The PhilHealth Local Health Insurance Office (LHIO) in Caloocan. Photo from PhilHealth鈥檚 website
MANILA, Philippines 鈥� The Philippine Health Insurance Corp. (PhilHealth) has increased its coverage for open heart surgeries to almost P1 million and launched a new benefit package for heart valve repair and replacement surgeries worth up to P810,000.
The state health insurer said there was a need to significantly increase the coverage for cardiovascular diseases, which impose a heavy financial burden on patients and their families, apart from being the leading cause of death among Filipinos.
According to the World Health Organization, an average of 118,740 Filipinos die every year due to heart diseases, and the number swells by 5 percent annually.
The Philippine Statistics Authority reported that in 2023, a total of 129,300 Filipinos died due to ischemic heart diseases, accounting for one out of every five fatalities recorded that year.
READ: Breaking hearts and the bank: The cost of heart attack, stroke in PH
The PhilHealth benefit packages will be available only in a limited number of tertiary hospitals in the country equipped to undertake the different heart procedures.
Catastrophic illnesses
Under PhilHealth Circular No. 2025-004, the first circular signed by its new president, Edwin Mercado, the Z Benefit Package for coronary artery bypass graft (CABG) surgery has been raised to P660,000 from P550,000 (up by 20 percent) for standard risk and P960,000 (up by 75 percent) for expanded risk.
Z benefit packages cover 鈥淐ase Type Z鈥� or catastrophic illnesses that could result in prolonged hospitalization and poor outcomes if early intervention is not done.
The benefit package for the correction of ventricular septal defect (VSD) 鈥� a congenital problem where there is a hole in the wall that separates the two lower chambers of the heart 鈥� has also been significantly increased.
From P250,000, the case rate for the closure of VSD with or without associated special conditions is now at P498,000 (up by 100 percent), while the closure of VSD with severe pulmonary stenosis 鈥� which involves the narrowing of the pulmonary valve, making it difficult for the heart to pump blood to the lungs 鈥� has been increased to P614,000 (up by 145 percent).
The benefit package for correction surgery of tetralogy of Fallot (TOF) 鈥� which is a combination of four heart defects, namely VSD, pulmonary stenosis, overriding aorta, and hypertrophy (enlargement) of the right ventricle 鈥� was also expanded to P614,000 from P320,000 (up by 92 percent).
Valve repair
It also includes postcardiac surgery services, including laboratory tests, medicines, and rehabilitation services after surgery.
Meanwhile, PhilHealth Circular No. 2005-005 created the new Z Benefit Package for heart valve repair and replacement for valvular heart disease (VHD).
The rate for mitral valve (which controls blood flow from the left atrium to the left ventricle) repair for pediatric patients is at P642,000, while mitral and tricuspid valve (which controls blood flow between the right atrium and right ventricle) is at P64,000.
The cost of replacing either the mitral or aortic valve (which controls blood flow from the left ventricle to the aorta) is pegged at P762,000.
The package rate for replacing either the mitral or aortic valve with tricuspid valve annuloplasty (a surgical procedure that repairs a damaged valve by tightening or reshaping the ring around it) is P810,000.
Citing data from the Philippine Heart Center, PhilHealth said a total of 1,019 patients are enrolled in its valve registry.
It noted a higher frequency of cases in the 41-45 age group.