PhilHealth Enhanced Benefits for Neonatal Sepsis, Bronchial Asthma and Konsulta Package

Effective May 1, 2024, the 

Philippine Health Insurance Corporation  (PhilHealth) is implementing another  round of enhancements in two of its  existing benefit packages, this time for  neonatal sepsis and bronchial asthma which have been increased heftily by more  than 100%.  

PhilHealth Circulars 2024-0008 and 0009,  the implementing guidelines of these two  case rate packages, prescribe that all  patients admitted on May 1, 2024 onwards  may avail themselves of the increased  benefits in accredited health facilities.  

PhilHealth President and CEO  Emmanuel R. Ledesma Jr.

According to PhilHealth President and CEO  Emmanuel R. Ledesma Jr. “the PhilHealth  Board has approved the increase in  package rate for neonatal sepsis to  P25,793 from P11,700 and bronchial  asthma in acute exacerbation to P22,488  from P9,000. The increase translates to 120% and 150%, respectively”.  

Neonatal sepsis and other infectious  conditions are among as the leading causes  of neonatal deaths in the Philippines. In  2023, PhilHealth paid P733.86 million for  more than 57,000 cases for the said  condition.  

On the other hand, asthma remains to be a  high-burden ailment in the Philippines  despite medical advancements. The  majority of Filipinos with asthma do not  have adequate control over their  conditions, resulting to confinements.  Based on PhilHealth data for 2023, asthma  ranks eight among the top medical  confinements paid by the state insurer,  where P717 M have been paid for, for more  than 90,000 cases of asthma. 

PhilHealth identified neonatal sepsis and  bronchial asthma as priority conditions in  rationalizing its All Case Rates packages to  further improve financial coverage and  lower, if not eradicate the patients out-of  pocket expenses.  

Ledesma explained that “PhilHealth is  continuously improving its benefit  packages in line with our thrust Pinalawak  at mga Bagong Benepisyo para sa  Mamamayang Filipino. We are hoping  that these enhancements bring positive  impact in the behavior of the Filipinos in  seeking medical attention. Sa mga  nangangailangang magpagamot, huwag  na pong magdalawang isip dahil  nakaalalay ang PhilHealth sa kanilang  gastusing medikal”.

PhilHealth also reminded the members  that the adjusted case rates may be availed  of in Levels 1 to 3 accredited public and  private health facilities nationwide.  Meanwhile, the previous rates of P11,700  for neonatal sepsis and P9,000 for  bronchial asthma will be applied to patients  admitted in accredited primary care  facilities. 

The state agency also emphasized the  important role that primary care plays in  disease prevention and early detection. It  has again called on primary care facilities to  be Konsulta Package Providers (KPP) to  provide wider access to drugs and  medicines for the control of asthma. “Since  our accredited KPP provides  consultations, drugs and medicines and  laboratory tests, hospital admission due to  worsening of asthma will be avoided”, Ledesma added.  

The PhilHealth Chief also urged all  members to register to their preferred to  Konsulta Package Provider to avail  themselves of free consultations, health  screening and assessment, as well as any of  the 21 essential drugs and medicines and 13  laboratory tests as will be required by their  primary care physician.