The National Health Insurance Corporation (PhilHealth) declared
agency coverage level at 98% 63 with the remaining 2% probably belonging to
indigenous peoples (IPs), and workers in the informal sector. Although they are
lacking in data on IPs, they have a partnership with NCIP in providing identification
so that the agency can record them in their database and provide access to services.
The agency’s KPI are coverage rate, benefit payments, collection efficiency rate, turnaround time for payment of claims, customer satisfaction rate, and percentage of
support value.64 The amount of benefit payments that they make exceeds the rate of
collection. It is said that they payout benefits at a rate of 3 Billion Php per week, and
their collections are 400 Million Php lower than benefit payments last year 65
Coverage numbers as of December 2018 are as follows66
Category
Count
Government (permanent/regular, casual, contractual, job order)
2,814,078
Informal Sector
Overseas Filipino Workers
NHTS-PR
Private (permanent/regular, casual, contract/project-based)
Self-Earning Individual
Senior Citizen (under RA 10645)
6,682,616
3,672,908
21,987,834
14,217,561
1,399,210
7,600,025
The high coverage level is due to the “point-of-service program” (POS)
wherein you become a member at the point where you decide to use PhilHealth in an
accredited health service facility. This was part of the previous administration’s PDP,
in order to secure coverage for the poor and indigent, and those who “fall in the
cracks” of the current PhilHealth system. 67 If they pass the DSWD means-test, they
would also be included in the 4Ps immediately the year after. They also offered
coverage for women about to give birth,68 by allowing them to make an annual
63 With 2018 population estimated at 106M
64 Actual value paid by PhilHealth to the health service provider
65 Consultation with PhilHealth national office (11 March 2019)
66 Data from PhilHealth Corporate Planning Department, available from
https://drive.google.com/open?id=17_w6oDZ6P6DL3YJ0ILx-pURyBzKjOGcL
67 Consultation with PhilHealth national office (11 March 2019)
68 Ibid.
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