PhilHealth Updates & Compliance in 2025: A Guide for SMEs in the Philippines

Supplementary HMO plans bridge PhilHealth gaps, ensuring full coverage for your SME workforce.

As 2025 unfolds, SMEs in the Philippines must stay updated with PhilHealth regulations to ensure compliance and continuous employee coverage. While PhilHealth serves as the foundation of healthcare support, supplementing it with an HMO plan can bridge gaps and enhance protection for your workforce.

Key PhilHealth Updates for 2025

PhilHealth regularly adjusts its policies, premiums, and benefit packages to keep up with healthcare demands. Recent updates include:

• Premium Contribution Adjustments: Contributions may increase to strengthen PhilHealth’s fund pool. SMEs should budget accordingly to avoid penalties.

• Expanded Coverage: New benefits may include broader outpatient and inpatient treatments, maternity packages, and disease-specific programs.

• E-PhilHealth Features: Employers are encouraged to use digital tools for easier premium payments and member monitoring.

Steps to Stay Compliant

1. Verify Contributions and Payments:
   Double-check that all contributions are up-to-date and accurately recorded in PhilHealth’s online system.

2. Update Employee Records:
   Ensure all new hires, resignations, and employment status changes are reflected in PhilHealth’s database.

3. Educate Employees About PhilHealth Benefits:
   Provide orientation sessions to help employees understand their PhilHealth entitlements and how to access them.

4. Prepare for Audits:
   Keep organized records of payments and employee updates to avoid compliance issues during audits.

5. Partner with HMOs for Supplementary Coverage:
   While PhilHealth offers essential coverage, it may not cover 100% of medical expenses. HMOs like Purple Cow complement these benefits, providing extended coverage for pre-existing conditions, specialist treatments, and outpatient care.

Why Supplementary Coverage Matters

PhilHealth’s coverage works best when paired with an HMO plan that fills in gaps and reduces out-of-pocket costs for employees. Purple Cow offers:

• Cashless Transactions: Employees can access accredited hospitals without upfront payments.

• Out-of-Network Reimbursements: Coverage even for non-accredited facilities.

• Mental Health and Dental Add-Ons: Comprehensive wellness support that goes beyond standard PhilHealth benefits.

Seamless Coverage for Your SME Workforce

See how Purple Cow complements PhilHealth benefits and provide your employees with uninterrupted and enhanced healthcare protection.