THE Philippine Health Insurance Corporation (PhilHealth) announced the implementation of its enhanced benefits for Extracapsular Cataract Extraction with Insertion of Intraocular Lens (IOL) covering both adult and pediatric surgeries, effective January 30, 2025.
This initiative is aligned with President Ferdinand R. Marcos Jr.’s directive to continually improve and sustain healthcare benefits being provided by the state health insurer, ensuring adequate financial support to patients seeking medical treatment.
Based on PhilHealth Circular 2025-0001 published on January 15, 2025, benefits for adult cataract surgery have significantly increased by more than fourfold, with financial support starting at P20,200. Coverage varies depending on the type of lens used, with procedures involving a monofocal IOL or standard lens at P28,300 per eye. Premium lenses such as monofocal toric IOL that provides clear vision at one specific distance while correcting astigmatism are covered for P43,800 per eye, a multifocal IOL that helps see both near and far objects at P66,900 per eye, and multifocal toric IOL that corrects astigmatism and multiple viewing distances at P80,900 for the right eye.
Meanwhile, pediatric cataract surgery coverage has seen an unprecedented increase of tenfold, with benefits reaching up to P135,000 per eye and P139,050 for both eyes. If an intraocular lens (IOL) is included, coverage is at P179,000 per eye and P187,100 for both eyes.
Previously, PhilHealth pays for cataract extraction at P16,000 per eye with no differentiation between adult and pediatric cases.
To ensure timely and uninterrupted healthcare services, the state health insurer reminds all accredited healthcare facilities to maintain minimum stock levels of intraocular lenses, essential eye medications, life-saving drugs, IV fluids, and necessary supplies to avoid unwarranted out-of-pocket from outside purchases and services.
This notable increase in coverage for cataract extraction is expected to help reduce preventable blindness and improve the quality of life of Filipinos suffering from this type of eye condition.
In 2024, PhilHealth has disbursed a total of P3.58 billion for 224,209 cataract removal procedures./PN
