MANILA – The Benefits Committee (BenCom) of the Philippine Health Insurance Corp. (PhilHealth) Board of Directors has decided to create a new policy that would remove the single period of confinement rule.
In a meeting on Tuesday, Health Secretary and PhilHealth Board chair Teodoro Herbosa said the new policy would be recommended to the board en banc that is scheduled to meet on Friday.
The single period of confinement rule means that admissions and re-admissions due to the same illness or procedure within a 90-calendar day period shall only be compensated with one case rate benefit.
PhilHealth’s All Case Rates Policy No. 2 (PhilHealth Circular 0035, series of 2013) states that availing of the benefit for the same illness or procedure – not separated from each other by more than 90 calendar days – will not be provided with a new benefit, until after the 90-calendar day period computed from the date of admission.
In 2023, the rule resulted in the denial of 26,750 claims, including community-acquired pneumonia, acute gastroenteritis, urinary tract infection, and chronic kidney disease.
“We are now in the era of the Universal Health Care Act of 2019, decades after the Philippine Medical Care Act of 1969,” Herbosa said. “Technologies against fraud are also better today.”
He added that health benefits policies must be fixed to bring down the out-of-pocket payments of Filipino families. (PNA)