PhilHealth board okays preventive oral health services coverage
SOCIAL WELFARE. A resident avails of free dental consultation at an outreach program in Davao City on June 22, 2024. The Philippine Health Insurance Corporation Board of Directors en banc on Friday approved the preventive oral health benefit package for all. (PNA photo by Robinson Niñal Jr.)
MANILA – The Philippine Health Insurance Corporation (PhilHealth) Board of Directors en banc on Friday approved the preventive oral health benefit package for all.
It is part of the state insurer’s expansion of primary care benefits in line with the government’s vision of “Ngiting 70-20,” ensuring more Filipinos will reach the age of 70 years old with 20 permanent teeth still in place.
“Universal health care must have oral health care and the best way to make it sustainable and felt by all Filipinos is through primary care,” Health Secretary Ted Herbosa said.
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“The Board agreed on a preventive oral health benefit to be delivered by dentists working in PhilHealth Konsulta package providers, and also by stand-alone dentists based on referrals from the Konsulta providers,” he added.
Mouth examination, oral screening
The package will pay for the annual routine preventive oral care services for every Filipino, such as mouth examination or oral screening, oral prophylaxis or cleaning, and fluoride varnish application.
It will also cover pit and fissure sealant and Class V procedures as needed for a maximum of two teeth, emergency tooth extractions and dental consultations.
Fluoride varnish application strengthens the enamel or the outermost layer of teeth, preventing new cavities from forming or to slow down or stop tooth decay from worsening.
Pit and fissure sealants are procedures that protect from tooth decay by filling in grooves and pits of teeth where bacteria combined with leftover food or sugars can cause damage.
Class V procedures
Meanwhile, Class V procedures remove decayed or damaged tooth tissue, and then replace the area with composite resin material.
A maximum payment of P1,000 for preventive oral health services is allotted for each patient per year.
Of the total amount, P300 will be paid for the first visit, covering mouth examination or oral screening, oral prophylaxis and fluoride varnish application.
Another P300 will be paid for the second visit, which must be at least four months apart from the first visit, for the same services.
The remaining amount will be used to pay pit and fissure sealant or a Class V procedure for a maximum of two teeth per year at PHP200 each. No co-payments will be allowed for public dentists.
Private dentists
Private dentists will be allowed maximum co-payment charges per visit of PHP1,500 for mouth examination and oral prophylaxis; PHP600 for both pit and fissure sealant or Class V procedure; and emergency tooth extraction.
The approval coincided with the country’s participation in the first World Health Organization Global Oral Health Meeting in Bangkok, Thailand on Nov. 26 to 29.
Following the approval, the PhilHealth management under the president and chief executive officer will draft and publish a circular for the development or enhancement of information and technology systems that will be used to capture data and facilitate payments.
The state insurer plans to implement the package in the first or second quarter of 2025. (PNA)
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