PhilHealth's 2025 Cataract Surgery Benefits: What to Know

PhilHealth Launches Enhanced Benefits Package for Cataract Surgery in 2025

The Philippine Health Insurance Corporation (PhilHealth) has introduced Circular No. 2025-0001, highlighting a comprehensive benefits package for Extracapsular Cataract Extraction with Insertion of Intraocular Lens (IOL). This initiative aims to address cataracts, one of the leading causes of blindness in the Philippines, and ensure improved access to quality eye care for Filipinos.

Why Cataract Surgery?

Cataracts are a major cause of visual impairment, as reported by the 2018 Philippine National Survey on Blindness and Eye Diseases. Surgery remains the sole treatment, involving the replacement of the damaged natural lens with an artificial intraocular lens. Recognizing the growing need for accessible eye care, PhilHealth has made cataract surgery a priority under the All Case Rates (ACR) system.

New Cataract Surgery Benefits Packages

PhilHealth’s revised benefits offer financial risk protection through fixed reimbursement rates for accredited health facilities. The new package rates cater to both adult and pediatric patients:

Adult Cataract Surgery Packages

• Basic Cataract Extraction: ₱20,200 per eye

• With Monofocal IOL: ₱28,300 per eye

• With Multifocal Toric IOL: Up to ₱80,900 per eye

Pediatric Cataract Surgery Packages

• Basic Surgery: ₱135,000 per eye

• With IOL: Up to ₱187,100 for both eyes

Key Highlights of the Policy

1. No Co-Payment for Basic Accommodations: Patients admitted under basic or ward accommodation in both public and private health facilities will not bear out-of-pocket expenses for essential services.

2. Accredited Health Facilities (HFs): Only certified public and private facilities capable of performing cataract surgeries are included in the program.

3. Transparent Billing: Patients will be informed of any additional charges, particularly for upgrades or non-essential services.

4. Emphasis on Quality Care: Health facilities must adhere to globally recognized clinical practice guidelines to ensure optimal outcomes.

Monitoring and Feedback Mechanism

PhilHealth encourages patients to report issues or provide feedback about their experience through its Corporate Action Center hotline or email. Additionally, strict control mechanisms are in place to monitor provider compliance and prevent unwarranted cost increases.

Commitment to Universal Health Care

This initiative aligns with the Universal Health Care Act (R.A. No. 11223), aiming to provide equitable access to essential health services. With the enhanced benefits for cataract surgery, PhilHealth continues to protect Filipinos from the financial burden of health care while ensuring top-notch service delivery.

What This Means for Patients

Patients, particularly senior citizens and children, can now benefit from cost-effective and quality cataract surgeries. By removing financial barriers, this policy ensures improved access to vision-restoring procedures across the country.

Have questions about the new cataract surgery packages? Contact PhilHealth today at (02) 8862-2588 or email [email protected] for more information.

Reference: Circular No.: 2025-0001