Filipinos to get added coverage as PhilHealth, HMOs team up to cut medical bills

The PhilHealth YAKAP-HMO/PHI Benefit Complementation initiative is part of efforts to support the Universal Health Care law.

Patients with both PhilHealth and private health coverage may now have more of their medical bills covered under a new arrangement between PhilHealth, HMOs and private insurers.

The stakeholders have agreed to coordinate their coverage under the Yaman ng Kalusugan Program (YAKAP), with PhilHealth serving as the first layer of coverage and private insurers providing additional benefits where applicable.

The arrangement, called the PhilHealth YAKAP-HMO/PHI Benefit Complementation initiative, is part of efforts to support the Universal Health Care law. It is designed to reduce patients’ out-of-pocket costs when medical expenses go beyond PhilHealth’s benefit limits or fall outside its primary care coverage.

YAKAP covers consultations, 13 laboratory tests, selected outpatient medicines under the GAMOT package, and outpatient services for six cancer screening tests. Its primary care benefits also include animal bite treatment, maternal care, TB treatment, HIV/AIDS management and mental health services, as applicable.

Private insurers can then serve as secondary payers for eligible costs beyond the PhilHealth package. These may include specialized procedures, branded medicines and hospital room upgrades.

The Department of Finance said integrating YAKAP with private insurance policies could help prevent duplicate payments while lowering out-of-pocket costs for patients who have both types of coverage.

PhilHealth is urging members to register for YAKAP through the eGovPH app, PhilHealth Member Portal, or their nearest PhilHealth office. It is also inviting other HMOs and private health insurers to join the network.

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