MANILA, Philippines — 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 PhilHealth benefit packages.
Recto said he would meet with PhilHealth officials this week to discuss the expansion of benefits for 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 also 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 PhilHealth services, as their contributions are subsidized by the government.
Meanwhile, direct members regularly pay PhilHealth premiums amounting to 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.
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Under Republic Act No. 11223, or the Universal Health Care 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, as well as their qualified dependents, and lifetime members who have paid 120 months of PhilHealth premiums.
Under the current 5 percent premium rate of PhilHealth, direct contributors are required to pay a monthly contribution ranging from P500 to P5,000, depending on 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 RA 11223, PhilHealth shall provide additional program benefits for direct contributors.
P209B in premiums collected
Based on PhilHealth’s data as of end-2025, of the 108.1 million registered members, 48 percent are direct contributors, or 33.3 million (with 18.7 million dependents), while the remaining 36.6 million, or 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 of P121 billion in claims, equivalent to 42 percent of the P289.2 billion claims that PhilHealth processed last year.
The majority of claims, 58 percent, were reimbursements for indirect members, amounting to P167.9 billion.
PhilHealth benefit denial claim
Recto’s call to increase the benefit package for direct contributors followed the harrowing story of Marvin Sulit, who died due to a brain hematoma on June 4 without being able to avail of any PhilHealth benefits despite being a paying member for more than 25 years.
READ: Palace orders probe into PhilHealth benefit denial claim
His wife, Maria Lourdes, said Sulit was rushed to a private hospital in Manila, which informed them that a life-saving surgery would cost about P4 million. Because of the exorbitant amount, they transferred to another hospital in Manila where the operation would be reduced to P2 million, but they would need to pay a P1 million deposit upfront for the surgery to proceed.
“With time running out and no way to raise that amount immediately, we had no choice but to wait for Marvin to die. It was heartbreaking and devastating,” Sulit’s wife wrote in a viral Facebook post.
When they settled hospital charges, Sulit’s family learned that the bill had reached P200,000 in seven hours since admission until his death.
Worse, the hospital informed them that Sulit was not eligible for any PhilHealth benefits because he had been hospitalized for less than 24 hours.
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Under PhilHealth’s current 24-hour confinement rule, a patient must be confined in an accredited healthcare facility for at least 24 hours to avail of inpatient benefit packages.
Their claim for the P7,800 resuscitation package was also denied since they did not authorize Sulit to be revived.
“What is the purpose of PhilHealth if the people who have contributed for decades cannot access the benefits when they need them most?” she lamented.
Meanwhile, Recto was accused of plunder, graft, and malversation complaints before the Office of the Ombudsman for authorizing the transfer of PhilHealth’s unused funds amounting to P60 billion to the national treasury in 2024 when he was finance secretary.
The Ombudsman dismissed the complaint for “lack of prima facie evidence with reasonable certainty of conviction and insufficiency of evidence.”
The complaints were filed separately in December by the Save the Philippines Coalition, a Duterte-allied group, and another coalition composed of doctors, health advocates, and lawyers led by lawyer Rodel Taton.
Taton and their coalition filed a motion for reconsideration last week.
Health reform advocate Dr. Tony Leachon filed plunder, graft, and malversation complaints against Recto and other officials over the alleged illegal transfer of PhilHealth funds. /mcm
