PhilHealth expands coverage for blood tests, preventive medicine, children’s therapy

But long queues, service delays, and unpaid provider claims persist.

The Philippine Health Insurance Corp. (PhilHealth) is set to expand coverage for outpatient blood tests, preventive medicine, and children’s developmental therapy, but the move comes as patients and health providers continue to grapple with service delays, long queues, and unpaid claims from the state insurer.

At the State of the Nation Address on July 27, President Ferdinand Marcos Jr. committed to expanding specific PhilHealth benefits for certain outpatient procedures and preventive medications.

PhilHealth YAKAP, the insurer’s primary care package, will soon include blood tests and preventive medicine aimed at addressing hepatitis B and liver, kidney, and thyroid issues.

YAKAP, or the Yaman ng Kalusugan Program, carries an annual limit of ₱20,000 for check-ups, procedures, and medications that can be availed of at over 2,000 accredited clinics.

PhilHealth will also increase its package for children with developmental disabilities, raising therapy coverage from 90 to 150 sessions.

While the expansion adds more services covered by PhilHealth, patients and health providers say longstanding concerns remain unresolved. Many patients frequently report delays in service, long queues and wait times, and mismatched instructions at partner clinics. Health providers have also raised concerns over years-long backlogs in payments owed by the insurer.

PhilHealth reportedly saw over 4.5 million members avail of benefits in the past year, representing nearly 20% of its 25-million-member base.

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