PhilHealth guarantees coverage of heat-related illnesses

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) has assured its members of coverage for heat-related illnesses as the scorching summer season raises the risk of conditions such as heat stroke, dehydration and other seasonal diseases.

In a statement, the state insurer said its inpatient benefit packages for common summer- and heat-related illnesses are available at any PhilHealth-accredited hospital, helping reduce out-of-pocket expenses.

“PhilHealth stands ready to protect every Filipino. We want all members to know that coverage is available to help ensure their safety, wherever they are and regardless of the season,” PhilHealth president and CEO Edwin Mercado said.

Covered conditions include heat stroke, heat exhaustion, heat collapse, heat cramps and sunstroke, with a benefit package worth P12,675.

For heat fatigue and other effects of heat and light, members may avail themselves of coverage worth P18,135, while moderate to severe dehydration is covered up to P7,800.

PhilHealth also covers several seasonal illnesses that tend to rise during the summer months.

Members admitted for varicella or chickenpox without complications may avail themselves of a benefit package worth P7,800, while those diagnosed with typhoid fever are entitled to P19,500.

Eye infections are likewise covered, with conjunctivitis or sore eyes carrying a benefit of P16,575.

For gastrointestinal illnesses, infectious diarrhea or acute gastroenteritis is covered up to P11,700.

Cases involving the toxic effects of contact with marine animals, such as jellyfish, sea anemones, shellfish and starfish are covered up to P11,115.

The state insurer added that emergency health care needs – whether heat-related or not – are covered under the Outpatient Emergency Care Benefit (OECB) package, available in accredited Level 1 to 3 hospitals.

“This ensures that members can access immediate care for urgent conditions, further strengthening financial protection during emergencies,” PhilHealth said.

The Philippine Atmospheric, Geophysical and Astronomical Services Administration (PAGASA) yesterday urged the public to take extra precautions as heat index levels in several areas have reached the “danger level” during the peak of the summer season.

According to PAGASA’s forecast, Catarman, Northern Samar; Dumangas, Iloilo; Cotabato City, Maguindanao; Zamboanga City and Zamboanga del Sur may record a heat index of 42 degrees Celsius.

Hemophilia

Aside from heat-related illnesses, PhilHealth is also extending support and benefit packages for patients with hemophilia as the country observes National Hemophilia Awareness Month this April.

Hemophilia is a condition in which the blood does not clot properly due to a lack of clotting proteins, causing prolonged bleeding after injury.

For members requiring regular blood transfusion, PhilHealth said they may avail themselves of a case rate worth P7,098 per session, which covers medicines, laboratory tests, x-ray and operating room fees.

The agency clarified that one day of blood transfusion, regardless of the number of bags consumed, is counted as one session.

“Take care of yourself and be conscious of any problem related to blood. Make use of the benefits provided by PhilHealth to ensure proper care and treatment,” it said.

Claims gap

Meanwhile, PhilHealth data showed that claims paid to indirect contributors exceeded those released to direct contributors by over P46 billion last year.

From Jan. 1 to Dec. 31, 2025, claims paid to indirect contributors reached P167.91 billion covering 11,104,949 claims, compared to P121.35 billion for 7,692,549 claims paid to direct contributors.

Among indirect contributors, senior citizens accounted for the highest claims at P65.73 billion, followed by sponsored members at P65.11 billion and indigents at P37.07 billion. — Rhodina Villanueva