The Philippine Health Insurance Corp. (PhilHealth) has implemented a 50% increase in nearly all its benefit packages starting January 1, 2025. The adjustment, outlined in Circular No. 2024-0037 signed by PhilHealth president Emmanuel Ledesma Jr. on December 23, aims to enhance healthcare affordability and access while reducing out-of-pocket expenses for its members.
According to an Inquirer.net report, this marks the second comprehensive adjustment to PhilHealth’s benefit rates since 2013, with the first increase of 30% implemented in February 2024 to account for inflation over the past decade.
PhilHealth, which is operating without a government subsidy this year, is relying heavily on contributions from Filipino workers, both domestic and overseas. Congress cut the agency’s proposed ₱74-billion budget for the National Health Insurance Program (NHIP), which previously covered benefits for 16 million indirect contributors, including senior citizens, persons with disabilities, indigents, and beneficiaries of the 4Ps program.
Among the revised rates, moderate-risk pneumonia—PhilHealth’s most claimed benefit—has increased from ₱19,500 to ₱29,500, while acute gastroenteritis coverage rose from ₱7,800 to ₱11,700. In total, around 9,000 medical and procedural case rates have been updated.
However, certain packages remain excluded from the adjustment. These include benefits being rationalized, such as acute stroke, high-risk pneumonia, and severe dengue, as well as “Z benefit packages” for catastrophic illnesses like cancer. Newly introduced packages, such as outpatient mental health services, and cases identified as high-risk for moral hazard, like cataract procedures, are also excluded.
PhilHealth’s corporate operating budget for 2025 is set at ₱284 billion, driven by contributions from direct contributors. In 2023, Filipinos contributed ₱158 billion, with this figure expected to rise following the 5% premium rate implemented in 2024 under the Universal Healthcare Act.
Despite these increases, health reform advocates continue to criticize PhilHealth for its limited contribution to household health expenditures. A study revealed that the agency only covered 14% of Filipino households’ total health costs, leaving 45% to be paid out of pocket.
Members can access updated benefit details through PhilHealth’s Case Rates Search portal, with a full list of adjustments available on the agency’s website and official channels.
