FACT SHEET: How to avail of medicine, lab and diagnostic tests from PhilHealth

The Konsultang Sulit at Tama (Konsulta) program of the Philippine Health Insurance Corp. (PhilHealth) is an expanded benefit package for outpatient services for all Filipinos. Konsulta covers consultation, laboratory and diagnostic tests and medication.

Introduced under the Universal Health Care Act (UHCA) or Republic Act No. 11223 in 2019, Konsulta shifts focus from cure to prevention. It provides primary care, which, according to the World Health Organization (WHO), is the “entry point” to other health services. It aims for a continuous relationship between an individual and the healthcare system.

What are the benefits under PhilHealth Konsulta?

Konsulta covers 18 laboratory and diagnostics tests, following the inclusion of mammography and ultrasound of the breast and the lungs, said PhilHealth Spokesperson Dr. Israel Francis Pargas in the Sept. 3 episode of Tres from Tress podcast. Twenty-one different medicines are also provided, including drugs for hypertension, diabetes and asthma.

Section 6(d) of RA 11223 requires every Filipino to register with a public or private primary care provider to avail of the services under the Konsulta program.

Ideally, there should be a primary care physician to attend to a group of people within a certain area for easier access and convenience, Pargas said. Consultations on health concerns with a primary care doctor and referrals to specialty doctors are covered under Konsulta.

According to Pargas, each member has an annual allotment of P1,700 worth of services under the Konsulta package. While the amount is seemingly small, this is only an average, he explained, because “hindi naman po lahat nu’ng ating 110 million ay magkakasakit, (not all of the 110 million [Filipinos] will get sick.)”

Regardless, Konsulta will provide for the necessary tests the primary care doctors may request, Pargas said.

How to register for PhilHealth Konsulta?

PhilHealth members can register online for the Konsulta benefit at www.philhealth.gov.ph. They can also opt for assisted registration through the local health insurance offices, local government units, private and government health facilities and other PhilHealth-authorized institutions.

In the Konsulta registration form, the member will be asked to choose a primary care provider, typically the most accessible and convenient. Simply refer to the updated list of accredited Konsulta Package Providers, composed of hospitals and clinics all over the country.

After registration, a health screening follows as part of the first patient encounter and an initial primary care consultation.

Pargas reiterated that since every Filipino is automatically a PhilHealth member, everyone is eligible for the Konsulta health service. “‘Yung iba, kung hindi pa sila rehistrado or walang (PhilHealth) number, ang feeling nila hindi sila member (Those who are not registered and do not have a number yet feel like they are not members),” he said.

Pargas clarified that even those not enrolled with the agency can avail of the service. “Hindi hadlang kung hindi ka naka-register para makakuha ng benepisyo sa PhilHealth (It is not a hindrance if you are not registered to avail of PhilHealth benefits),” he said.

“Ang bawat Filipino kapag nagkasakit o na-ospital o nangangailangan ng pagamutan ay dapat makakakuha ng (Every Filipino, when sick or hospitalized or needs treatment, should get) immediate eligibility to all the benefits,” Pargas said, “Hindi ka man naka-enroll, hindi ka naka-register dapat i-register ka sa oras na iyon at dapat magagamit mo o makukuha mo ‘yung benepisyo (Even if you’re not enrolled or registered, you should be registered when the time comes so you can use or avail of the benefits).”