THE Philippine Health Insurance Corporation (PhilHealth) has lifted a 45-day limit benefit limit policy for all case rates for its members
PhilHealth president and chief executive officer Edwin Mercado said the 45-day limit policy is “an outdated cost-containment strategy.”
“We cannot always predict or schedule our medical needs. Many health services require more than 45 days of coverage,” he said in a statement.
The 45-day benefit limit states that each member is entitled to a maximum of 45 days for room and board allowance and another 45 days to be shared by all of the dependents per calendar year. Confinement/s may be continuous or successive but benefits for room and board allowance shall not be more than 45 days.
“This was originally designed to prevent overutilization of health services. However, with the expanded mandates of PhilHealth as prescribed in Republic Act No. 7875, as amended by RA. Nos. 9241, 10606 and 11223, cost-containment strategies must not hamper access to critical services,” Mercado said.
He said PhilHealth lifted the limit so Filipinos with “severe health problems, chronic conditions, and those in need of prolonged hospitalization to continuously get healthcare services.”
PhilHealth said it has previously recognized that certain conditions need more than 45 days, as seen in the expansion of the hemodialysis packages from to 156 sessions from the initial 90 sessions.
“The agency is now extending this realization with the lifting of the 45-day benefit limit,” said Mercado.
