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PhilHealth KaSAPI (Kalusugang Sigurado at Abot-Kaya sa PhilHealth Insurance)

Summary

PhilHealth has introduced a better and more convenient enrollment scheme to cover organized groups such as associations, cooperatives, etc. called iGroup.

Program goals

The National Health Insurance Program (NHIP) aims to provide health care access to all segments of society. However, a study has shown that only 40 percent of the total population is covered. In a country where a significant portion of its labor force is in the informal sector, it is necessary to have a systematic mechanism to include them in the safety net loop. In 2005, PhilHealth launched the KaSAPI (Kalusugang Sigurado at Abot-Kaya sa PhilHealth Insurance) initiative, a program to enhance enrollment among employees on the informal economy. As of 2013, they have introduced a better and more convenient enhanced enrollment package called iGroup.

Key program components

PhilHealth discovered the need to shift from KaSAPI to iGroup for the following reasons:

  1. Better benefits

  2. Immediate access to expanded outpatient care

  3. Easier enrollment scheme

  4. Flexible payment scheme

  5. Mass enrollment and financial risk protection

Primary Preventive Services determined by the doctor based on patient's health need provided for free to iGroup members are:

  • Consultation

  • Visual inspection with acetic acid

  • Regular BP measurements

  • Breastfeeding program education

  • Periodic clinical breast examinations

  • Counseling for lifestyle modification

  • Counseling for smoking cessation

  • Body measurements

  • Digital rectal examination

  • Diagnostic examinations

  • Drugs and medicines

Initially made available to sponsored program members, overseas workers and iGroup members, the no balance billing (NBB) ensures zero out-of-pocket expenses during hospitalization in government facilities. To qualify as an iGroup, one should be an:

  • Existing KaSaPi partner

  • Any organization for social protection and social health insurance registered with appropriate government agencies

  • LGUs

  • Other entities approved by PhilHealth