MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) and major health maintenance organizations (HMOs) and private health insurers on Thursday signed a memorandum of understanding (MOU) to coordinate coverage and split healthcare costs for patients with both types of insurance.
The agreement, signed at the Department of Finance in Manila, created the PhilHealth YAKAP-HMO/PHI Benefit Complementation initiative.
Under the arrangement, PhilHealth will provide the initial coverage for primary care through its Yaman ng Kalusugan Program (YAKAP), while private insurers will cover eligible expenses beyond the PhilHealth package.
“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,” Dr. Beverly Lorraine Ho, PhilHealth acting president and CEO, said.
Private insurers may shoulder costs that exceed PhilHealth benefit limits or services outside primary care coverage, including specialized procedures, branded medicines and hospital room upgrades.
YAKAP covers consultations, 13 laboratory tests, selected outpatient medicines under the GAMOT package and outpatient services for six cancer screening tests.
Its primary care benefits also include, as applicable, animal bite treatment, maternal care, Tuberculosis Directly Observed Treatment Short-Course (TB-DOTS), and HIV/AIDS and mental health services.
The benefit-complementation framework is intended to avoid duplicate payments and reduce out-of-pocket expenses for patients covered by both PhilHealth and private insurers.
The participating companies are Maxicare Healthcare Corp., MediCard Philippines Inc., PhilHealthCare Inc., Health Plan Philippines Inc., United Coconut Planters Life Assurance Corp., Asalus Corp. (Intellicare), Medicare Plus Inc., Avega Managed Care Inc., Cooperative Health Management Federation, iCare HMO (Insular Health Care Inc.), Pacific Cross, The Manufacturers Life Insurance Co. (Phils.) and InLife Benefits Insurance Company Inc.
Finance Secretary Frederick Go, concurrent PhilHealth board member attended the signing and said the partnership could help improve access to quality healthcare.
PhilHealth is also inviting other HMOs and private health insurers to join the arrangement as it expands.
