Filipinos with private health coverage could get more out of their plans as PhilHealth and private insurers move to coordinate benefits and reduce patients’ out-of-pocket healthcare costs.
Philippine Health Insurance Corp. (PhilHealth) has signed an agreement with 13 health maintenance organizations (HMOs) and private health insurers to launch the YAKAP-HMO/PHI Benefit Complementation initiative under the Universal Health Care law.
The arrangement makes PhilHealth’s Yaman ng Kalusugan Program (YAKAP) the first layer of coverage for primary care, with private insurers stepping in for eligible expenses beyond PhilHealth’s benefit limits.
That means HMOs and insurers can focus their coverage on services not fully covered by YAKAP—including specialized procedures, branded medicines and hospital room upgrades—instead of duplicating benefits already paid by PhilHealth.
“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,” PhilHealth Acting President and CEO Beverly Lorraine Ho said.
YAKAP covers consultations, 13 laboratory tests, selected outpatient medicines under the GAMOT package and six cancer screening services. It also provides outpatient benefits for animal bite treatment, maternal care, tuberculosis treatment, HIV/AIDS management and mental health services.
The partnership is intended to streamline payments between public and private health coverage, particularly for Filipinos enrolled in both PhilHealth and private health plans.
PhilHealth Board Member and Finance Secretary Frederick Go said the initiative could help build a healthcare system that supports a “healthier, more productive Philippines.”
PhilHealth has invited other HMOs and private insurers to join the network, potentially expanding the number of patients who can benefit from coordinated coverage.
