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Health Insurances in the Philippines

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Submitted By eraompok
Words 451
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Increasing Medical Expenses among Individuals * Premium tax credits and savings out-of-pocket costs based on household size and income * Medicard (for the indigenous people) * 2% penalty record * Exemption from the few based on income or other situations

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Source of Financial Statements Sector Premium collections (in million pesos)
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Government employed 9,135.16
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Private employed 24, 945.28
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Sponsored employed 16,899.18
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Individually-paying program 3,133.68
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Overseas Workers Program 1,245.85
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Total 55,359.05

In the year 2013, they worked double-time in order to achieve a collection of P55,359.05 and 36 billion pesos in premium contributions.

The private sectors contributed the target share of total premium payments at 45% while collections from the NG and LGUs for the annual premium sponsored program. -------------------------------------------------
Benefit Payments
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Sector Jan – Dec 2013 (million pesos) % Distribution
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------------------------------------------------- Government employed 7,161.00 13
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Private employed 14,208.96 26
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Sponsored program 17,971.59 32
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Individually-paying program 10,410.54 19
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Overseas workers program 1,662.83 3
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Lifetime program 4,144.83 7
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Total 55, 559.48 100

In 2013, Phil Health paid 55.56 billion pesos for 5.8 million peso claims, an amount that was 16% more than they paid last 2012.
Significant portions they paid went to Sponsored program members or No Balance Billing (NBB). 26% of benefit payments went to private sector workers, 19% to individual paying workers, 13% to government workers, 7% to Lifetime membership members, and 3% to overseas worker members.
Number of Claims Paid by Sector * 40% and more claims coming from the working population * 27% from the less privileged sector * 22% from individual paying members; the rest came from lifetime members and overseas workers members.

More than third total paid claims for Sponsored program members were paid by virtue of the NBB policy and around 64% claims were paid through the cash rate mechanism.

Number of Claims by Sector (make into a circle chart/column)

OWP – 3%
IPP – 22%
LIFETIME PROGRAM – 7%
GOVERNMENT – 13%
SPONSORED – 27%
PRIVATE – 27%

Packages rates
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2012 Initial explanation
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Acute Lymphoblastic Leukemia in Children (Standard risk) P 210,000.00
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Breast Cancer (early stage) 100,000.00
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Prostate Cancer (low to intermediate risk) 100,000.00
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Low risk kidney Transplantation 600,000.00
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2013 (Benefits expansion)
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Elective Surgery for Coronary Artery Bypass Graft P 550,000.00
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Tetralogy of Fallot (“Blue Baby Syndrome”) 320,000.00
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Ventricular Septal Defect 250,000.00
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Cervical Cancer (Stage 1-111B)
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Low dose 120,000.00
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High dose 175,000.00

R.A. Kasambahay Law – 2.5 million domestic household workers gained access to health pay. For Phil Health premium, income monthly salary is below P5,000.00.

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