The Philippine Health Insurance Corp. (PhilHealth) said its Yaman ng Kalusugan Program (YAKAP) would serve as the first layer of coverage for primary care, while participating health maintenance organizations (HMOs) and private health insurers would cover benefits beyond the government package.
Layered coverage
Under a memorandum of understanding, HMOs and private insurers will act as secondary payers and may cover expenses exceeding PhilHealth benefit limits or services outside its primary care package.
These may include specialized procedures, branded medicines and hospital room upgrades.
“With PhilHealth YAKAP as the first layer of protection, our private partners can focus their benefits on what lies beyond the program package. That way, every Filipino gets more care for every peso,” PhilHealth acting president and CEO Beverly Lorraine Ho said.
The initiative supports the Universal Health Care law and seeks to coordinate public and private healthcare benefits more closely.
PhilHealth said directly integrating YAKAP with private insurance policies could help prevent duplicate payments while allowing shared beneficiaries to maximize both their PhilHealth and private coverage.
What's covered
YAKAP provides consultations, 13 laboratory tests, selected outpatient medicines under the GAMOT package and outpatient services for six cancer screening tests.
PhilHealth's primary care program also includes specialized outpatient benefits such as animal bite treatment, maternal care, tuberculosis directly observed treatment, HIV/AIDS management and mental health services, when applicable.
“Together, we can establish a system that builds a healthier, more productive Philippines–where quality healthcare empowers every Filipino to drive the nation forward,” PhilHealth Board Member and Finance Secretary Frederick Go said.
Among the participating companies are Maxicare Healthcare Corp., MediCard Philippines Inc., PhilhealthCare Inc., Intellicare, Avega Managed Care Inc., Pacific Cross Health Care Inc., Insular Health Care Inc. and InLife Benefits Insurance Co. Inc.
Other participants include Health Plan Philippines Inc., United Coconut Planters Life Assurance Corp., Medicare Plus Inc., Cooperative Health Management Federation and The Manufacturers Life Insurance Co. (Phils.).
Wider network
PhilHealth is also encouraging other HMOs and private insurers to join the benefit complementation network as it seeks to expand financial protection for patients.
Members with private health plans are being urged to register for YAKAP through the eGovPH app, PhilHealth Member Portal or a PhilHealth office so they can use the government benefits alongside their HMO or insurance coverage.
The arrangement is intended to make PhilHealth the starting point for eligible primary care expenses, leaving private plans to cover additional benefits rather than paying for services already covered by the state insurer. —Ed: Corrie S. Narisma
