A possible overhaul of benefits for salaried and self-paying workers is now under discussion at the Philippine Health Insurance Corporation (PhilHealth), following directives from the President to rebalance coverage in favor of those who directly fund the system.
Health Secretary Teodoro Herbosa said the review comes after years of PhilHealth programs being weighted toward sponsored members—individuals whose premiums are paid by the government. Speaking in a radio interview on Saturday, Herbosa noted that while these groups remain a priority, attention is now shifting toward contributors from the middle-income sector.
“For many years, ang tinututukan natin yung ating indirect o sponsored programs [na] wala silang binabayaran pero may benepisyo sila ng PhilHealth [dahil] estado nagbabayad ng premium nila,” Herbosa said.
He said President Ferdinand Marcos Jr. has instructed PhilHealth to reassess how benefits are distributed, particularly for workers who consistently pay premiums and taxes.
“Sa ating bagong programa, sabi niya pagandahin natin ang serbisyo para sa ating mga middle class,” Herbosa added.
Among the proposals under consideration are improvements in hospital accommodations for direct contributors, including possible access to less crowded rooms and upgraded facilities. Herbosa said these ideas were raised by Executive Secretary Ralph Recto as part of a broader recommendation to improve benefit packages.
“Baka pwedeng two in a room lang or may aircon, para yung mga direct member naman mas maganda yung benefit,” he said.
Recto has also suggested expanding PhilHealth coverage under hospitals that implement Zero-Balance Billing, a system where patients no longer pay out-of-pocket expenses. Herbosa said this proposal would be formally reviewed by the agency’s benefits committee.
“Mayroon pa siyang isang [suggestion] na gustong-gusto ko at ipapasok ko sa benefits committee, na pag yung hospital ay nagiimplement ng zero-balance, gusto niyang madagdagan ang package ng PhilHealth,” he said.
Herbosa added that PhilHealth’s actuaries have been asked to study the financial viability of these enhancements.
“Ipapaaral ko sa aming mga actuarials yung kaya ng PhilHealth,” he said.
PhilHealth Senior Vice President and Health Finance Policy Sector head Dr. Israel Pargas confirmed that the agency has received formal instructions from both the President and the Executive Secretary to pursue expanded benefits for middle-income contributors, reiterating PhilHealth’s mandate to “provide additional programs to direct contributors where applicable.”
