Where your PhilHealth contribution goes: PHP 10.79 billion in claims

By Rjay Zuriaga Castor

ILOILO CITY – Contributions paid by Philippine Health Insurance Corporation (PhilHealth) members not only protect them and their families but also help fund medical care for other Filipinos with serious and costly illnesses, PhilHealth Regional Office 6 said.

PhilHealth-6 Regional Vice President Marjorie Cabrieto said the National Health Insurance Program (NHIP) operates on the principle of shared responsibility.

“Every contribution you make to our NHIP helps our patients who are suffering and undergoing treatment for cancer, chronic kidney disease, and other catastrophic conditions,” she said during a press conference on Aug. 11, 2026.

“It also helps our less fortunate fellow Filipinos, such as Indigenous Peoples, indigents, solo parents, senior citizens, and persons with disabilities, who are able to avail themselves of free benefits at our accredited YAKAP clinics and hospitals,” Cabrieto said.

The NHIP is anchored on the Universal Health Care Act, or Republic Act 11223, which provides for immediate eligibility for health benefits and aims to ensure equitable access to affordable health care while protecting Filipinos from financial hardship caused by medical expenses.

For employed members, PhilHealth contributions are set at 5% of the monthly basic salary, shared equally between the employer and employee.

The rate is the final scheduled adjustment under the law’s premium schedule and is unchanged from 2025.

With a salary floor of PHP 10,000 and a ceiling of PHP 100,000, the total monthly contribution ranges from PHP 500 to PHP 5,000.

Nonemployed and self-employed members, including freelancers and independent professionals, shoulder the full 5% contribution based on their declared monthly income.

PhilHealth-6 currently covers more than 7.79 million members and dependents out of the region’s projected population of more than 8.1 million, including Negros Occidental.

This leaves less than 5% of the population still to be covered under the NHIP.

Cabrieto said the funds collected from members are returned to the public through benefit payments that cover a wide range of illnesses and health conditions.

She said the agency has paid more than PHP 10.79 billion for health care claims involving nearly 800,000 patients in Western Visayas as of June 2026.

Among the biggest benefit payments in the region were for hemodialysis, which accounted for more than PHP 2.7 billion, and moderate-risk pneumonia, for which PhilHealth-6 paid more than PHP 800 million.

The agency also reported expanded benefits under its YAKAP and GAMOT programs, which provide free primary care services and up to PHP 20,000 in annual outpatient medicines for registered members and their dependents.

YAKAP, or the Yaman ng Kalusugan Program, is PhilHealth’s primary care program that provides consultations, selected laboratory services, essential medicines, and preventive care through accredited primary care providers.

It replaced the Konsulta package in July 2025, expanding the list of covered medicines from about 21 drugs to 75.

Under PhilHealth GAMOT, or Guaranteed and Accessible Medications for Outpatient Treatment, beneficiaries can receive up to PHP 20,000 worth of outpatient medicines annually, with the program covering essential medicines for conditions including infections, asthma, chronic obstructive pulmonary disease, diabetes, high cholesterol, high blood pressure, heart conditions, and nervous system disorders.

Cabrieto said more than 1.7 million people in Western Visayas and Negros Occidental have registered under YAKAP.

PhilHealth has paid accredited providers more than PHP 286.12 million for services used by 282,183 members and their dependents.

Under GAMOT, PhilHealth-6 said it has paid more than PHP 21 million, with claims processed within two to three days of receipt and payments credited to providers’ accounts every Wednesday.

With the rainy season bringing an increased risk of dengue, Cabrieto also reminded members that PhilHealth provides separate benefit packages for dengue fever and severe dengue.

The benefit package for dengue fever is set at PHP 19,500, while coverage for severe dengue has been increased to PHP 47,000 from the previous PHP 16,000 package.

From January to June 2026, PhilHealth-6 covered 3,232 dengue cases and paid PHP 61.64 million in benefits.

The agency has likewise continued to assist patients with breast cancer under its Z Benefit Package for catastrophic and severe illnesses.

PhilHealth-6 reported that it has covered 351 breast cancer patients and paid PHP 25.72 million for their treatment so far in 2026.

In 2025, it paid PHP 33.24 million for breast cancer benefits.

The agency also reported improvements in claims processing, recording an average turnaround time of 5.29 days as of June.

Data for July showed that claims filed by health facilities were processed in an average of two days.

“You can rely on your PhilHealth to be fast, fair, and dependable. Let us all move as one for a healthier Western Visayas and a productive Philippines,” Cabrieto said.