PhilHealth now covers readmissions for same illness within 90 days

Members readmitted due to the same illness in a span of 90 days can now avail of PhilHealth benefits after the state health insurer lifted its Single Period of Confinement policy beginning 1 October. This applies to medical conditions and surgical procedures under the All Case Rate payment scheme.

The Single Period of Confinement Rule is a policy developed during the Philippine Medicare era that imposes that admissions and readmissions due to the same illness or procedure within a 90-calendar day period shall only be compensated once. This has 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 R. Ledesma, Jr., during a recent media forum.

"This move also shows our strong commitment to fulfill our mandate—tto provide health insurance coverage and ensure affordable, acceptable, available, and accessible health care services for all Filipinos," he added.

PhilHealth reminds members and qualified dependents that they are entitled to a total maximum of 45 days of coverage for room and board per year.

However, this does not apply to the hemodialysis benefits package, as it has 156 separate sessions allocated per year. PCEO Ledesma assures all members that PhilHealth continues to move forward with benefit enhancements to provide better financial coverage to all Filipinos.

“We are really working very hard 24/7. Talagang nagpapakahirap po kami because we understand that health is not just a privilege but an essential right for every Filipino. In these challenging times, we stand with them and always make sure to deliver all the benefits they deserve," Ledesma added.