In 2025, many expanded benefits were introduced by the Philippine Health Insurance Corporation to improve healthcare access for all Filipinos and to become a more financially secure society. And these changes come with stronger commitments made by Philhealth to provision of quality as well as affordable healthcare all across the country. A quick synopsis of the most significant changes and newly added benefits follows.
Enhanced Coverage for Ischemic Heart Disease
PhilHealth Beneficiaries to Get Better Coverage for Ischemic Heart Disease
PhilHealth has upped its financial coverage to members with ischemic heart disease, especially those having acute myocardial infarction (heart attack). One of the highlights was a jump in its benefit coverage for percutaneous coronary intervention (PCI), or coronary angioplasty, from ₱30,300 to ₱524,000.
Expanded Peritoneal Dialysis Support
Fibrinolysis-a procedure to dissolve blood clots-also has an increased benefit rate of ₱133,500, up from ₱30,290. Further, a new benefit will cover emergency medical services including coordinated referral and inter-facility transfer for ₱21,900. Cardiac rehabilitation after PCI will also be charged at ₱66,140; all these provisions took effect last December 21, 2024.
Additional Benefits under the Expanded Peritoneal Dialysis
The Z Package for Peritoneal Dialysis (PD) now has a wider scope of cover. Benefit amounts range from ₱389,640 to ₱510,140 per annum, depending on how many PD solutions are daily needed by a CAPD-adult patient. The previous limit was at ₱270,000.
For pediatric patients undergoing CAPD or Automated Peritoneal Dialysis, the amount ranges from ₱510,000 all the way up to ₱1.2 million. Apart from that, preventive benefits against infections caused by the procedure are also available at PhilHealth. This became effective January 1, 2025, spreading to 51 accredited PD centers over the country.
Better Kidney Transplant Benefits
PhilHealth has further expanded the provision of benefits for kidney transplants. For living donor transplants, the new benefit has been raised from ₱600,000 to more than ₱1 million; while for deceased donor transplants, the new amount stands at ₱2.14 million. These all again took effect on January 1, 2025.
Preventive Oral Health Services
For the first time, preventive oral health services are part of PhilHealth’s Konsulta package. This will include oral screening, dental cleanings, fluoride varnish applications, and fissure sealants or restorations for a limited of 2 teeth in one year. Included too would be emergency tooth extractions when medically warranted. Available starting December 28, 2024, via accredited health facilities.
Outpatient emergency care is being recognized
PhilHealth has launched the new Outpatient Emergency Care Benefit (OECB), granting funds for emergency services that avert admission into the hospital. They include emergency-room care within the facilities and pre-hospital emergency transport services. The OECB circular became effective on 11 January 2025, while implementation guidelines are to follow.
A 50% case rate package increase
In a historic move, PhilHealth has raised the case rate packages by 50% for almost 9,000 benefit items. The increase, effective from the 1st of January 2025, translates to a financial boost of colossal proportions offered for coverage after nearly ten years of no substantial changes.
For instance, moderate-risk pneumonia coverage NJP increased from ₱19,500 to ₱29,250. Caesarean section payment improved from ₱24,700 to ₱37,050, and cholecystectomy benefits rose from ₱40,300 to ₱60,450. These increases followed an earlier hike that was effected in February 2024.
No contribution rate increase
PhilHealth assured that, in spite of these significant benefit upgrades, no increase in contribution rates for 2025 will be instituted, thus not transferring any financial load onto the members.
Enforcement of No-Co-Payment Policy
PhilHealth reiterates its call for the strict implementation of the No Co-Payment policy by all 12,600 partner health facilities, wherein members thus process that they may receive all their benefits and never have to pay any amount on their own for services that are covered. This is in support of the Universal Health Care Act, which aims to safeguard patients from excessive medical expenses.
Expected Benefits
More benefit packages are being planned by PhilHealth for launch. These are the elementary prescription eyewear for children 0-15 years; outpatient rehabilitation services; and assistive mobility devices such as wheelchairs, crutches, and walkers, with increased rates for cataract surgeries expected to follow.
This forward-looking plan reflects PhilHealth’s commitment to the provision of comprehensive and inclusive health care for all Filipinos in 2025 and beyond.