THE Philippine Health Insurance Corp. (PhilHealth) said on Wednesday that member contribution rates will not rise because they are fixed by law, adding that it will seek to offset the loss of government subsidies through operational efficiencies.
PhilHealth President and Chief Executive Officer Edwin M. Mercado said the efficiencies will come in the form of streamlined collections.
“Right now, (rates are) set by law. The maximum (premium contribution rate) is 5% of basic pay. At this point, it’s more about our efficiency in collecting from the paying sectors and direct members,” Mr. Mercado told reporters on the sidelines of the Management Association of the Philippines (MAP) general membership meeting.
The health insurer, however, is considering adjusting the cap on members’ basic monthly salary or income, which currently stands at P100,000.
“What’s being considered is a so-called progressive rate — those who can afford it might be able to contribute more. That’s what we’re currently studying,” Mr. Mercado said.
“Our economy is growing and the per capita income of Filipinos is also increasing, so that’s something we will look into. It’s not about raising the percentage, but rather adjusting the cap,” he added.
Under the Universal Health Care Act, PhilHealth charges its members a premium of 5% of their monthly basic salary or declared income, subject to a P10,000 salary floor and a P100,000 ceiling.
Last year, the government discontinued its subsidies for the health insurer, citing its large reserve funds.
Mr. Mercado said PhilHealth has about P480 billion in cash from retained earnings, which he said remain adequate to fund existing and planned benefit packages.
However, Mr. Mercado said PhilHealth is seeking additional funding for 2026 from the General Appropriations Act to support the planned upgrades to collection efficiency, as well as planned new benefit packages.
“Last week, the Department of Health and PhilHealth, had a meeting, and based on the benefit payments we expect for next year, we really had to request additional funding,” he said, noting that the extra funding to be requested is not yet final.
“We are also reviewing the benefit packages we have lined up. And if those get approval, there will be corresponding additional budget requirements. But… a large portion of what we will spend on benefit payments next year will also depend on our collection efficiency,” he added.
Earlier this year, PhilHealth introduced a set of expanded benefits, including coverage for ischemic heart disease — acute myocardial infarction, peritoneal dialysis, kidney transplants, preventive oral health services, and an outpatient emergency care benefit.
Mr. Mercado said PhilHealth is also investing more in primary care, including preventive measures such as screenings and early treatment. — Katherine K. Chan
