PhilHealth to cover oral health care

The Philippine Health Insurance Corp. (PhilHealth) board has approved the expansion of primary care benefits for the mouth, boosting the Department of Health’s (DOH) aim to improve the oral health of Filipinos.

In a statement, the DOH said the new package is designed to pay for annual routine preventive oral care services for every Filipino, such as mouth examination or oral screening, dental prophylaxis or cleaning, and fluoride varnish application.

Also covered are pit and fissure sealant and other procedures, as needed, for a maximum of two teeth. Emergency tooth extractions and dental consultations will also be part of the benefit package.

Rolled out next year

According to the DOH, this dental care package, expected to be rolled out early next year, is in line with the overall vision of “Ngiting 70-20” (“ngiti” is Filipino for smile) to ensure that more Filipinos will reach the age of 70 with 20 permanent teeth still in place.

“Universal Health Care (UHC) must have oral health care, and the best way to make it sustainable and felt by all Filipinos is through primary care. The [PhilHealth] board agreed on a preventive oral health benefit to be delivered by dentists working in PhilHealth Konsulta package providers, and also by stand-alone dentists based on referrals from the Konsulta providers,” the DOH statement quoted Health Secretary Teodoro Herbosa, chair of the PhilHealth board, as saying.

‘Roller coaster’

“We want dentists to come together and join us for UHC. This new PhilHealth oral health benefit will help make that happen,” Herbosa said.

The approval of the PhilHealth oral package coincided with the country’s participation in the World Health Organization’s first Global Oral Health Meeting in Bangkok, Thailand, running from Nov. 26 to Nov. 29.

Dr. Rochelle Pambid, dentist at the DOH’s Disease Prevention and Control Bureau, represented the Philippines alongside the DOH spokesperson, officer-in-charge Assistant Secretary Albert Domingo, who headed the delegation.

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“The Philippine journey for oral health care has been like a roller coaster with ups and downs in implementation. Under the administration of President Marcos and Secretary Herbosa, we are now rising again to fulfill the mandate of Universal Health Care that includes oral health,” Domingo said.

Copayment terms

PhilHealth board approved a maximum payment of P1,000 per patient per year for preventive oral health services, to be paid as follows: P300 for the first visit, covering mouth examination or oral screening, oral prophylaxis (cleaning), and fluoride varnish application; another P300 for a second visit at least four months from the first visit, for the same services; and P200 per tooth (maximum of two teeth per year) for pit and fissure sealant or a Class V procedure.

There will be no copayment allowed for public dentists, while private dentists will be allowed maximum copayment charges per visit of P1,500 for mouth examination and oral prophylaxis, P600 for pit and fissure sealant, and P600 for emergency tooth extraction.

The DOH said the next step would be for the PhilHealth management to publish the details of the package in a circular, which would then lead to the development or enhancement of information technology systems that would be used to capture data and facilitate payments.