The Philippine Health Insurance Corporation (PhilHealth) lifted its long-standing 45-day benefit limit for members, following the directive of President Ferdinand Marcos Jr. to ensure uninterrupted healthcare services.
“The 45-day benefit limit is an outdated cost-containment strategy. We understand why this was implemented in the past, but with the changes in our payment mechanism, it’s now the right time to reform it,” said PhilHealth Acting President and CEO Dr. Edwin Mercado.
PhilHealth previously acknowledged the need for more extensive coverage, notably expanding its hemodialysis package from 90 sessions to 156.
The move aims to provide continued support for Filipinos with severe illnesses, chronic conditions, or prolonged hospital stays without the fear of financial hardship.
“We cannot always predict or schedule our medical needs, and many services require more than 45 days of coverage. That’s why we thank the PhilHealth Board for approving this policy update,” he said.
Mercado emphasized that while the limit is removed, medical services must still be based on proper medical indication and aligned with established treatment plans.
He noted that care must meet widely accepted standards, including Department of Health-approved Clinical Practice Guidelines and PhilHealth Circulars on quality care.
To prevent misuse and ensure effective implementation, PhilHealth will monitor patient admissions, readmissions, and benefit utilization that exceed the previous 45-day limit.
“Our hospitals are already doing this. I, too, focused on monitoring outcomes when I was a hospital administrator. However, what we want now is for PhilHealth to gradually transition to value-based financing,” he explained.
Health facilities will undergo performance assessments through PhilHealth’s Health Care Providers Performance Assessment System to ensure compliance with clinical standards and reimbursement rules.
“Our goal is for every service supported by PhilHealth to truly provide peace of mind to its members,” he said.