PhilHealth Rates Up but Benefit Package Boosted

PhilHealth Rates Up but Benefit Package Boosted

 

For disease prevention and early detection.

philhealth2The bad news for the New Year is that the Philippine Health Insurance Corp. members would now have to pay higher contributions starting this month.

But the good news is, PhilHealth has recently re-introduced its Primary Care Benefit Package under a new brand called TSeKaP or Tamang Serbisyong Kalusugang Pampamilya, whose main beneficiaries are indigents or subsidized sectors.

While the contributions would be equally shared by employers and employees, employed PhilHealth members who used to pay monthly contributions of P175 are now required to pay P200.

Meanwhile, individually paying members of the state-run health insurance fund who used to pay a monthly premium of P150 would also be required to cough up P200. IPMs, including self-employed and voluntary members, can choose three payment schemes: P600 per quarter, P1,200 semi-annually or P2,400 annually.

PhilHealth said it re-introduced TSeKap to be able to respond to the growing health care needs of its members, especially the poor. TSeKaP aims to make the benefit package more endearing to its beneficiaries which include indigent and sponsored members, members of organized groups, and land-based OFWs.

[pq]PhilHealth extended the benefit package to employees of the Department of Education last year as part of a pilot test.[/pq]

 

“Gone are the days when PhilHealth is just remembered when one is sick because our TSeKaP package is here to encourage entitled members and their qualified dependents to avoid getting sick or to even arrest sicknesses early on.” PhilHealth president and chief executive officer Alexander A. Padilla was quoted by the Philippine News Agency as saying.

Padilla noted that “disease prevention and early detection saves money, and strengthens the gate-keeping function of primary care facilities which allows tertiary hospitals to maximize their resources on complicated cases”.

In due time, PhilHealth said TSeKaP would be extended to other member-categories after careful studies have been made. TSeKaP covers essential services aimed at prevention, early detection of diseases and even interventions for healthy living.

It includes consultations, visual inspection with acetic acid, regular blood pressure monitoring, periodical breast examination, and health promotion like education on breastfeeding, counseling on lifestyle modification and smoking cessation.

philhealth3Preventive services also include body measurements and digital rectal examination while diagnostics such as complete blood count, urinalysis, fecalysis, sputum microscopy, fasting blood sugar, Lipid profile and chest X-ray are also available upon the recommendation of the physician.

“TSeKaP even provides medicines for asthma, acute gastroenteritis with no or mild dehydration, pneumonia, and urinary tract infection.” Padilla added.

Qualified beneficiaries can avail themselves of these services at their designated rural health units, health centers or at outpatient departments of government hospitals nearest them in the case of DepEd employees.

Land-based OFWs have the option to choose their TSeKaP providers. Beneficiaries must enlist themselves with TSeKaP providers and be assigned to a primary care physician to enjoy the services within the validity period as indicated in their PhilHealth cards or Member Data Record in the case of land-based OFWs.

The benefit was first introduced in 2000 to provide adequate access to quality outpatient services and has undergone several enhancements until its re-introduction as TSeKaP to help encourage usage especially among the poor.

“TSeKaP is PhilHealth’s concrete and lasting contribution to ensuring a level of care that is ‘effective, safe, person-centered, comprehensive, integrated and with continuity by a regular and trusted provider.” Padilla stressed, partly quoting the World Health Organization’s definition of primary care.

To date, a total of 2,482 outpatient clinics covering at least 93 percent of all cities and municipalities in the country have been accredited as TSeKaP providers and some P2.9B has already been paid for the said package from 2012 to 2013 alone.

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