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PHILHEALTH. Philippine Health Insurance Corporation (PhilHealth) employees manually process member ransactions at PhilHealth National Capital Region Central Branch in Quezon City, after a shutdown of their online system due to a cyberattack last week. PhilHealth advises its members and their qualified dependents to present a copy of their PhilHealth identification card, member data record, or other supporting documents to access health benefits, on September 26, 2023.
Jire Carreon/Rappler
The lifting of the 45-day benefit limit will take effect on Friday, April 4
MANILA, Philippines – The Philippine Health Insurance Corporation (PhilHealth) has removed its 45-day benefit limit to ensure the state health insurer provides “unhampered” services to its members.
In a statement on Wednesday, March 19, PhilHealth President and CEO Edwin Mercado described the benefit limit as an “outdated cost-containment strategy.”
“We cannot always predict or schedule our medical needs. Marami ring mga serbisyo ang kinakailangan ng higit sa 45 days na coverage (There are other services that require coverage of more than 45 days),” he said.
Under PhilHealth Circular No. 2025-007, the lifting of the 45-day benefit limit will take effect on April 4, 15 days after the document’s circulation.
The policy will not affect hemodialysis benefits and other benefits that are not subject to the 45-day rule.
PhilHealth earlier extended the number of hemodialysis sessions covered to 156 from the previous 90.
The 45-day benefit limit was originally imposed to prevent the over-utilization of healthcare services. However, its removal aligns with PhilHealth’s mandate to provide individual-based services to its members under the Universal Health Care Act.
“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,” the state health insurer wrote in its circular.
PhilHealth will closely monitor patient admissions, readmissions, and benefit utilization exceeding 45 days to ensure effective implementation of the new policy.
The state health insurer earlier vowed to improve existing care packages while introducing new ones, such as a post-kidney transplant benefit package.
– Rappler.com
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