Members readmitted due to the same illness in a span of 90 days can now avail of Philippine Health Insurance Corp. (PhilHealth) benefits after the state health insurer lifted its single period of confinement policy beginning Oct. 1, 2024.
This applies to medical conditions and surgical procedures under the All Case Rate payment scheme, it said.
The single period of confinement rule is a policy developed during the Philippine Medicare era which provided that admissions and readmissions due to the same illness or procedure within a 90-calendar day period should only be compensated once. This resulted in members paying for the entire hospitalization and caused denial of claims on the side of health facilities.
“After extensive evaluation, we have lifted the rule of single period of confinement to ensure continuous coverage for patients with recurring conditions,” said PhilHealth chief Emmanuel Ledesma Jr. in a recent media forum.
“This move also shows our strong commitment to fulfill our mandate ― to provide health insurance coverage and ensure affordable, acceptable, available, and accessible health care services for all Filipinos,” he said.
The lifting of the policy was well-received by healthcare providers and members. Ma. Celia Buñag, supervising administrative officer of Quezon City General Hospital, said many patients have recurring illnesses such as pneumonia and chronic obstructive pulmonary disease.
Lucila Salvador, a PhilHealth member whose sister was readmitted due to urinary tract infection was relieved when she learned the news.
PhilHealth reminds members and qualified dependents that they are entitled to a total maximum of 45 days coverage for room and board per year.
This does not apply to the hemodialysis benefits package as it has a separate 156 sessions allocated per year.
Ledesma assured all members that PhilHealth continues to move forward with benefits enhancements to provide better financial coverage to all Filipinos.
