PhilHealth raises benefit packages for cataract surgery, lens implant
The Philippine Health Insurance Corp. (PhilHealth) has increased its coverage for patients in need of cataract surgery and the insertion of a replacement artificial lens.
Under Circular No. 2025-001 signed by PhilHealth president Emmanuel Ledesma Jr., which takes effect by the end of the month, the state-owned health insurer will pay up to P80,900 for extracapsular cataract extraction with insertion of intraocular lens (IOL) in adult patients, and P187,100 for the same procedure in pediatric patients.
The amounts represent a significant hike in the P16,000 benefit package for cataract patients that was first implemented in 2014: up by 405.6 percent for adult patients, and around 1,069.4 percent for children.
The reimbursable amount will depend on the type of lens to be implanted.
For adult cataract extraction surgery alone on one eye, it will be P20,200. The package for cataract surgery with monofocal IOL shall be P28,300, and P48,300 for monofocal toric IOL. Cataract extraction with multifocal IOL shall be P66,9000, and P80,900 for multifocal toric IOL.
For pediatric patients, PhilHealth shall reimburse up to P135,000 for cataract extraction in one eye and P139,050 for both eyes. For cataract surgery with IOL, it shall be P179,000 for one eye, and P187,000 for both eyes.
The health facility shall indicate the cost of the IOL in the bill. If the IOL is provided by the patient or acquired through donation, the claim will be limited only to cataract extraction.
PhilHealth said it was discouraging ophthalmologists from procuring and selling IOLs directly to their patients who are availing of the benefit package.
Cataract is a condition in which the clear lens of the eyes becomes cloudy, resulting in blurry vision and blindness. Cataracts are one of the leading causes of vision impairment among the elderly, though the condition can affect adults at any age.
Sole solution
Surgery is the only treatment for cataract, during which an artificial IOL replaces the damaged natural lens of the patient.
Similar to prescription glasses, IOLs come in different focusing powers and range in cost from P10,000 to P100,000 in private clinics. The most common type of lens is called a monofocal IOL, which has one focusing distance —close, medium or distance vision. On the other hand, multifocal IOLs provide both distance and near focus at the same time, while toric IOLs are prescribed for people with astigmatism.
PhilHealth’s newest adjustment for cataract surgery and IOL implants is the seventh update it has implemented on its benefit packages since the start of the year.
