PhilHealth lifts 45-day benefit limit

The Philippine Health Insurance Corporation (PhilHealth) has lifted the 45-day benefit limit in a bid to make the services of the state health insurer “unhampered.”

In a statement, PhilHealth president and CEO Edwin Mercado said that the 45-day benefit limit is “an outdated cost-containment strategy,” underscoring the need to cover for more than 45 days for certain conditions.

“Naiintindihan natin kung bakit ito inilagay noon, ngunit, sa pagbabago ng ating payment mechanism, napapanahon na rin talagang repormahin ito,” Mercado said in a statement.

(We understand why it was put in place before, but with the changes in our payment mechanism, it is time that we reform it.)

“We cannot always predict or schedule our medical needs. Marami ring mga serbisyo ang kinakailangan ng higit sa 45 days na coverage. Kaya naman nagpapasalamat tayo sa PhilHealth Board for approving this policy update,” he added.

(Many services also require more than 45 days of coverage. That’s why we thank the PhilHealth Board for approving this policy update.)

PhilHealth first extended the number of sessions covered by its hemodialysis packages from 90 to 156 sessions. 

To ensure the responsible and effective implementation of the new policy, PhilHealth said it will closely monitor patient admissions, readmissions, and benefit utilization exceeding 45 days. 

Health facility compliance with clinical standards and reimbursement rules will also be assessed through the Health Care Providers Performance Assessment System (HCPPAS). —Giselle Ombay/ VAL, GMA Integrated News