MANILA – The Philippine Health Insurance Corporation (PhilHealth), in collaboration with the Department of Health (DOH), is advancing new health benefit packages aimed at improving children’s vision and emergency care services. The PhilHealth Benefits Committee (BenCom) has been actively reviewing these proposals, which include benefits for children’s eyeglasses and emergency care under the ‘Konsulta Plus’ initiative.
The proposed package for children’s eyeglasses targets the assessment and correction of refractive errors among kids, initially focusing on those aged 5 to 6. Recognizing the significant educational benefits of clear vision, the committee has decided to extend this benefit to a broader age range within the pediatric population.
Additionally, PhilHealth’s BenCom has approved adjustments to the case rates for cataract surgeries, which will now include coverage for specific intraocular lenses, particularly beneficial for pediatric patients. This move is part of a broader effort to enhance surgical outcomes and accessibility.
Under the ‘Konsulta Plus’ program, mandated by the Universal Health Care Act, the committee has also endorsed guidelines for an emergency care benefit. This benefit will cover services provided in emergency departments, including ambulance services, ensuring comprehensive care during critical situations.
Further, the committee has greenlit a second round of increases in selected case rates by up to 50%, following a previous 30% increase aimed at adjusting for health inflation over the past decade. This adjustment will affect rates for procedures such as coronary artery bypass graft surgery, closure of ventricular septal defects, and total correction of Tetralogy of Fallot, among others.
DOH Secretary Teodoro Herbosa, who chairs the BenCom, has approved these new and enhanced packages. The implementation process involves multiple stages including benefit and policy development, approval, IT system enhancements, training, and effectiveness evaluation. The PhilHealth Board oversees policy development and approval, while the president and CEO manage the operational aspects of these new benefits.