PhilHealth says actuarial life only until 2027

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Metro Manila (CNN Philippines, September 3) – The Philippine Health Insurance Corporation's (PhilHealth) projected actuarial life is only until 2027, an official of the state health insurer told lawmakers during a House hearing on Friday.

This is due to projected net losses, which PhilHealth Actuarial Service chief Nerissa Santiago said could reach ₱57 billion by the end of the year, due to the expected rise in the number of COVID-19 related claims.

Santiago said based on their estimates, they will be paying for 173,000 COVID-19 hospitalization claims, and around 6.5 million COVID-19 tests.

"Average value per claim... Doon po sa (In) 2021, it's about ₱162,000 per claim or confinement. And for tests, that's an average of ₱3,000," Santiago explained.

By 2022, the state health insurer also projected a net loss of ₱17 billion, with the introduction of the Konsulta package (medical consultation package).

Santiago said the projected cost of the Konsulta package - benefitting around 89 million Filipinos - could reach ₱53 billion.

But Marikina Rep. Stella Quimbo questioned why PhilHealth is shouldering the medical consultation package when it's the job of the Health department to provide primary care for all Filipinos.

"Bakit kayo ang magbabayad ng Konsulta package? Kasi Mr. Chair, Konsulta package is a check-up. They basically, they pay for check-up for every Filipino, which is really not insurable. So arguably, dapat ang nagbabayad niyan is DOH," Quimbo said.

[Translation: Why are you paying for the Konsulta package? Because Mr. Chair, Konsulta package is a check-up. They basically, they pay for check-up for every Filipino, which is really not insurable. So arguably, the DOH (Department of Health) should be paying for that.]

A third party audit on the actuarial projections of PhilHealth was mandated by the General Appropriations Act of 2021.

But so far, PhilHealth said the Insurance Commission has yet to get a third party firm that will do the audit.