State-run Philippine Health Insurance Corp. (PhilHealth) said Friday it lifted its 45-day benefit limit policy effective April 4, 2025.
“This policy change aligns with the Universal Health Care Act and follows the directive of President Ferdinand Marcos Jr. to ensure continuous and accessible health benefits for all Filipinos,” PhilHealth said in a statement.
PhilHealth senior vice president for health finance policy sector Israel Francis Pargas said the move allows members to use their benefits for the entire year without a 45-day coverage limit.
He said the change is in accordance with the Universal Healthcare Act, which mandates that every Filipino receive immediate healthcare services, and President Marcos’ directive for the national health insurance program to cover members’ healthcare needs.
PhilHealth acting president and chief executive Edwin Mercado previously described the 45-day benefit limit as an “outdated cost-containment strategy.”
PhilHealth said it already recognized the need for coverage beyond 45 days for certain conditions, extending the number of covered hemodialysis sessions from 90 to 156.
“We want Filipinos with serious illnesses, chronic conditions or those requiring lengthy hospital stays to continue receiving healthcare services without worrying about falling into debt,” Mercado said.
PhilHealth said benefit availment should be based on proper medical indication, necessity and alignment with the patient’s treatment plan, adhering to Department of Health (DOH)-approved Clinical Practice Guidelines (CPGs) and PhilHealth Circulars on quality standards.
PhilHealth said it would closely monitor patient admissions, readmissions, and benefit utilization exceeding 45 days.
Health facility compliance with clinical standards and reimbursement rules will be rigorously assessed through the Health Care Providers Performance Assessment System (HCPPAS), it said.
PhilHealth also urged health facilities to implement comprehensive organization-wide policies focused on quality and performance improvement.
This will be critical in PhilHealth’s focus on incentivizing services that lead to the best outcomes, it said.