MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) has significantly increased its coverage for open-heart surgeries, raising financial support to nearly P1 million, while also launching a new benefit package for heart valve repair and replacement surgeries worth up to P810,000.
PhilHealth highlighted the need to enhance coverage for cardiovascular diseases, as these conditions place a heavy financial burden on patients and their families. Additionally, heart disease remains the leading cause of death among Filipinos.
According to the World Health Organization (WHO), around 118,740 Filipinos die annually due to heart diseases, with the number increasing by 5 percent every year. Meanwhile, data from the Philippine Statistics Authority (PSA) revealed that in 2023, ischemic heart diseases caused 129,300 deaths, accounting for one out of every five fatalities recorded that year.
Increased Coverage for Catastrophic Illnesses
PhilHealth’s expanded benefit packages will be available in a limited number of tertiary hospitals in the country that are equipped to perform specialized heart procedures.
Under PhilHealth Circular No. 2025-004, which was the first circular issued by new PhilHealth President Edwin Mercado, the Z Benefit Package for coronary artery bypass graft (CABG) surgery has been increased.
- Standard-risk CABG coverage has been raised from P550,000 to P660,000 (a 20 percent increase).
- Expanded-risk CABG coverage is now P960,000, up 75 percent from its previous P550,000 limit.
The Z Benefit Package is designed for “Case Type Z” illnesses, which include catastrophic diseases that may require prolonged hospitalization and have poor outcomes without early intervention.
Higher Support for Congenital Heart Defects
PhilHealth also significantly increased its coverage for congenital heart conditions, particularly for ventricular septal defect (VSD) and tetralogy of Fallot (TOF) surgeries.
- VSD closure with or without associated conditions now has a coverage of P498,000, up 100 percent from the previous P250,000.
- VSD closure with severe pulmonary stenosis has been increased to P614,000, marking a 145 percent increase.
- TOF correction surgery, which addresses a combination of four heart defects, has been raised from P320,000 to P614,000—a 92 percent increase.
These procedures are essential in treating life-threatening heart conditions, especially in children born with congenital heart defects.
New Benefit Package for Heart Valve Repair and Replacement
Meanwhile, PhilHealth Circular No. 2005-005 introduced a new Z Benefit Package specifically for heart valve repair and replacement procedures related to valvular heart disease (VHD).
The package includes coverage for various valve-related surgeries:
- Mitral valve repair (for pediatric patients): P642,000
- Mitral and tricuspid valve repair: P64,000
- Mitral or aortic valve replacement: P762,000
- Mitral or aortic valve replacement with tricuspid valve annuloplasty: P810,000
These benefit packages also include post-cardiac surgery services, such as laboratory tests, medications, and rehabilitation services to ensure proper recovery after the procedure.
Heart Disease Remains a Major Health Concern
Citing data from the Philippine Heart Center, PhilHealth reported that 1,019 patients are currently enrolled in its valve registry, with most cases occurring in individuals aged 41 to 45 years old.
The expansion of heart-related benefit packages reflects PhilHealth’s commitment to addressing cardiovascular diseases, ensuring that more Filipinos can access lifesaving medical procedures without facing overwhelming financial challenges.
