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Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION
Citystate Centre, 709 Shaw Boulevard, Pasig City
Call Center: (02) 8441-7442 | Trunkline: (02) 8441-7444
www.philhealth.gov.ph

PHILHEALTH’S CY 2022 PROJECTIONS

September 28, 2021

PROJECTIONS ON COVID BENEFITS

The number of new COVID-19 cases are increasing daily, as evident in the graph
below showing the trend in the 7-Day Moving Average (7DMA) of the daily COVID-
19 cases. However, hoping that with the implementation of the vaccination program
of the government, the daily cases will soon decrease over time.

Graph 1. Number of New COVID-19 Cases Daily

Comparing the DOH COVID data to those claims received by PhilHealth for the same
period, we can see from Table 2 that for In-Patient COVID claims in 2020, the ratio
of PHIC Received claims (less Denied claims) is estimated to be 19.71% only of the
DOH reported cases; while for the conducted tests, those which were received by
PhilHealth is about 37.42% of DOH reported tests. Using the same ratios for
projecting 2021, the projected In-Patient COVID-19 cases to be covered by
PhilHealth is about 473,000 out of the projected 2.4 Million DOH reported cases, and
about 5 Million tests will be paid-for by PhilHealth out of the projected 18 Million
DOH reported tests.
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Table 2. Projected Number of COVID-19 Claims

*Projected using 2020 experience

This projected number of COVID-19 In-patient claims and tests to be paid by
PhilHealth will have an impact in the budget of PhilHealth of about PHP 94 Billion in
total for 2021.

Table 3. Projected Amount of COVID-19 Claims

(in Billions)

2020 2021 2022

PHIC COVID
In-Patient 17.82 76.61 24.87
Tests 7.40 17.76 12.43
PRC 3.86 8.32 4.97
Non-PRC 3.55 9.44 7.47
Total PHIC COVID 25.22 94.36 37.30

Reflecting the above projected COVID-19 claims amount (Table 3) in the Income
Statement (Table 4), in addition to the projected non-COVID claims of PHP 100
Billion, projected Primary Care Benefit (PCB) claims of PHP 17 Billion and the
impact of the coverage of additional Hemodialysis sessions in excess of 90 sessions
up to 144 sessions of about PHP 5 Billion, the total projected benefit payouts for 2021
would be about PHP 211.58 Billion. With a projected collection of PHP 158.98
Billion for the same year, there is a projected Net Loss of PHP 57.78 Billion. Shown
also in Table 4 is the projected Income Statement for the year 2022 comparing the
results if the appropriation from the government for the payment of the premiums for
Indirect Contributors would be based on the proposal of PhilHealth against that of the
recommendation of DBM (as shown in Table 1). It can be seen that the DBM
recommended 2022 GAA would result to a net loss for 2022, whereas the PHIC
proposal would result to a positive bottom line.
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