PhilHealth raises benefit packages for heart diseases this 2025
The Philippine Health Insurance Corporation (PhilHealth) has increased its benefits coverage for members confined to heart diseases by up to P500,000.
In case you missed it, the state health insurer has enhanced the health packages for Ischemic Heart Disease-Acute Myocardial Infarction or “heart attack” under Circular 2024-0032 signed on Dec. 18, 2024, and took effectivity on Dec. 21.
“This package offers crucial coverage for heart disease, one of the critical health issues prevalent among us Filipinos. Our goal is to alleviate financial strain on Filipino patients and ensure timely access to life-saving services from hospitalization, diagnostic tests, and procedures like angioplasty, stenting, and medication,” PhilHealth president and CEO Emmanuel Ledesma said.
Recognizing heart disease as the leading cause of death in the Philippines, the reimbursement rate is now P523,853—a significant increase from the previous P30,300—for patients needing percutaneous coronary intervention (PCI)—a minimally invasive procedure to open blocked coronary arteries.
Those who need fibrinolysis—treatment to dissolve blood clots in the coronary artery to help blood flow—are covered up to P133,500, while those who need emergency medical services with coordinated referrals and interfacility transfers can avail of the package for P21,900. Those who will undergo cardiac rehabilitation can access the package for P66,140.
The enhanced benefit packages will also cover emergency care, medications, laboratory and diagnostic tests, medical supplies, equipment, and other administrative fees.
The reimbursement rate is available to accredited public and private health facilities classified as Level 1 to 2, capable of providing necessary treatments and procedures.
PhilHealth reminded members that there should be no co-payment for inpatient admissions in basic or ward accommodations in both public and private health facilities nationwide. He also emphasized that members should not be charged additional fees other than what PhilHealth covers for the standards of care and services included in PhilHealth benefit packages.
This is among the enhanced benefits that were approved by the Benefits Committee (BenCom), covering kidney disease, mobility limitations, oral health, and ten rare diseases despite having zero subsidies for this year.
The state health insurer also implemented a 50% adjustment in Case Rates packages.
“Last year, we implemented a 30% adjustment to over 9,000 case rates. This year, we have taken it a step further by increasing the adjustment by another 50% to provide greater financial support and coverage for common illnesses and diseases,” Ledesma said. Examples of illnesses covered are pneumonia moderate-risk, from P15,000 to P29,250; and caesarian section from P19,000 to P37,050.
Ledesma has previously assured the state insurer's financial position is "strong" with P281 billion in reserves and P150 billion of surplus funds as of October 2024. (With reports from Rhodina J. Villanueva)
