PhilHealth designs packages for kids’ eyeglasses, emergency care

MANILA, Philippines – The Department of Health (DOH) has facilitated the review of two new benefit packages, improvement of four existing packages and another round of case rates increase as presented by the Philippine Health Insurance Corporation (PhilHealth) benefits committee (BenCom).

In a news release Thursday night, the DOH said the BenCom discussed the outpatient benefit package that would pay for the assessment of children for errors of refraction, including a pair of prescription glasses if needed.

This is in preparation for their presentation to the PhilHealth Board of Directors en banc (Board).

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“During the initial presentation, technical staff focused on ages 5 to 6 years old,” the DOH said.

“Upon finding out that the benefit of correcting vision problems in children so that they can learn better, among other advantages, far outweighs the cost of consultation and glasses, the Health chief and the BenCom members gave instructions to include more age groups among children,” it added.

The PhilHealth BenCom approved at its level a proposal to rationalize case rates for cataract extractions to also cover selected intraocular lenses, especially among pediatric patients.

It also endorsed proposed implementing guidelines for an emergency care benefit as part of “Konsulta Plus” or the comprehensive outpatient benefit mandated by the Universal Health Care Act.

This proposed emergency care benefit would pay for emergency department services, including ambulance coverage.

“The BenCom also scrutinized and gave its nod to the proposed implementing guidelines for a second round of increases in selected case rates, by as much as 50 percent,” the DOH said.

The first round of case rate increases was only 30 percent in order for PhilHealth to correct aggregate health inflation from 2012 to 2022.

“The committee also endorsed proposals to markedly increase the package rates for coronary artery bypass graft surgery, closure of ventricular septal defect (VSD), and VSD with aortic stenosis, and total correction of Tetralogy of Fallot,” the DOH said.

“Similar Z benefit packages for heart valve repair or replacement in valvular heart disease were also evaluated and cleared for presentation to the Board,” the DOH added.

DOH Secretary Teodoro Herbosa, as chair of PhilHealth’s BenCom, approved 10 new or improved benefit packages.

The implementation of a new or enhanced PhilHealth benefits packages include benefit development; policy development; policy approval; information technology (IT) system development; publication; IT system enhancement; user training or orientation; and effectiveness assessment.

PhilHealth’s Board is responsible for policy development and policy approval.

The PhilHealth’s president and chief executive officer has direct control over the remaining procedures. (PNA)