Recto: PhilHealth benefits must be commensurate with premiums
Paying members of the Philippine Health Insurance Corp. (PhilHealth) should receive benefits commensurate with their monthly contributions, according to Executive Secretary Ralph Recto.
He raised the proposal following the death of a 47-year-old father from Manila, who had been diligently paying his monthly premiums for more than two decades, but was denied of availing any PhilHealth benefit package.
Recto said he would meet with PhilHealth officials this week to discuss the expansion of benefits for the more than 33 million paying members of the state-run health insurance provider.
“Under the law, they have a different benefit package. Let’s increase it,” he said in an interview on dzRH over the weekend.
Recto said he understands the frustrations of those who regularly pay their PhilHealth premiums but feel that the benefits they receive do not match their contributions.
According to Recto, indigents pay nothing to avail of services of PhilHealth, as their contributions are subsidized by the government.
Meanwhile, direct members regularly pay their PhilHealth premiums amounting from P6,000 to P60,000 annually, yet they do not receive proportionate benefits.
“If you’re indigent, you paid zero to avail of PhilHealth benefit packages, so you’re already ahead. That’s why I believe those who are paying should receive higher PhilHealth benefits,” he said.
Direct, indirect contributions
Under Republic Act No. 11223, or the Universal Health Care (UHC) Act enacted in 2019, there are two types of PhilHealth members: direct and indirect contributors.
Direct contributors are those who have the capacity to pay their premiums, including those who are employed and self-earning, including their qualified dependents, as well as lifetime members, who have paid 120 months of their PhilHealth premiums.
Under the current 5 percent premium rate of PhilHealth, direct contributors need to pay a monthly contribution ranging from P500 to P5,000, depending on their basic salary.
Meanwhile, indirect contributors and their dependents, are those whose premiums are subsidized by the national government, including senior citizens, persons with disability, indigents, 4Ps beneficiaries, and those without the capacity to pay.
The government allocated P53 billion for the implementation of the National Health Insurance Program to subsidize the premiums of indirect contributors under PhilHealth’s budget for this year.
Under Section 9 of the UHC law, PhilHealth shall provide additional program benefits for direct contributors.
Based on PhilHealth’s data as of end of 2025, of the 108.1 million registered members of PhilHealth, 48 percent are direct contributors at 33.3 million (with 18.7 million dependents), while the remaining 36.6 million at 52 percent are indirect members (with 19.6 million dependents).
Direct contributors paid P209 billion in premiums last year, but were only able to avail P121 billion in claims—equivalent to 42 percent of the P289.2 billion claims that PhilHealth processed last year.
Majority of the claims (58 percent) were reimbursements for indirect members at P167.9 billion.
