In alignment with President Ferdinand R. Marcos Jr.’s directive to ensure “services of PhilHealth remain unhampered,” PhilHealth Acting President and CEO Dr. Edwin M. Mercado has announced the elimination of the 45-day benefit limit.
“The 45-day benefit limit is an outdated cost-containment strategy,” explained Dr. Mercado. “We understand why it was implemented previously, but with changes to our payment mechanism, it’s time to reform this policy. We cannot always predict or schedule our medical needs, and many services require coverage beyond 45 days. We thank the PhilHealth Board for approving this policy update.”
PhilHealth had previously recognized the need for extended coverage in certain conditions, as evidenced by increasing hemodialysis coverage from 90 to 156 sessions. The organization is now applying this principle more broadly by completely lifting the 45-day limit.
“We want Filipinos with serious illnesses, chronic conditions, or those requiring extended hospitalization to continue receiving healthcare services without worrying about falling into debt,” added Dr. Mercado.
PhilHealth emphasizes that benefit eligibility will continue to be based on medical necessity, proper treatment planning, and adherence to established standards of care, Department of Health-approved Clinical Practice Guidelines, and PhilHealth quality standards.
To ensure responsible implementation, PhilHealth will monitor patient admissions, readmissions, and benefit utilization exceeding 45 days. Health facilities will be evaluated through the Health Care Providers Performance Assessment System to verify compliance with clinical standards and reimbursement rules.
Healthcare facilities are encouraged to implement comprehensive quality and performance improvement policies, supporting PhilHealth’s focus on incentivizing services that deliver optimal outcomes.
“Our goal is for every PhilHealth-supported service to provide genuine peace of mind to our members,” said Dr. Mercado. “Hospitals are already monitoring outcomes, as I did when I was a hospital administrator. Now, we want PhilHealth to gradually transition to value-based financing.”
For more information on PhilHealth Circular 2025-0007, members can contact PhilHealth’s 24/7 service lines at (02) 866-225-88 or mobile numbers: (Smart) 0998-857-2957, 0968-865-4670, (Globe) 0917-1275987 or 0917-1109812. The circular is also available for download at www.philhealth.gov.ph.
