PhilHealth’s Expanded Benefits for 2025: What You Need to Know

In a significant step toward making healthcare more accessible and affordable, the Philippine Health Insurance Corporation (PhilHealth) has introduced a series of expanded and new benefits packages starting in 2025. These changes aim to ease the financial burden of Filipinos needing critical medical treatments, especially as healthcare costs continue to rise.

With enhanced coverage across multiple healthcare areas—including heart disease, kidney failure, oral health, and emergency care—these reforms promise better medical access for millions of Filipinos.

Why do These Changes Matter?

The government’s commitment to improving the healthcare system is evident in these new policies. PhilHealth President and CEO Emmanuel Ledesma Jr. highlighted how these updates will help families struggling with the costs of expensive medical treatments like angioplasty, dialysis, and organ transplants.

The revised health benefit packages are designed to:

• Provide financial relief to patients requiring costly medical procedures.
• Ensure timely medical care to improve overall health outcomes.
• Expand preventive healthcare to reduce long-term medical expenses.

Let’s dive into the key changes introduced in the 2025 PhilHealth benefit updates.

Expanded Coverage for Heart Disease Treatment

Heart disease remains a leading cause of death in the Philippines. To address this, PhilHealth has expanded coverage for ischemic heart disease and acute myocardial infarction (heart attacks), including critical heart-related treatments.

Key Updates:

• Increased financial support for Percutaneous Coronary Intervention (PCI), including angioplasty and coronary stenting.
• Coverage for fibrinolysis treatment for patients experiencing acute heart attacks.
• Inclusion of long-term cardiac rehabilitation for post-surgery recovery.

These changes will enable more Filipinos to access life-saving heart treatments without overwhelming medical bills.

Also Read: Philippines Salary Increase 2025: Big Update

Comprehensive Z Package for Peritoneal Dialysis

Kidney disease is another major health issue in the country. PhilHealth has significantly improved its peritoneal dialysis (PD) coverage, making this treatment more accessible and affordable.

Patient Group	Previous Coverage	New Coverage
Adult CAPD	PHP 270,000	PHP 389,640 – PHP 510,140
Pediatric CAPD & APD	PHP 270,000	PHP 510,000 – PHP 1.2 Million

Why This Matters:

• Expanded coverage allows patients to choose between different dialysis methods.
• The inclusion of both pediatric and adult patients ensures equitable healthcare access.
• Support for automated peritoneal dialysis (APD) provides advanced treatment options.

Increased Coverage for Kidney Transplants

Kidney transplants are often the best solution for end-stage renal disease, but they come with a hefty price tag. PhilHealth has boosted its Z Package benefits for both living and deceased organ donors.

Transplant Type	Previous Coverage	New Coverage
Living Organ Donor	PHP 600,000	Over PHP 1 Million
Deceased Organ Donor	PHP 1.5 Million	PHP 2.14 Million

How This Helps Patients:

• Lower financial burden for transplant recipients and their families.
• Encourages more organ donations by providing better coverage.
• Better post-surgery care through extended financial assistance.

New Preventive Oral Health Services

Recognizing the importance of oral health, PhilHealth has now included preventive dental services in its coverage.

Covered Services:

• Mouth examination and oral screening – Early detection of dental issues.
• Dental cleaning (scaling) – Helps prevent gum diseases.
• Fluoride varnish application – Strengthens enamel and prevents cavities.
• Pit and fissure sealants – Preventive care for children’s teeth.
• Emergency tooth extractions – Covered at accredited healthcare facilities.

Regular dental care can prevent more serious health complications, ensuring better overall well-being.

Also Read: AFP Soldiers to Receive Historic Increase in Subsistence Allowance

Expanded Outpatient Emergency Care

Medical emergencies don’t always require hospital admission, but urgent care can still be costly. PhilHealth has introduced outpatient emergency care benefits for non-hospitalized cases.

Two Key Components:

1. Facility-Based Emergency Care – Covers treatment at accredited emergency departments.
2. Pre-Hospital Emergency Care – Includes ambulance transport services to ensure patients reach medical facilities quickly.

This update ensures that Filipinos can access emergency treatment without the need for hospital admission, reducing delays in care.

Increased Case Rate Adjustments

PhilHealth is also adjusting its case rates to reflect the rising cost of healthcare.

What’s Changing?

• Over 9,000 medical packages will see a 50% increase in case rates starting January 1, 2025.
• Ensures better reimbursement for healthcare providers, improving service quality.
• Helps patients access more comprehensive treatments without extra out-of-pocket costs.

What’s Next for PhilHealth?

Despite the expanded benefits, PhilHealth has reassured its members that there will be no increase in premiums for 2025. This ensures that healthcare remains affordable while providing enhanced coverage.

With these major updates, PhilHealth is taking a bold step toward making healthcare more accessible and reducing the financial burden on Filipino families. These reforms are expected to improve public health and provide better medical support nationwide.

Frequently Asked Questions (FAQs)

1. Will my PhilHealth premiums increase with these new benefits?

No. PhilHealth has confirmed that there will be no premium hikes in 2025 despite the expanded coverage.

2. Who can avail of the expanded heart disease treatment coverage?

All PhilHealth members diagnosed with ischemic heart disease or acute myocardial infarction can benefit from the increased coverage, provided they receive treatment at accredited hospitals.

3. How do I apply for the increased kidney transplant coverage?

Patients undergoing kidney transplantation must ensure their procedure is performed at a PhilHealth-accredited hospital. Required documents, including medical certificates and billing statements, should be submitted for claims processing.

4. Are the new dental services available to all PhilHealth members?

Yes. The preventive oral health services are now included in PhilHealth’s primary care benefits and are available to all eligible members at accredited healthcare facilities.

Click here to learn more