Article by:
Ma. Teresa Montemayor
MANILA – The Philippine Health Insurance Corporation (PhilHealth) has reaffirmed its commitment to sustain primary care gains and further expand access to health services nationwide as it observed National Health Insurance Program (NHIP) Month.
In a news release on Friday, PhilHealth President and Chief Executive Officer Edwin Mercado said the observance serves as a reminder of the agency’s mandate to provide reliable and equitable health insurance coverage to all members.
“Ito ang aming mandato: Sa Bagong Pilipinas, mayroon tayong Mabilis, Patas at Mapagkakatiwalaang PhilHealth (This is our mandate: In the New Philippines, we have a PhilHealth that is fast, fair, and trustworthy),” Mercado said.
He noted that PhilHealth continues to enhance its benefit packages, streamline processes, and improve partnerships with healthcare providers to make services more responsive and accessible.
With this year’s theme, “Ka-YAKAP ang Pilipino sa Kalusugang Segurado,” the state health insurer underscored its focus on strengthening primary care benefits, expanding coverage for high-cost illnesses, and ensuring that members—especially vulnerable sectors—are adequately supported.
It also called on members, healthcare providers, and stakeholders to work together in advancing the goals of the NHIP and in building a health system that is efficient, fair, and trustworthy for every Filipino.
To further improve services for patients with severe heart conditions, the PhilHealth and the Philippine Heart Center (PHC) reaffirmed their commitment to strengthening cardiovascular care during the 7th Annual Summit 2026, focused on the Open Heart Z Benefit Package.
Mercado emphasized that the partnership plays a crucial role in guaranteeing that patients who require heart surgery receive comprehensive financial coverage under the expanded Z Benefit Package.
“Our strong and productive collaboration with the Philippine Heart Center ensures that every Filipino in need of heart surgery can access quality and affordable medical services,” Mercado said.
The Open Heart Z Benefit Package covers complex and high-cost medical conditions, including selected cardiovascular procedures, providing substantial financial risk protection to members and their families.
In 2025, PhilHealth increased the package rates for Coronary Artery Bypass Graft (CABG), Closure of Ventricular Septal Defect (VSD), and Total Correction of Tetralogy of Fallot (TOF).
The CABG now ranges from PHP660,000 to PHP960,000, up from PHP550,000; the VSD ranges from PHP498,000 to PHP614,000, up from the previous PHP250,000; and the TOF costs up to PHP614,000, previously at PHP320,000.
The Heart Valve Repair and Replacement Z Benefits Package covers PHP642,000 to PHP810,000, while cardiac rehabilitation packages are worth PHP15,000 for adults and PHP6,500 for children.
Patients with rheumatic fever or rheumatic heart disease undergoing treatment may also enroll in the outpatient benefit package under PhilHealth Circular 2019-0005.
If admitted under ward accommodations in PhilHealth-contracted facilities nationwide, qualified members and dependents can avail of these without co-payments. (PNA)
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