Proclamation No. 1400 series of 2007, enacted by former President Gloria Macapagal-Arroyo.

This month commemorates PhilHealth’s achievements and its significant role in national development and marks the anniversary of Republic Act No. 7875 (National Health Insurance Act of 1995), signed into law by then-President Fidel Ramos on February 14, 1995.

As of August 31, 2023, 7.59 million individuals in Region 6 were registered with PhilHealth, representing a coverage rate of 93.86 percent.

Janimhe Jalbuna, head of the Public Affairs Unit, highlighted a considerable 5-percent increase from the 89 percent coverage publicized in December.

“We only have little work to do to ensure that all [eligible] members of PhilHealth in Western Visayas have access to [our] programs and benefits,” Jalbuna said.

The region collected P4.96 billion in contributions as of December 2023, a figure expected to rise following a 1 percent increase in mandatory contributions.

Furthermore, Jalbuna reported that 99.33 percent of backlog claims, amounting to 9.59 million out of 9.65 million, were addressed in the region from 1995 to 2022, as of the end of last year.

Specifically, 96.73 percent of the claims filed or refiled in the last year were settled timely, between January 1 and November 1, 2023.

For claims considered “good” or filed with all necessary documents and thus “valid and worthy of payment,” 98.69 percent were paid within the specified period.

Under Section 35 of Rep. Act No. 7875, healthcare institutions are required to process claims within 60 days post-discharge of a patient, while PhilHealth must notify members about any deficiencies or ineligibilities in their claims.

All 156 healthcare institutions stipulated by the law have been accredited, ensuring that registered members have enhanced access to benefits.

Garry Zabala, head of the Membership and Marketing division, shared that ‘Alaga Ka para sa Maayos na Buhay’ (ALAGA KA) caravans and member forums continue, in collaboration with the Department of Health and local governments.

The ALAGA KA initiative aims to engage indigent and ‘near poor’ families with PhilHealth’s benefits and services.

Additionally, Jalbuna mentioned that PhilHealth is expanding its PhilHealth Konsultasyong Sulit at Tama (KonSulTa), an outpatient care benefits package under Republic Act No. 11223. This includes services like consultations, health screenings, select tests, and medications.

As of October 31, 2023, PhilHealth has accredicted165 KonSulTa Package Providers, with claims up to P13.66 million already disbursed under this program.

The registration of 1.68 million members and dependents to the program signifies its growing reach, and an increase in accredited providers is anticipated to enhance service delivery further.

Jalbuna said they aim to increase the number of KonSulTa providers.

“This year, we hope to accredit more KonSulTa providers. We want to accredit more facilities because if there are more facilities, there are more places that our members can go to for their consultations, laboratory work, and drugs and medicines.”

She explained the need for more facilities and doctors to cater to the growing number of members eligible for the KonSulTa package, given that current policy allows one doctor to serve up to 20,000 members.

Legal Officer Dennis Guevarra refrained from commenting on the proposed legislation that would require PhilHealth to cover 50 percent of hospital bills, noting that the matter is “still in the pipeline”.