PhilHealth premium hike ‘vital’ in meeting UHC Act’s goals–officials

STATE-RUN Philippine Health Insurance Corp. (PhilHealth) on Tuesday defended anew before the members of the House of Representatives the scheduled premium contribution hike this June.

Philhealth Executive Vice President and Chief Operating Office Eli Dino D. Santos told lawmakers that “the increase is vital in the attainment of the goals of” the Universal Health Care (UHC) Act.

“With funding for PhilHealth’s indirect contributors already lacking in the past years, this increase for the direct contributors is crucial to achieve advancements in the plans of the Corporation,” Santos said, reading the statement of PhilHealth President and CEO Dante A. Gierran.

“I can never stress enough the importance of protecting the National Health Insurance Fund; a pool borne of every hardworking Filipinos’ collective contribution, to afford everyone a fighting chance to pursue a healthy life unburdened by medical conditions,” he said during the hearing of the House Special Committee on the North Luzon Growth Quadrangle.

Santos further told lawmakers that the premium increase introduced this year through PhilHealth Advisory 2022-0010 was authorized by Section 10 of Republic Act 11223 [UHC Act] and with the support of the administration of President Rodrigo Duterte.

“I assure this body that PhilHealth has nothing but the best interests of the [millions of] Filipinos [who] depend on us for their medical upkeep,” he added.

Earlier, the PhilHealth said it is duty-bound to collect the higher premium rate of 4 percent this year since Congress has yet to pass a new law allowing the deferment of scheduled premium adjustment in the UHC Act.

Under the UHC law, premium rates should gradually increase starting from 2.75 percent in 2019 until it reaches 5 percent for both 2024 and 2025. For this year, the premium rate for this year should be at 4 percent, with the income floor fixed at P10,000 and the income ceiling set at P80,000.

Last year, the PhilHealth agreed to postpone the premium hike to 3.5 percent from 3 percent in 2020 under an “interim arrangement” that will be good only until Congress passes a new law allowing for the deferment. However, the 18th Congress is set to adjourn sine die this week.

Lawmakers from the Makabayan bloc slammed the premium hike for PhilHealth, saying the move will further “burden the already suffering Filipino workers with the measly wage increase and high inflation rate.”

Claims processing

MEANWHILE, Santos said the PhilHealth remains steadfast in its commitment to pay hospital claims that are in order and compliant to rules and regulations.

As the national purchaser of health services, he said PhilHealth is expected to pay the benefit claims of health care providers based on diagnosis and performance.

“In view of this, PhilHealth anticipates receiving no less than complete required documents needed for claims assessment and compliance to the existing standards of care required for the management of patients,” he said.

Santos further explained that in addition to requirements per RA 11223 and RA 7875 (as amended), or the National Health Insurance Act, “other requirements based on government accounting rules and regulations would have to be complied with consistently.”

“Otherwise, claims submitted needing compliance, questionable or in violation of the policy will be denied or returned back to hospitals for compliance or submission of requirements,” Santos said. “Hence, the seeming discrepancy in figures between PhilHealth and the hospitals may be due, in large part, to differences in accounting treatments.”

The Philhealth official further explained that during reconciliation meetings with a number of hospitals, “it was noted that these facilities have been including Denied and Return-to-Hospital (RTH) claims in their accounts receivables.”

“Further, claims that purportedly have yet to be paid by PhilHealth are actually settled already,” he added.

Santos said the PhilHealth only recognizes “good claims” as its payables pursuant to prevailing government accounting rules and regulations.

He said PhilHealth is mandated to process claims within 60 days per Section 47, Letter l of the Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013 (RA 7875 as amended by RA 9241 and RA 10606).

“This is to give the corporation ample time to review the claims for completeness and more importantly for fraud,” Santos added. “However, some facilities still insist on payments immediately upon submission of claims documents.”